Popisujeme prípad mladej pacientky, u ktorej došlo k vzniku ulcerácií na pravej nohe v teréne 15 rokov trvajúcej ložiskovej sklerodermie (LS, morfey). Podľa CT vyšetrenia a RTG bol nález zhodnotený ako osteomyelitída a pacientka bola liečená kombináciou antibio­tík. Opakované histologické vyšetrenia zo spodiny vredu preukázali granulačné tkanivo, chronické zápalové zmeny a pseudoepiteliomatóznu hyperpláziu. Stav ale progredoval a bolo nutné pristúpiť k amputácií pod kolenom. S odstupom troch mesiacov bola dia­gnostikovaná metastáza spinocelulárneho karcinómu v lymfatickej uzline v triesle. Aj napriek kombinovanému prístupu (chirurgickej liečbe, rádioterapii a systémovej chemoterapii) sa tvorili ďalšie metastázy a pacientka po niekoľkých mesiacoch ochoreniu podľahla. Prípad bol uzatvorený ako spinocelulárny karcinóm maskovaný osteomyelitídou. Spinocelulárny karcinóm v teréne ložiskovej sklerodermie je veľmi vzácny a obvykle vzniká práve na dolných končatinách u pacientov s dlhotrvajúcou, pansklerotickou či generalizovanou morfeou.

We present a case of a young 26-year-old woman, who has been suffering from localised scleroderma (morphea) for 15 years. Recently, a lesion on the dorsum of her right foot ulcerated. Based on a CT scan and X-ray a diagnosis of ulcerative osteomyellitis was established. The pa­tient was treated with a combination of antibiotics. Subsequent histological examinations showed granulomatous tissue and chronic inflammatory changes on top of pseudoepiteliomatous hyperplasia. The patient’s status was deteriorating, which resulted in a limb amputation under the knee. Three months later, there was a metastasis of squamous cell carcinoma found in the patient‘s inguinal lymph node. In spite of combined therapy (surgery, radioterapy and systemic chemotherapy), new metastases occurred and the patient succumbed to the disease several months afterwards. The case was concluded as a squamous cell carcinoma camouflaged by osteomyelitis. Malignant turn of localised sclerodema is very rare. It usually occurs on the lower extremities of patients with a long course of the disease and is associated with pansclerotic or generalised variants of morphea. Key words: localized scleroderma – squamous cell carcinoma – ulcer – osteomyelitis The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study. The Editorial Board declares that the manuscript met the ICMJE “uniform requirements” for biomedical papers. Submitted: 17. 9. 2014 Accepted: 21. 10. 2014

1 dermatovenerologická klinika LF MU a FN u sv Anny v Brně

1 patologicko anatomický ústav LF MU a FN u sv Anny v Brně

Klinika komplexní onkologické péče Masarykův onkologický ústav Brno

Squamous cell carcinoma in localized scleroderma

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