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Filho ASM, Pazin GS, Genaro LM, Oliveira PDSP, Ayrizono MDLS, Leal RF. Squamous cell carcinoma arising in chronic hidradenitis suppurativa: A case report and comprehensive literature review. Int J Surg Case Rep 2024; 123:110271. [PMID: 39260341 PMCID: PMC11415856 DOI: 10.1016/j.ijscr.2024.110271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2024] [Revised: 09/03/2024] [Accepted: 09/06/2024] [Indexed: 09/13/2024] Open
Abstract
INTRODUCTION Hidradenitis Suppurativa (HS) is a chronic inflammatory disorder that affects the pilosebaceous unit. Squamous Cell Carcinoma (SCC) can emerge as a complication. PRESENTATION OF CASE A 58-year-old male patient with a history of smoking, obesity, and type 2 diabetes was initially managed by a dermatology team for Follicular Occlusion Syndrome manifesting as HS. Despite clinical treatment, the patient was referred to the Coloproctology Unit because of the development of a lesion in the perianal region near the HS lesions. Physical examination revealed an ulcerated, vegetative, painful, and friable lesion in the right perianal region consistent with SCC of the HS scar. The patient underwent chemotherapy and radiotherapy, but the lesions recurred, necessitating abdominoperineal amputation of the rectum. DISCUSSION Although rare, patients with chronic HS are at an increased risk of developing SCC, particularly in the perineal and gluteal regions. The standard treatment protocol for SCC in HS involves chemoradiotherapy with the aim of preserving the anal sphincter and avoiding surgery. Surgical intervention is reserved for patients that are unresponsive to chemoradiotherapy or for advanced cases in which local resection is insufficient. CONCLUSION This disease course aligns with the epidemiology of HS, which predominantly affects male individuals with chronic lesions in the perianal, gluteal, and perineal regions. Such lesions can progress severely, often resisting non-invasive treatments and requiring more aggressive surgical interventions.
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Affiliation(s)
| | - Giovanna Savoy Pazin
- Colorectal Surgery Unit, School of Medical Sciences, University of Campinas, Campinas, São Paulo, Brazil
| | - Lívia Moreira Genaro
- Colorectal Surgery Unit, School of Medical Sciences, University of Campinas, Campinas, São Paulo, Brazil
| | | | | | - Raquel Franco Leal
- Colorectal Surgery Unit, School of Medical Sciences, University of Campinas, Campinas, São Paulo, Brazil.
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Perez OD, Tarazi M, Husain S, Makkar J, Gallitano SM. A complication in a patient with hidradenitis suppurativa taking adalimumab. JAAD Case Rep 2022; 27:147-150. [PMID: 36051225 PMCID: PMC9424257 DOI: 10.1016/j.jdcr.2022.05.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Olivia D Perez
- Vagelos College of Physicians & Surgeons, Columbia University Medical Center, New York, New York
| | - Meera Tarazi
- Department of Dermatology, Columbia University Medical Center, New York, New York
| | - Sameera Husain
- Department of Dermatology, Columbia University Medical Center, New York, New York
| | - Jasnit Makkar
- Department of Radiology, Columbia University Medical Center, New York, New York
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3
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Gleue C, Shah K, Gliem T, Reed K, Davis MDP, Guo R. Extensive Genomic Copy Number Alterations are common in Squamous Cell Carcinoma Arising in Hidradenitis Suppurativa with Moderate Histological Differentiation. Hum Pathol 2022; 126:28-30. [PMID: 35561841 DOI: 10.1016/j.humpath.2022.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 04/28/2022] [Accepted: 05/03/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Casey Gleue
- Department of Anatomic and Clinical Pathology, Mayo Clinic, Rochester, Minnesota
| | - Kabeer Shah
- Department of Pathology, St. Mary's Hospital, Madison, Wisconsin
| | - Troy Gliem
- Department of Laboratory Genetics and Genomics, Mayo Clinic, Rochester, Minnesota
| | - Katelyn Reed
- Department of Anatomic and Clinical Pathology, Mayo Clinic, Rochester, Minnesota
| | - Mark D P Davis
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota
| | - Ruifeng Guo
- Department of Anatomic and Clinical Pathology, Mayo Clinic, Rochester, Minnesota.
