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CASE REPORT
Year : 1990  |  Volume : 56  |  Issue : 3  |  Page : 226-227

Malignant change in lupus vulgaris




Correspondence Address:
M Girdhar


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Source of Support: None, Conflict of Interest: None


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  Abstract 

Two cases developed squamous cell carcinoma over the lupus vulgaris lesions. The first patient was a, 14 year male with a gradually developing painless, hypertrophic lesion just below the left knee for 6 years. Four years later a cauliflower growth developed over it. He was on antitubercular therapy for 3 months without any improvement. The second patient was 42 year male with a painless, growing lesion behind the right knee for 25 years. About 9 months back a rapidly progressive painful ulcerated mass developed over it which used to bleed easily o n slight trauma. Histopathological findings in both the cases were compatible with lupus vulgaris and squamous cell carcinoma. None of the cases had recurrence following excision and subsequent antitubercular therapy.


Keywords: Lupus vulgaris, Squamous cell carcinoma.


How to cite this article:
Girdhar M, Gupta M, Arora S K, Mohan L, Mukhija R D. Malignant change in lupus vulgaris. Indian J Dermatol Venereol Leprol 1990;56:226-7

How to cite this URL:
Girdhar M, Gupta M, Arora S K, Mohan L, Mukhija R D. Malignant change in lupus vulgaris. Indian J Dermatol Venereol Leprol [serial online] 1990 [cited 2019 May 20];56:226-7. Available from: http://www.ijdvl.com/text.asp?1990/56/3/226/3532


Squamous cell carcinoma (SCC) de novo is comparatively rare. In most cases a provocative factor exists.[1] It has been described in long-standing cases of lupus vulgaris (LV)[2],[3],[4],[5],[6],[7],[8]. Sometimes the clinical features of both the conditions are identical and the secondary process thus may remain undiagnosed.[2] Malignant change in LV has not been reported in young children and adolescents so far. We report 2 cases of SCC developing over the lesions of LV. One of them was a 14 year male.


  Case Reports Top


Case 1

A 14 year male had a slowly developing lesion below the left knee for 6 years and a rapidly growing painless mass over it for 4 years. He was on antitubercular therapy for 3 months without improvement. A well-defined hyperpigmented hypertrophic plaque, measuring about 5 x 4 cm was seen just below the left knee. It was firm and showed atrophic scarring at places. An ulcerated non-tender growth, measuring about 3 x 3 x 2 cm, was present over the plaque which bled easily on probing. There was no lymphadenopathy. Total white cell count was 8,600/m M3 with 40% lymphocytes and ESR was 20 mm. Mantoux test was moderately positive and chest skiagram was normal. Histopathological findings from the lesion were compatible with LV and the growth revealed a well differentiated SCC. The plaque along with the tumour mass was excised and antitubercular therapy was continued. There was no recurrence of the growth during the 6 month follow up.

Case 2

A 42 year male rickshaw-puller had a gradually progressive painless swelling behind the right knee for 25 years, following trauma. About 9 months back, it became irritable and was soon followed by a rapidly developing painful growth, which would bleed profusely on minor injuries. A well defined brownish nodular place measuring 7 x 5 cm was present in the right popliteal fossa, extending laterally towards the front of leg. Skin atrophy was present at places, in and around the lesion. Overlying this lesion, a cauliflower growth measuring about 5 x 4 x 4 cm, showing pus discharge at places, was seen. The growth was tender and bled easily on probing. There was scarring with contracture in the popliteal fossa. The extension at knee joint was incomplete and painful. The inguinal lymph nodes were not enlarged. Systemic examination revealed no abnormality. Total white cell count was 8,700/mm3 with 36% lymphocytes and ESR was 53 mm. X-ray of the chest was normal and of the knee revealed erosion of lateral condyle of tibia. Histopathological examination of the underlying lesion revealed hyperkeratosis, acanthosis, papillomatosis and well defined tubercles in the dermis, while the tumour tissue showed SCC with well defined epithelial pearls. The lesion along with the tumour mass was excised and antitubercular therapy was instituted.


  Comments Top


Carcinomatous change in LV is usually late though occasionally it may occur early, as was seen in one of our cases. Repeated trauma seems 'to be an important factor in carcinogenesis. The carcinomatous change might not be suspected in the initial stages. It is usually the failure to respond to antitubercular therapy, which should give the clue.

 
  References Top

1.Bowers RF and Young JM : Carcinoma arising in scars, Osteomyelitis and fistulae, Arch Surgery, 1960; 80 564.  Back to cited text no. 1    
2.Swanbech G : Aetiological factors in squamous cell skin cancer, Brit J Dermatol, 1971; 85 : 394.  Back to cited text no. 2    
3.Saving JA and Wilkinson DS: Mycobacterial infections including tuberculosis, in : Text book of Dermatology, Fourth ed, Editors, Rook A, Wilkinson DS, Ebling FJG et al : Oxford University Press, Bombay, 1987; p 791-822.  Back to cited text no. 3    
4.Wolff K and Tappeiner G : Mycobacterial diseases Tuberculosis and a typical mycobacterial infections, in : Dermatology in General Medicine, 3rd ed, Editors, Fitzpatrick TB, Eisen AZ, Wolff K et al : Mc Graw Hill Book Company, New York, 1987; p 2160.  Back to cited text no. 4    
5.Moschella SL : Diseases of the mononuclear phagocytic system, in : Dermatology, second ed, Editors, Moschella SL and Hurley HJ : Jaypee Brothers, New Delhi, 1987; p 940.  Back to cited text no. 5    
6.Ghei PN and Dhawan IK : Squamous cell carcinoma in a case of lupus vulgaris, J Ind Med Assoc, 1963; 41 :305-306. '  Back to cited text no. 6    
7.Talvalkar GV : Squamous cell carcinoma of the skin, its incidence and atiopathogenesis in 625 cases, Ind J Cancer, 1970; 7 : 24-33.  Back to cited text no. 7    
8.Dhir GG and Sharma RP : Squamous cell carcinoma in lupus vulgaris, Ind J Dermatol Venereol Leprol, 1984; 50 : 111-112.  Back to cited text no. 8    




 

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