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Lyundup AV, Balyasin MV, Maksimova NV, Kovina MV, Krasheninnikov ME, Dyuzheva TG, Yakovenko SA, Appolonova SA, Schiöth HB, Klabukov ID. Misdiagnosis of diabetic foot ulcer in patients with undiagnosed skin malignancies. Int Wound J 2021; 19:871-887. [PMID: 34713964 PMCID: PMC9013580 DOI: 10.1111/iwj.13688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 08/25/2021] [Indexed: 11/27/2022] Open
Abstract
A growing number of studies report dermal malignancies mimicking diabetic foot ulcers (DFUs). We reviewed clinical cases reporting malignant tumours misdiagnosed to be DFU aiming to identify factors contributing to misdiagnosis. We systematically searched in PubMed for clinical cases reporting on misdiagnosis of DFU in patients with cancer. A chi‐square analysis was conducted to show the link between the incidence of initial DFU misdiagnosis and patient age, gender and wound duration. Lesions misdiagnosed to be DFU were subsequently diagnosed as melanoma (68% of the cases), Kaposi's sarcoma (14%), squamous cell carcinoma (11%), mantle cell lymphoma, and diffuse B‐cell lymphoma (both by 4%). Older age (≥65 years) was associated with a significantly increased risk of malignancy masked as DFU (OR: 2.452; 95% CI: 1.132 to 5.312; P value = .019). The risk of such suspicion in older patients (age ≥ 65 years) was 145% higher than in younger patients (age < 65 years). Clinicians should maintain a high level of awareness towards potentially malignant foot lesions in elderly patients with diabetes (age ≥ 65).
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Affiliation(s)
| | | | - Nadezhda V Maksimova
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Marina V Kovina
- Peoples' Friendship University of Russia, Moscow, Russia.,AltraVita IVF Clinic, Moscow, Russia
| | | | - Tatiana G Dyuzheva
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Sergey A Yakovenko
- AltraVita IVF Clinic, Moscow, Russia.,Department of Biophysics, Faculty of Physics, Lomonosov's Moscow State University, Moscow, Russia
| | - Svetlana A Appolonova
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Helgi B Schiöth
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia.,Department of Neuroscience, Functional Pharmacology, Uppsala University, Uppsala, Sweden
| | - Ilya D Klabukov
- National Medical Research Radiological Center, Obninsk, Russia
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Wang NR, Wang MM, Zhou L, Liu ZL, Chen NP, Hu JP, Deng YJ, Qi XQ, Huang XF, Su Y, Zhang SY, Tong F, Zhang Y, Lu Q, Zhu ZY, Deng H. Cutaneous clear cell/signet-ring cell squamous cell carcinoma arising in the right thigh of a patient with type 2 diabetes: combined morphologic, immunohistochemical, and etiologic analysis. Diagn Pathol 2016; 11:36. [PMID: 27066782 PMCID: PMC4827219 DOI: 10.1186/s13000-016-0487-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 04/02/2016] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The clear cell/signet-ring cell variant of cutaneous squamous cell carcinoma (cSCC) is extremely rare. Its carcinogenesis has consistently been linked to ultraviolet radiation and HPV in the literature. However, there is little definite information about the contribution of diabetes mellitus (DM) to cSCC. CASE PRESENTATION A 78-year-old Chinese woman with type 2 DM presented with a mushroom-like lump in her right thigh. Histological findings revealed that the lesion was mainly composed of clear cells and signet-ring cells. The septa of vacuoles in cytoplasm displayed positivity for periodic acid schiff (PAS) and cytokeratins such as AE1/AE3, CK5/6, CK14, and CK19. Malignant cells did not express CK7, CK8, CK18, CK20, p16, p53, or c-erbB-2, and the Ki-67 index was less than 5 %. We further explored the etiology of clear cell/signet-ring cell cSCC using human papillomavirus (HPV) type-specific PCR and genotyping and confirmed that the patient was not infected with HPV. Nucleus positivity for p63 indicated the involvement of the p53 family in the lesion. Meanwhile, the expression of fibroblast growth factor receptor-2 (FGFR2), a downstream effector of p63, was upregulated in tumor cells. CONCLUSIONS This study provides the first report on the clear cell/signet-ring cell variant of cSCC found in the right thigh of a patient with type 2 DM. Metabolic imbalance in addition to conventional pathogens such as UV and HPV may contribute to the development of the lesion via p63/FGFR2 axis.
