Pilonidal Sinus Carcinoma found in a Pilonidal Sinus – a surprise diagnosis from the pathologist
Introduction: Malignancy arising in long standing chronic infection is known in ulcerative colitis and non healing burns scars. It is exquisitely rare in long standing pilonidal sinus infection. We report a male case with the incidental finding of a SCC in a 20 year old untreated pilonidal sinus.
Methods: Decription of the diagnostic and therapeutic course till his demise of reported world case #125.
Results: A 59 yr. old male presented with extensive fistulous disease in the presacral area with induration and reddening. On surgery, tracts were found to extend into the perianal up to the perineum. Pathology specimen analysis revealed SCC with involvement of the PSD tracts with R1 situation (pT2pN0M0G2R1). Despite consecutive wide excision and tumor board advised radiochemotherapy the patient recurred twice locally, in lymph nodes and in the ischorectal fossa and demised 3 years later.
Conclusion: Despite best surgical and oncological practice, the patient demised due to a – if defined by the skin SCC classification – low TNM stage carcinoma. Pilonidal carcinoma is a exquisitely rare disease which most surgeons have not experienced in their professional lifetime. As earlier carcinomas may arise within the pilonidal sinus system, all histopathological specimen should be either opened and meticulously inspected by the surgeon himself, or sent for routine histopathological examination. Despite early diagnosis, aggressive therapy may change the otherwise dismal course of disease.
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