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Hidradenitis Suppurativa: Host-Microbe and Immune Pathogenesis Underlie Important Future Directions. JID INNOVATIONS 2021; 1:100001. [PMID: 34909706 PMCID: PMC8659377 DOI: 10.1016/j.xjidi.2021.100001] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 11/24/2020] [Accepted: 12/10/2020] [Indexed: 12/17/2022] Open
Abstract
Hidradenitis suppurativa (HS) is an inflammatory disease of the skin with a chronic, relapsing-remitting course. The pathogenesis of the disease is poorly understood and involves multiple factors, including genetics, environment, host-microbe interactions, and immune dysregulation. In particular, the composition of the cutaneous microbiome shifts as the disease progresses, although it is unclear whether this is a primary or secondary process. Trials with immunomodulatory therapy elucidate the role of specific immune pathways and cytokine signaling in disease mechanism, such as TNF-α, IL-1β, IL-12, IL-17, IL-23, and complement. Future studies should continue examining the causes of and contributing factors to microbial changes and immune dysregulation in HS pathogenesis.
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Key Words
- AMP, antimicrobial peptide
- BD, β-defensin
- BMI, body mass index
- DC, dendritic cell
- DCD, dermcidin
- GSC, γ-secretase complex
- HS, hidradenitis suppurativa
- HiSCR, hidradenitis suppurativa clinical response
- IBD, inflammatory bowel disease
- IHS4, International Hidradenitis Suppurativa Severity Score System
- KC, keratinocyte
- MMP, matrix metalloproteinase
- NET, neutrophil extracellular traps
- NMSC, nonmelanoma skin cancer
- PG, pyoderma gangrenosum
- RCT, randomized controlled trial
- SAPHO, synovitis, acne, pustulosis, hyperostosis, and osteitis
- TLR, toll-like receptor
- Th, T helper type
- iNOS, inducible nitric oxide synthase
- pDC, plasmacytoid dendritic cell
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Boo M, Eva L, Kellow M, Scurry J. Vulval squamous cell carcinoma arising from hidradenitis suppurrativa. BMJ Case Rep 2021; 14:14/6/e241075. [PMID: 34130973 DOI: 10.1136/bcr-2020-241075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 47- year-old woman developed a rapidly enlarging vulvar mass. Although the clinical appearance suggested malignancy, its lack of atypia and invasion on initial superficial biopsy delayed the pathological diagnosis. It was not until a large incisional biopsy was performed that showed the diagnosis of verrucous squamous cell carcinoma (VSCC) involving pre-existing sinuses of hidradenitis suppurativa (HS). VSCC arising in HS is very rare and often leads to death in published cases. This case demonstrates the challenge in pathological diagnosis of this condition which impacted time to treatment.
