Indian Journal of Pathology and Microbiology
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LETTER TO EDITOR Table of Contents   
Year : 2009  |  Volume : 52  |  Issue : 4  |  Page : 588-590
Longstanding lupus vulgaris with basal cell carcinoma


Department of Pathology, MGM Medical College, Navi Mumbai, 410 209, Maharashtra, India

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Date of Web Publication1-Oct-2009
 

How to cite this article:
Kate MS, Dhar R, Borkar D B, Ganbavale DR. Longstanding lupus vulgaris with basal cell carcinoma. Indian J Pathol Microbiol 2009;52:588-90

How to cite this URL:
Kate MS, Dhar R, Borkar D B, Ganbavale DR. Longstanding lupus vulgaris with basal cell carcinoma. Indian J Pathol Microbiol [serial online] 2009 [cited 2014 Aug 21];52:588-90. Available from: http://www.ijpmonline.org/text.asp?2009/52/4/588/56135


Sir,

Lupus vulgaris is a chronic, progressive tissue destructive form of cutaneous tuberculosis. The lesions progress by peripheral extension and central healing, atrophy and scarring. The areas of predilection are head and neck (80%), followed by arms and legs, then trunk. It can be associated with tuberculosis of lymph node, lung, bone and joint. In longstanding cases, patients may have scarring, deformity, squamous cell carcinoma, basal cell carcinoma. [1]

We present one rare case of longstanding lupus vulgaris which eventually led to the development of secondary malignancy, namely basal cell carcinoma. A 17-year-old male with humble origins presented with swelling in the left groin since last 10 years. He complained of mild pain in the area. He gave a history of similar swelling in the left buttock for which he had taken treatment nine years back. Medical records for the same were not available. He did not have symptoms of chronic cough, weight loss, fever or decreased appetite. The hematological and biochemical parameters were within normal limits. Serological status for HIV was non-reactive. Mantoux test was positive. Chest, cardiovascular system and abdominal examination revealed no abnormality. Renal function test and liver function test were found to be normal.

Clinical and external examination showed an irregular, firm, ulcerative swelling measuring 6 cm x 4 cm x 1 cm. The swelling was raised from the surface and had ill-defined margins. The local temperature was not raised nor was there any discharge from the site. A biopsy from the lesion was done, the diagnosis of basal cell carcinoma was made [Figure 1]. Wide excision of the hypertrophic tissue was performed and histological diagnosis of lupus vulgaris was offered.

Gross examination: Specimen showed an elliptical piece of skin with an ulcerated plaque measuring 4 cm x 3 cm x 2 cm and the underlying gray-white tissue. Cut section was gray-white and firm. Three lymph nodes were dissected from the underlying fibro fatty tissue measuring 1.5 cm, 1 cm and 0.5 cm each in diameter.

Microscopically, the epidermis was hyperplastic showing acanthosis, papillomatosis along with few areas of ulceration and atrophy. There was marked inflammation in the epidermis and dermis, at places, forming abscesses. The dermis showed multiple granulomas comprising minimal caseous necrosis, epithelioid cells, Langhans giant cells, lymphocytes, plasma cells and neutrophils. Hence a diagnosis of cutaneous tuberculosis (lupus vulgaris) was offered [Figure 2]. Sections from all the lymph nodes revealed similar granulomas. Ziehl-Nielsen stain for acid-fast bacilli was found to be negative. However, polymerase chain reaction (PCR) was not done.

Lupus vulgaris presents as a chronic disorder. [2] In course of time, the affected areas may become atrophic, ulcerated and scarred. Secondary infection can also occur. [1] The characteristic feature of lupus vulgaris is that new lesions appear in areas of atrophy. Carcinomas are known to develop at the margins of ulcers in rare instances. [2] Non-melanoma skin cancer (NMSC) accounts for around 90% of skin cancers and consists of basal cell carcinoma and squamous cell carcinomas. Basal cell carcinoma is the commonest form of NMSC and arises predominantly from the basal keratinocytes of the epidermis but also from cells in hair follicles and sebaceous glands. [3] Orfuss [4] in 1971 has documented the occurrence of basal cell malignancy superimposed on longstanding lupus vulgaris. He postulated the probable role played by the scarring treatment modalities for lupus vulgaris and also the burn injuries to have played a role in the production of the malignancy. In this case, chronic non-healing ulceration may have been the etiological factor for the development of basal cell carcinoma. [5]

To conclude, this case emphasizes the rare possibility of malignancies in longstanding cases of lupus vulgaris. Thus, it is imperative to perform wide excision of the affected area, particularly the atrophic and scarred lesions in such cases.

 
   References Top

1.Boffa MJ, Farrugia B, Degaetano JS. Lupus Vulgaris in a Maltese Patient. Malta Medical Journal 2005;16:35-8.  Back to cited text no. 1      
2.Walter F. Lever, Gundula Schaumburg-Lever. Histopathology of theSkin. 9 th ed. Philadelphia: J. B. Lippincott Co; 1990. p. 562-63.  Back to cited text no. 2      
3.Severi G. English DJ. Descriptive epidemiology of skin cancer. In: Hill D, Elwood JM, English DJ, editors. Prevention of Skin Cancer. Vol. 3. Cancer Prevention-Cancer Causes. Dordrecht: Kluwer Academic Publishers; 2004. p. 73-88.   Back to cited text no. 3      
4.Orfuss AJ. Lupus Vulgaris and Superimposed Basal Cell Epitheliomas. Arch Dermatol 1971;103:555.  Back to cited text no. 4      
5.Vora SN, Dave NJ, Mukhopadhyay A. Basal cell carcinoma in a long standing case of lupus vulgaris. Indian Journal of Dermatology Venereology and Leprology 1995;6:109-10.  Back to cited text no. 5      

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Correspondence Address:
Madhuri S Kate
29/203,Seawoods Estates, Nerul, 400706,Navi Mumbai, Maharashtra
India
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DOI: 10.4103/0377-4929.56135

PMID: 19805990

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