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MESH Headings
- Aged
- Biomarkers, Tumor/analysis
- Biopsy
- Carcinoma, Signet Ring Cell/chemistry
- Carcinoma, Signet Ring Cell/etiology
- Carcinoma, Signet Ring Cell/pathology
- Carcinoma, Signet Ring Cell/surgery
- Carcinoma, Squamous Cell/chemistry
- Carcinoma, Squamous Cell/etiology
- Carcinoma, Squamous Cell/pathology
- Carcinoma, Squamous Cell/surgery
- Diabetes Mellitus, Type 2/complications
- Diabetes Mellitus, Type 2/diagnosis
- Female
- Humans
- Immunohistochemistry
- Predictive Value of Tests
- Risk Factors
- Skin Neoplasms/chemistry
- Skin Neoplasms/complications
- Skin Neoplasms/pathology
- Skin Neoplasms/surgery
- Thigh
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Affiliation(s)
- Nong-Rong Wang
- />Molecular Medicine and Genetics Center, The Fourth Affiliated Hospital of Nanchang University, Nanchang, China
| | - Meng-Meng Wang
- />Molecular Medicine and Genetics Center, The Fourth Affiliated Hospital of Nanchang University, Nanchang, China
| | - Lv Zhou
- />Department of Pathology, The Fourth Affiliated Hospital of Nanchang University, 133 South Guangchang Road, Nanchang, 330003 China
| | - Ze-Lin Liu
- />Molecular Medicine and Genetics Center, The Fourth Affiliated Hospital of Nanchang University, Nanchang, China
- />Department of Endocrinology, The Fourth Affiliated Hospital of Nanchang University, Nanchang, China
| | - Nan-Ping Chen
- />Molecular Medicine and Genetics Center, The Fourth Affiliated Hospital of Nanchang University, Nanchang, China
| | - Jin-Ping Hu
- />Department of Pathology, The Fourth Affiliated Hospital of Nanchang University, 133 South Guangchang Road, Nanchang, 330003 China
| | - Yan-Juan Deng
- />Department of Pathology, The Fourth Affiliated Hospital of Nanchang University, 133 South Guangchang Road, Nanchang, 330003 China
| | - Xiao-Qing Qi
- />Department of Pathology, The Fourth Affiliated Hospital of Nanchang University, 133 South Guangchang Road, Nanchang, 330003 China
| | - Xiao-Feng Huang
- />Department of Pathology, The Fourth Affiliated Hospital of Nanchang University, 133 South Guangchang Road, Nanchang, 330003 China
| | - Yue Su
- />Medical College, Nanchang University, Nanchang, China
| | - Si-Yao Zhang
- />Medical College, Nanchang University, Nanchang, China
| | - Fei Tong
- />Medical College, Nanchang University, Nanchang, China
| | - Yu Zhang
- />Medical College, Nanchang University, Nanchang, China
| | - Qi Lu
- />Medical College, Nanchang University, Nanchang, China
| | - Zi-Yu Zhu
- />Medical College, Nanchang University, Nanchang, China
| | - Huan Deng
- />Molecular Medicine and Genetics Center, The Fourth Affiliated Hospital of Nanchang University, Nanchang, China
- />Department of Pathology, The Fourth Affiliated Hospital of Nanchang University, 133 South Guangchang Road, Nanchang, 330003 China
- />Renmin Institute of Forensic Medicine, Nanchang, China
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Cancers mimicking fungal infections. Adv Skin Wound Care 2014; 27:301-9. [PMID: 24932950 DOI: 10.1097/01.asw.0000446864.26807.43] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Primary and metastatic malignancies may occasionally mimic or coexist with cutaneous fungal infections. The authors report 3 cases of cancers that were initially presumed to be cutaneous fungal infections. Dermatologists should maintain a low threshold for skin biopsy in patients with persistent or refractory fungal infections.