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Affiliation(s)
- Marilyn Boo
- Department of Gynaecological Oncology, Christchurch Women's Hospital, Christchurch, New Zealand
| | - Lois Eva
- Department of Gynaecological Oncology, Auckland City Hospital, Auckland, New Zealand
| | - Mayada Kellow
- Department of Histopathology, LabPLUS, Auckland, New Zealand
| | - James Scurry
- Pathology North, New Lambton Heights, New South Wales, Australia.,University of New South Wales, Sydney, New South Wales, Australia
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Sachdeva M, Mufti A, Zaaroura H, Abduelmula A, Lansang RP, Bagit A, Alhusayen R. Squamous cell carcinoma arising within hidradenitis suppurativa: a literature review. Int J Dermatol 2021; 60:e459-e465. [PMID: 34075588 DOI: 10.1111/ijd.15677] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 03/28/2021] [Accepted: 05/02/2021] [Indexed: 01/18/2023]
Abstract
Squamous cell carcinoma (SCC) can present as a rare complication of longstanding hidradenitis suppurativa (HS) lesions. Limited data exist on characteristics and outcomes of SCC development within HS lesions. The purpose of this review is to conduct a literature review of previously reported cases of SCC development in pre-existing HS lesions. EMBASE and MEDLINE searches were conducted in OVID on June 25, 2020, to yield 59 studies. Of the 95 patients (mean age: 52.9 years) who developed a total of 122 SCCs within HS lesions, the majority were males (77.9%, n = 74/95). The most common sites of SCC were the gluteal region (47.5%, n = 58/122), the perianal region (18.9%, n = 23/122), and the genitals (13.9%, n = 17/122). The mean duration between HS onset and SCC development was 25.5 years. Of the patients that had outcomes reported, 54.0% (n = 34/63) experienced SCC metastasis, 43.1% (n = 28/65) experienced SCC recurrences, and 58.7% (n = 44/75) experienced a mortality outcome. The most common documented reasons for death included metastasis (34.1%, n = 15/44) and sepsis (13.6%, n = 6/44). Patients with longstanding HS lesions can develop SCCs with a high rate of metastasis and mortality. Thus, chronic HS lesions, especially in the gluteal, perianal, genital, and perineal regions, should be monitored regularly for timely SCC diagnosis and management.
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Affiliation(s)
| | - Asfandyar Mufti
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Hiba Zaaroura
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | | | | | - Ahmed Bagit
- Faculty of Health Sciences, Brock University, St. Catharines, ON, Canada
| | - Raed Alhusayen
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, ON, Canada.,Sunnybrook Health Sciences Centre, Toronto, ON, Canada
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Aboud C, Zamaria N, Cannistrà C. Treatment of hidradenitis suppurativa: Surgery and yeast (Saccharomyces cerevisiae)–exclusion diet. Results after 6 years. Surgery 2020; 167:1012-1015. [DOI: 10.1016/j.surg.2019.12.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 12/07/2019] [Accepted: 12/17/2019] [Indexed: 12/18/2022]
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Nielsen VW, Jørgensen AR, Thomsen SF. Fatal outcome of malignant transformation of hidradenitis suppurativa: A case report and literature review. Clin Case Rep 2020; 8:504-507. [PMID: 32185045 PMCID: PMC7069843 DOI: 10.1002/ccr3.2608] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 11/07/2019] [Accepted: 11/21/2019] [Indexed: 01/16/2023] Open
Abstract
Squamous cell carcinoma arising in hidradenitis suppurativa (HS) is a rare albeit the most serious complication in HS, with a reported fatality of up to 42.9%. This calls for greater clinical awareness in patients with long-standing chronic HS.
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Affiliation(s)
| | | | - Simon Francis Thomsen
- Department of Dermato‐Venereology & Wound Healing CentreBispebjerg HospitalCopenhagenDenmark
- Department of Biomedical SciencesUniversity of CopenhagenCopenhagenDenmark
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Squamous Cell Carcinoma in Perineal, Perianal, and Gluteal Hidradenitis Suppurativa: Experience in 12 Patients. Dermatol Surg 2019; 45:519-526. [PMID: 30608295 DOI: 10.1097/dss.0000000000001713] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Few reports describe squamous cell carcinoma (SCC) arising in hidradenitis suppurativa (HS). OBJECTIVE The 2 objectives were (1) to describe the clinical characteristics, pathologic findings, and postoperative outcomes of SCC in HS and (2) to assess whether human papillomavirus (HPV) is involved in the pathogenesis. MATERIALS AND METHODS Cases of SCC in HS were identified through institutional medical records (1976-2013) and the Rochester Epidemiology Project. Tumor specimens were assessed for HPV DNA/RNA with in situ hybridization. RESULTS Twelve patients were identified (11 Caucasians and 9 men). All SCCs involved gluteal, perianal, or perineal skin; 1 patient had, in addition, involvement of the vagina. Surgical excision was performed on all 12 patients, 4 of whom had a colostomy. Mean duration of HS before SCC development was 28.5 years (range, 15-53 years). Mean follow-up was 4.3 years after surgical excision. Seven of 12 patients followed had postoperative SCC recurrence. Squamous cell carcinoma caused death despite wide surgical excision in these 7 patients. Of the remaining 5 patients, 4 are unknown and 1 who did not recur had an in situ SCC (Bowen disease carcinoma). Squamous cell carcinoma was not associated with high-risk or low-risk HPV. CONCLUSION Invasive SCC arising in HS carries a high risk of death.
