1994 Volume 56 Issue 1 Pages 61-66
We report a case of squamous cell carcinoma considered to have developed in fistules caused by old osteomyelitis. A 62-year-old man presented with multiple ulcers surrounded by hard, brownish skin over his entire buttocks area. He was suffered from a severe injury on the buttocks 40 years earlier when he fell down from a telegraph pole. Since then, he had been paralyzed below the S2 segment and experienced persistent pus discharge from several fistules. The physical examination revealed seven ulcers on the buttocks which were connected to each other by subcutaneous fistules. The largest ulcer measured 3.8×4.3 cm and the sacral bone was exposed in this ulcer. An X-ray demonstrated that the sacral bone below the S2 and the coccygeal bone were absent. After three months of treatment with radiation and chemotherapy, an apparent healing of the skin cancer was observed with a markedly decreased level of the SCC-associated antigen. However, a subsequent operation failed to totally resect the sequestral bones and carcinomatous regions, since almost the whole sacrum and ilium were found to be sequestral and the nerve fibers in the sacral areas had already been invaded by tumors. The patient’s condition gradually deteriorated and he eventually died of respiratory insufficiency and malnutrition twenty-one months after admission.