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Alavi A, Sibbald RG, Mayer D, Goodman L, Botros M, Armstrong DG, Woo K, Boeni T, Ayello EA, Kirsner RS. Diabetic foot ulcers: Part I. Pathophysiology and prevention. J Am Acad Dermatol 2014; 70:1.e1-18; quiz 19-20. [PMID: 24355275 DOI: 10.1016/j.jaad.2013.06.055] [Citation(s) in RCA: 167] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Revised: 06/17/2013] [Accepted: 06/23/2013] [Indexed: 12/24/2022]
Abstract
Diabetes mellitus is a serious, life-long condition that is the sixth leading cause of death in North America. Dermatologists frequently encounter patients with diabetes mellitus. Up to 25% of patients with diabetes mellitus will develop diabetic foot ulcers. Foot ulcer patients have an increased risk of amputation and increased mortality rate. The high-risk diabetic foot can be identified with a simplified screening, and subsequent foot ulcers can be prevented. Early recognition of the high-risk foot and timely treatment will save legs and improve patients' quality of life. Peripheral arterial disease, neuropathy, deformity, previous amputation, and infection are the main factors contributing to the development of diabetic foot ulcers. Early recognition of the high-risk foot is imperative to decrease the rates of mortality and morbidity. An interprofessional approach (ie, physicians, nurses, and foot care specialists) is often needed to support patients' needs.
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Affiliation(s)
- Afsaneh Alavi
- Department of Medicine (Dermatology), University of Toronto, Toronto, Ontario, Canada; Wound Care Centre, Women's College Hospital, Toronto, Ontario, Canada.
| | - R Gary Sibbald
- Department of Medicine (Dermatology), University of Toronto, Toronto, Ontario, Canada; Department of Medicine (Dermatology) and Public Health, University of Toronto, Toronto, Ontario, Canada; Wound Care Centre, Women's College Hospital, Toronto, Ontario, Canada
| | - Dieter Mayer
- Clinic for Cardiovascular Surgery, University Hospital of Zurich, Zurich, Switzerland
| | | | - Mariam Botros
- Wound Care Centre, Women's College Hospital, Toronto, Ontario, Canada
| | - David G Armstrong
- Department of Surgery, the University of Arizona College of Medicine/SALSA, Tucson, Arizona
| | - Kevin Woo
- Faculty of Nursing, Queen's University, Kingston, Ontario, Canada
| | - Thomas Boeni
- Department of Prosthetics and Orthotics, University of Zurich, Zurich, Switzerland
| | | | - Robert S Kirsner
- Department of Dermatology and Cutaneous Surgery, University of Miami, Miami, Florida
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Valero J, Gallart J, Gonzalez D, Deus J, Lahoz M. Subungual squamous cell carcinoma and exostosis in third toe - case report and literature review. J Eur Acad Dermatol Venereol 2013; 28:1292-7. [DOI: 10.1111/jdv.12271] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Revised: 08/12/2013] [Accepted: 08/14/2013] [Indexed: 11/30/2022]
Affiliation(s)
- J. Valero
- Department of Human Anatomy and Histology; University of Zaragoza; Zaragoza Spain
| | - J. Gallart
- Department of Human Anatomy and Histology; University of Zaragoza; Zaragoza Spain
| | - D. Gonzalez
- Department of Human Anatomy and Histology; University of Zaragoza; Zaragoza Spain
| | - J. Deus
- Department of Surgery, Obstetrics and Gynecology; University of Zaragoza; Zaragoza Spain
| | - M. Lahoz
- Department of Human Anatomy and Histology; University of Zaragoza; Zaragoza Spain
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