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Squamous Cell Carcinoma of the Peristomal Skin of a Gastrostomy: Case Study. J Wound Ostomy Continence Nurs 2017; 44:384-386. [PMID: 28682856 DOI: 10.1097/won.0000000000000345] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Primary skin tumors that develop at enteral feeding stomas are extremely rare. Ongoing surveillance of these stomas, including the peristomal skin, is essential to early diagnosis and treatment of these tumors. CASE A 73-year-old man with an esophageal chemical burn caused by swallowing sodium hypochlorite (bleach) approximately 50 years earlier that was initially managed with esophageal exclusion and placement of a gastrostomy device for enteral feeding presented with an exophytic and painful mass of the skin adjacent to his gastrostomy site. The pathologic report confirmed differentiated squamous cell skin carcinoma. CONCLUSION Skin tumors arising from chronic wounds or ulcers of the skin surrounding a gastrostomy device are rare but should be considered if hypergranulation tissue or a peristomal lesion appears to be nonhealing. WOC nurses are frequently consulted for care of granulomas, and close monitoring is essential for avoiding this potentially fatal complication.
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11
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Fahradyan A, Howell AC, Wolfswinkel EM, Tsuha M, Sheth P, Wong AK. Updates on the Management of Non-Melanoma Skin Cancer (NMSC). Healthcare (Basel) 2017; 5:healthcare5040082. [PMID: 29104226 PMCID: PMC5746716 DOI: 10.3390/healthcare5040082] [Citation(s) in RCA: 92] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 10/20/2017] [Accepted: 10/24/2017] [Indexed: 12/21/2022] Open
Abstract
Non-melanoma skin cancers (NMSCs) are the most common malignancy worldwide, of which 99% are basal cell carcinomas (BCCs) and squamous cell carcinomas (SCCs) of skin. NMSCs are generally considered a curable diseases, yet they currently pose an increasing global healthcare problem due to rising incidence. This has led to a shift in emphasis on prevention of NMSCs with development of various skin cancer prevention programs worldwide. This article aims to summarize the most recent changes and advances made in NMSC management with a focus on prevention, screening, diagnosis, and staging.
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Affiliation(s)
- Artur Fahradyan
- Division of Plastic and Reconstructive Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA.
- Division of Plastic and Maxillofacial Surgery, Children's Hospital of Los Angeles, Los Angeles, CA 90027, USA.
| | - Anna C Howell
- Division of Plastic and Reconstructive Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA.
| | - Erik M Wolfswinkel
- Division of Plastic and Reconstructive Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA.
| | - Michaela Tsuha
- Division of Plastic and Maxillofacial Surgery, Children's Hospital of Los Angeles, Los Angeles, CA 90027, USA.
| | - Parthiv Sheth
- Keck School of Medicine of University of Southern California, Los Angeles, CA 91001, USA.
| | - Alex K Wong
- Division of Plastic and Reconstructive Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA.
