Carcinogenesis and precancerosis transformation of chronic osteomyelitis: 6 cases report and literature review

bcl-2 and p53 as novel biomarkers for predicting malignant transformation in chronic osteomyelitis

PURPOSE

To find whether B-cell lymphoma 2 (bcl-2) and p53 proteins could be used as parameters to detect malignant transformation of chronic osteomyelitis. We also attempted to determine whether they could be used to differentiate between secondary squamous cell carcinoma (SCC) resulting from chronic osteomyelitis, and primary cutaneous squamous cell carcinoma.

METHODS

Retrospective study was conducted during 5 years period, resulting in 7 patients in each group: secondary squamous cell carcinoma arising from chronic osteomyelitis, primary cutaneous squamous cell carcinoma, and chronic osteomyelitis patients. Immunohistochemistry staining with bcl-2 and p53 was performed with the pathologist blinded to the sample groups.

RESULTS

Contingency coefficient test was performed to assess the correlation between the biomarker status (bcl-2 and p53) and the case groups. Significant moderate correlations of bcl-2 and p53 were found between groups of chronic osteomyelitis and squamous cell carcinoma arising from chronic osteomyelitis in terms of malignant transformation (p = 0.005 for bcl-2 and p = 0.031 for p53). Insignificant correlations of bcl-2 and p53 expression were found between primary cutaneous squamous cell carcinoma and secondary squamous cell carcinoma arising from chronic osteomyelitis group (p = 0.577).

CONCLUSIONS

The expression of bcl-2 and p-53 is significantly correlated with chronic osteomyelitis malignant transformation into squamous cell carcinoma.

Squamous Cell Carcinoma Arising from Chronic Osteomyelitis in the Extremities: Treatment Approach and Oncological Outcomes-A Systematic Review of the Literature

Aims

In chronic osteomyelitis-derived squamous cell carcinoma, what are the demographic and clinical variables, risk factors associated with worse outcomes, and results of treatment modalities used?

Methods

A systematic review was performed using PubMed and EMBASE. Articles were evaluated for inclusion and exclusion criteria, and for quality analysis. PRISMA guidelines were applied. Demographic and clinical data and therapeutic approaches were presented narratively and in descriptive statistics registered at PROSPERO.

Results

Most patients were male (40/49), trauma was the most common etiology (27/36), and about half of all SCC were in the tibia (25/48). Amputation was the main definitive treatment (42/47). Adjuvant treatments were not analyzed. Well-differentiated SCC accounted for 58.3% (21/36) of all tumors. Bone invasion was described in 82.8% (24/29); recurrence, in 7.7% (3/39); and metastasis, in 7.7% (3/39). Recurrence and metastasis occurred more frequently when bone invasion was present (p = 0.578 and p = 0.646, respectively). SCC with lymph node involvement showed a higher tendency to metastasize (p = 0.377). Compared with limb salvage, amputation was associated with a tendency for less recurrence (p = 0.312) and longer survival (p = 0.219).

Conclusions

COM-derived SCC mostly occurs after trauma and is usually located in the tibia. Bone invasion is common, and patients predominantly undergo amputation. This treatment is associated with a trend toward higher survival, compared to limb salvage.

Management of Squamous Cell Carcinoma in Chronic Osteomyelitis: Our Experience, Review of the Literature and Role of MRI in Differential Diagnosis

Background. The authors describe a series of patients with chronic osteomyelitis associated with squamous cell carcinoma, whilst analyzing its incidence in chronic osteomyelitis, surgical options for treatment and focusing on the role of MRI in differential diagnosis. Methods. The authors reviewed 73 cases of chronic osteomyelitis (CO) treated in their department between 1995 and 2019. Six of these patients (8.2%) had a malignant degeneration in squamous cell carcinoma (SCC). All cases with malignancy were evaluated with preoperative gadolinium-enhanced MRI. Results. In this series, the authors observed an incidence rate of 8.2% (6 cases out of 73); all patients were male with a mean age of 63.5 years. The mean time between the occurrence of chronic osteomyelitis and the diagnosis of squamous cell carcinoma was 36 years (range: 21–66). The treatment consisted of amputation in five patients and limb salvage with vascularized fibula autograft in one case. Conclusions. MRI played a key role in the differential diagnosis between infected and tumoral tissue, and was found to be crucial during follow-up. Amputation is the treatment of choice in extended tumoral involvement of bone and soft tissue.