A 58-year-old man has had a discharging sinus over the mid-tibia from chronic osteomyelitis for 25 years. Over the past 6 months the sinus has enlarged, bleeds easily, and has developed a friable everted edge. Biopsy of the sinus margin will most likely show:
- A Squamous cell carcinoma ✓
- B Chronic granulation tissue
- C Osteogenic sarcoma
- D Marjolin's ulcer of basal cell type
Correct answer: A. Squamous cell carcinoma
Explanation
Long-standing sinuses from chronic osteomyelitis can undergo malignant transformation into well-differentiated squamous cell carcinoma, an example of a Marjolin-type change occurring in chronically inflamed epithelium. The warning signs are a change in discharge, bleeding, pain increase and an everted rolled edge after decades of quiescence. Basal cell carcinoma does not arise in these tracts, and osteosarcoma arises de novo in bone rather than in a sinus wall.
Reference: Bailey and Love's Short Practice of Surgery, 28th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.