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Alkeraye S, Nguyen T, Le Guern A, Alhaddad M, Mortier L. Mucinous adenocarcinoma in association with hidradenitis suppurativa. Clin Exp Dermatol 2017; 42:550-551. [PMID: 28597923 DOI: 10.1111/ced.13123] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/08/2016] [Indexed: 12/22/2022]
Affiliation(s)
- S Alkeraye
- Department of Dermatology, King Khalid University Hospital, Riyadh, Saudi Arabia.,College of Medicine, King Saud University, Riyadh, Saudi Arabia.,Department of Dermatology, University Hospital of Lille, 2 Avenue Oscar Lambret, Lille cedex, 59037, France
| | - T Nguyen
- Tufts University School of Medicine, Boston, MA, USA
| | - A Le Guern
- Department of Dermatology, University Hospital of Lille, 2 Avenue Oscar Lambret, Lille cedex, 59037, France
| | | | - L Mortier
- Department of Dermatology, University Hospital of Lille, 2 Avenue Oscar Lambret, Lille cedex, 59037, France
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Fabbrocini G, Ruocco E, De Vita V, Monfrecola G. Squamous cell carcinoma arising in long-standing hidradenitis suppurativa: An overlooked facet of the immunocompromised district. Clin Dermatol 2016; 35:225-227. [PMID: 28274364 DOI: 10.1016/j.clindermatol.2016.10.019] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The list of comorbidities and complications associated with hidradenitis suppurativa is extensive. Among the complications of hidradenitis suppurativa, squamous cell carcinoma is considered the most severe. After a meticulous literature research starting from the 1950s, we were able to identify over 90 cases of patients with hidradenitis suppurativa developing squamous cell carcinoma. Most squamous cell carcinomas appear on the perineal or buttock areas. We believe that the development of squamous cell carcinoma in longstanding hidradenitis suppurativa is a typical condition of an immunocompromised district. The "immunocompromised cutaneous district" is a novel concept that applies to an area of diseased or injured skin where local immune control has been altered, thereby permitting the development of a dysimmune reaction, infection, or tumor confined to the diseased or injured site.
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Affiliation(s)
- Gabriella Fabbrocini
- Section of Dermatology, Department of Clinical Medicine and Surgery, University Federico II, Naples, Italy
| | - Eleonora Ruocco
- Department of Dermatology, Second University of Naples, Naples, Italy
| | - Valerio De Vita
- Section of Dermatology, Department of Clinical Medicine and Surgery, University Federico II, Naples, Italy.
| | - Giuseppe Monfrecola
- Section of Dermatology, Department of Clinical Medicine and Surgery, University Federico II, Naples, Italy
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Miller IM, McAndrew RJ, Hamzavi I. Prevalence, Risk Factors, and Comorbidities of Hidradenitis Suppurativa. Dermatol Clin 2016; 34:7-16. [PMID: 26617352 DOI: 10.1016/j.det.2015.08.002] [Citation(s) in RCA: 92] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
It is challenging to estimate a true prevalence of hidradenitis suppurativa (HS) because it is underdiagnosed and misdiagnosed. Prevalences have been reported from 0.00033% to 4.1%. The incidence seems to be rising. In addition to dermatologic symptoms, HS is associated with metabolic syndrome, and increased cardiovascular risk. The majority of HS patients are smokers. Additional somatic comorbidities complicating HS include autoimmune conditions, follicular syndromes, rheumatologic conditions, and malignancies. HS patients are troubled by psychological comorbidities. When treating HS patients it is imperative not only to treat the skin symptoms, but also address the screening and treatment of possible comorbidities.
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Affiliation(s)
- Iben Marie Miller
- Department of Dermatology, Roskilde Hospital, Koegevej 7-3, Roskilde 4000, Denmark
| | - Rachel J McAndrew
- Department of Dermatology, Henry Ford Hospital, Detroit, MI 48202, USA
| | - Iltefat Hamzavi
- Department of Dermatology, Multicultural Dermatology Center, Henry Ford Hospital, Detroit, MI 48202, USA.
