Surgery Clinical Trial
Official title:
Squamous Cell Carcinoma Over Pilonidal Disease. A New Therapeutic Approach.
Background: Pilonidal sinus is a very common disease. Malignant transformation occurs in 0,1%
of patients. The investigators present a case of squamous cell carcinoma arised from
recurrent pilonidal disease, managed by multimodal treatment.
Case presentation: The investigators present a 70-year-old man with chronic pilonidal sinus.
Inflammation had worsened in previous months and exploration revealed a large ulcerative mass
which biopsy showed a squamous cell carcinoma. CT scan and MRI imaging showed tumoral
invasion of the coccyx and both gluteus major muscles. Neoadjuvant radiotherapy, chemotherapy
as radiosensitizer and surgery with intraoperative radiotherapy was decided in the
multidisciplinary tumor committee. Post neoadjuvant therapy MRI showed partial response with
a decrease of the mass but persistence of the coccyx infiltration.
Surgery consisted in en-bloc resection of the tumor with presacral tissues, coccyx and
partial gluteal resection. Intraoperative radiotherapy was administered over the sacrum and
in the bed of the coccyx resection. One week later, reconstructive surgery was practiced
using a latissimus dorsi free flap, advancement of gluteal flaps and skin graft. Histological
examination showed no residual tumor. The patient is currently asymptomatic and he has a
satisfactory quality of life.
Conclusions: Although squamous cell carcinoma is rare, it must be suspected in patients with
recurrent pilonidal disease. Diagnosis is done by histological examination of biopsies. This
type of tumors have a high local recurrence rate. The investigators propose a multimodal
treatment that includes neoadjuvant radiotherapy and chemotherapy as radiosensitizer and
surgery plus intraoperative radiotherapy with the aim to decrease local recurrence rate.
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