Pilonidal Sinus Carcinoma found in a Pilonidal Sinus – a surprise diagnosis from the pathologist

  • Dietrich Doll Marienhospital Vechta
  • M Koch
  • K Degiannis
  • D Wilhelm
Keywords: Pilonidal Sinus, Pilonidal Carcinoma, Histology, Radiotherapy


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.


1. Ntanasis-Stathopoulos I, Triantafyllou S, Xiromeritou V, Bliouras N, Loizou C, Theodorou D. Esophageal remnant cancer 35 years after acidic caustic injury: A case report. Int J Surg Case Rep 2016;25:215-7.
2. Zhang X, Wang M, Han H, Xu Y, Shi Z, Ma G. Corrosive induced carcinoma of esophagus after 58 years. Ann Thorac Surg 2012;94:2103-5.
3. Borras JA. [Cancerous degeneration of burn scar 50 years following the accident]. Med Esp 1951;26:231-4.
4. Guenther N, Menenakos C, Braumann C, Buettemeyer R. Squamous cell carcinoma arising on a skin graft 64 years after primary injury. Dermatol Online J 2007;13:27.
5. Pallapothu R, Anne N, Lombardo G, Lamaute HR, Mandava N. Malignant transformation in burn wound with a latent period of less than 1 year. ANZ J Surg 2008;78:329.
6. Chapman S, Delgadillo D, III, Barber C, Khachemoune A. Cutaneous squamous cell carcinoma complicating hidradenitis suppurativa: a review of the prevalence, pathogenesis, and treatment of this dreaded complication. Acta Dermatovenerol Alp Pannonica Adriat 2018;27:25-8.
7. Bosche F, Luedi MM, van der Zypen D, Moersdorf P, Krapohl B, Doll D. The Hair in the Sinus: Sharp-Ended Rootless Head Hair Fragments can be Found in Large Amounts in Pilonidal Sinus Nests. World J Surg 2018;42:567-73.
8. Doll D, Friederichs J, Boulesteix AL, Dusel W, Fend F, Petersen S. Surgery for asymptomatic pilonidal sinus disease. Int J Colorectal Dis 2008;23:839-44.
9. Kistner L, Doll D, Holtorf A, Nitsche U, Janssen KP. Interferon-inducible CXC-chemokines are crucial immune modulators and survival predictors in colorectal cancer. J Oncotarget 2017;8.
10. Doll D, Orlik A, Maier K, Kauf P, Schmid M, Diekmann M, Vogt AP, Stauffer VK, Luedi MM. Impact of geography and surgical approach on recurrence in global pilonidal sinus disease. Sci Rep 2019;9:15111.
11. Wolf H. Carcinom auf dem Boden des Dermoids. Arch Klin Chir 1900;62:731.
12. Michalopoulos N, Sapalidis K, Laskou S, Triantafyllou E, Raptou G, Kesisoglou I. Squamous cell carcinoma arising from chronic sacrococcygeal pilonidal disease: a case report. World J Surg Oncol 2017;15:65.
13. Boulanger G, Abet E, Brau-Weber AG, Leclair F, Denimal F, Jean MH, de Kerviler B, Comy M. L’analyse histologique du sinus pilonidal a-t-elle un intérêt ? Analyse rétrospective de 731 exérèses. J Chir Viscerale 2018;155:190-3.
14. Evers T, Doll D, Matevossian E, Noe S, Neumann K, Li HL, Hüser N, Lüdde R, Hoffmann S, Krapohl BD. [Trends in incidence and long-term recurrence rate of pilonidal sinus disease and analysis of associated influencing factors]. Zhonghua Wai Ke Za Zhi 2011;49:799-803.