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Case Reports
. 2018 Feb 23;2018(2):rjy030.
doi: 10.1093/jscr/rjy030. eCollection 2018 Feb.

A case report of squamous cell carcinoma in a suprapubic urinary catheter tract: surgical excision and simultaneous colostomy formation

Sinan Khadhouri  1 , Dupinderjit Singh Rye  2 , Manish Powari  3 , Ian R Daniels  4 , John S McGrath  1
Affiliations
Case Reports

A case report of squamous cell carcinoma in a suprapubic urinary catheter tract: surgical excision and simultaneous colostomy formation

Sinan Khadhouri et al. J Surg Case Rep. .

Abstract

Squamous cell carcinoma (SCC) arising from a suprapubic cystostomy tract is a rare complication of long-term suprapubic catheterization (SPC). A 53-year-old man with paraplegia secondary to spina bifida presented with a painful granulomatous lesion around his SPC site that was being treated with silver nitrate cauterization in the community. Consequently, he developed a sacral pressure sore due to reduced mobility from the pain. He also had increasing difficulties with defaecation secondary to his spina bifida. His sacral pressure sore was secondary to a cryptoglandular fistula with coccygeal osteomylelitis. Post-operative pathology revealed infiltrative SCC involving full thickness of the specimen from skin to the bladder wall with clear surgical margins. We describe the first case requiring a simultaneous suprapubic tract SCC excision and colostomy formation. We recommend early investigation of lesions arising from a long-term suprapubic tract especially in patients with spinal cord injuries or congenital defects.

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Figures

Figure 1:
Figure 1:
SCC growing from suprapubic tract.
Figure 2:
Figure 2:
CT cross-sectional plane of pelvis. (a) Infiltrating SCC along suprapubic tract. (b) Air in left ischiorectal space from sacral sore.
Figure 3:
Figure 3:
Elliptical en-bloc excision of SCC.
Figure 4:
Figure 4:
Post-operative image showing Fleur-de-Lys incision, SPC re-siting and colostomy.
Figure 5:
Figure 5:
Histopathological images of SCC. Microscopy showed widely infiltrative squamous cell carcinoma involving full thickness of the specimen from skin to the bladder wall. No lymphovascular invasion was seen. The margins were clear although the deep detrusor muscle margin was clear by only 1 mm. (a) Photomicrograph showing abdominal wall skin with carcinoma (H&E ×1.25), (b) Photomicrograph showing infiltrating islands of squamous carcinoma in the subcutaneous tissue (H&E ×10), (c) Photomicrograph showing squamous carcinoma involving the bladder (H&E ×4).
See this image and copyright information in PMC

References

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