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Rekawek P, Mehta S, Andikyan V, Harmaty M, Zakashansky K. Squamous cell carcinoma of the vulva arising in the setting of chronic hidradenitis suppurativa: A case report. Gynecol Oncol Rep 2016; 16:28-30. [PMID: 27331133 PMCID: PMC4899419 DOI: 10.1016/j.gore.2016.03.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 02/16/2016] [Accepted: 03/15/2016] [Indexed: 11/17/2022] Open
Abstract
Highlights the sheer mass of tumor encountered with hidradenitis suppurativa. Reviews the complexity of wound healing with hidradenitis suppurativa. Overview of multi-team approach to a vulvar cancer.
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Affiliation(s)
- Patricia Rekawek
- Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Shailja Mehta
- Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Vaagn Andikyan
- Department of Gynecologic Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Marco Harmaty
- Department of Plastic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Konstantin Zakashansky
- Department of Gynecologic Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
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Imaging of hidradenitis suppurativa and its complications. Case Rep Radiol 2014; 2014:294753. [PMID: 25221681 PMCID: PMC4158253 DOI: 10.1155/2014/294753] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Accepted: 07/23/2014] [Indexed: 11/17/2022] Open
Abstract
We present a 56-year-old man with known diabetes mellitus and a 10-year history of hidradenitis suppurativa (HS) and highlight, through MR imaging findings, the relentless natural progression of the disease, characterized by recurrent exacerbations of abscesses and fistulae and complications of perianal fistulae and sacral osteomyelitis. We also demonstrate the appearance of this condition on PET-CT with F-18 FDG, which was performed for staging after postexcision tissue specimen revealed well-differentiated squamous cell carcinoma. The association of arthritis and possible dactylitis was also manifested in our patient. Discussion of HS in the radiology literature is limited and, to our knowledge, there has been no case report describing these imaging findings in the same patient.
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Cannistrà C, Finocchi V, Trivisonno A, Tambasco D. New perspectives in the treatment of hidradenitis suppurativa: surgery and brewer's yeast-exclusion diet. Surgery 2013; 154:1126-30. [PMID: 23891479 DOI: 10.1016/j.surg.2013.04.018] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2012] [Accepted: 04/11/2013] [Indexed: 11/27/2022]
Abstract
BACKGROUND Hidradenitis suppurativa (HS), or acne inversa, is a chronic inflammatory skin disease characterized by abscesses, fistulating sinus tracts, and scarring. The exact pathogenesis of this disease remains unclear. We present our experience with HS and a possible cause of the disease and offer a surgical and clinical treatment that allows for disease resolution. METHODS We studied 12 patients who presented with axillary and perineal fistulas and underwent surgical excision (repaired by skin grafts or healing by secondary intention) or localized treatments followed by diet modification. All patients were found to have a specific immunology IgG reaction to brewer's yeast and wheat and were put on a controlled brewer's yeast-free diet for 12 months and followed monthly. RESULTS The diet demonstrated immediate stabilization of their clinical symptoms, and the skin lesions regressed over the 12-month treatment period. Similarly, all the patients demonstrated an immediate recurrence of skin lesions following accidental or voluntary consumption of beer or other foods containing brewer's yeast or wheat. The patients also demonstrated a return of their quality of life and activities, including the reestablishment of sexual activity in the patients with inguinal and perigenital lesions. CONCLUSION The results of the investigation suggested that the patients had severe reactions to brewer's yeast. Surgery followed by the elimination of the foods containing or made with the yeast resulted in a rapid stabilization of the dermatologic manifestation and a slow, but complete, regression of the skin lesions within a year. Despite the small number of patients in our study, our study could provide the basis for extensive and multicentric studies in order to better investigate this disabling and rare disease.
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Affiliation(s)
- Claudio Cannistrà
- Unit of Plastic Surgery, Department of General Surgery, Hôpital Bichat C.B., Paris, France
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Pink AE, Simpson MA, Desai N, Trembath RC, Barker JN. γ-Secretase Mutations in Hidradenitis Suppurativa: New Insights into Disease Pathogenesis. J Invest Dermatol 2013; 133:601-607. [DOI: 10.1038/jid.2012.372] [Citation(s) in RCA: 115] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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