Pressure ulcer
Pressure ulcer, also known as decubitus ulcer (as it often arises from lying down, i.e. being decubitus, a long time), is a relatively common ditzel.
Ulcers overlying the ischial tuberosity (ischial ulcers) are pressure ulcers.
General
Etiology:
Gross
Typical locations:
- Ischial tuberosity.
- Sacrum.[5]
Microscopic
Features:
- Ulceration - full thickness loss of the epidermis.
- Epidermal thickening (acanthosis and hyperkeratosis) adjacent to ulcer - pseudoepitheliomatous hyperplasia.[6]
- Inflammation - lymphocytes, plasma cells, neutrophils.
- +/-Abscess formation - clusters of extravascular neutrophils.
DDx:
- Squamous cell carcinoma of the skin.
- Known as a Marjolin's ulcer when arising in the context of long standing inflammation.[7]
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SKIN LESION ("DECUBITUS ULCER"), EXCISION:
- ULCERATED SKIN WITH ACANTHOSIS, HYPERKERATOSIS, PARAKERATOSIS, AND CHRONIC
ACTIVE INFLAMMATION -- CONSISTENT WITH A PRESSURE ULCER.
- NEGATIVE FOR MALIGNANCY.
SKIN LESION ("DECUBITUS ULCER"), EXCISION:
- ULCERATED SKIN WITH PSEUDOEPITHELIOMATOUS HYPERPLASIA AND CHRONIC ACTIVE
INFLAMMATION -- CONSISTENT WITH A PRESSURE ULCER.
- NEGATIVE FOR MALIGNANCY.
LESION ("LEFT ISCHIAL ULCER"), EXCISION:
- ULCERATED SKIN AND SUBCUTANEOUS TISSUE WITH REACTIVE CHANGES.
- NEGATIVE FOR MALIGNANCY.
LESION ("RIGHT ISCHIAL ULCER"), EXCISION:
- ULCERATED SKIN WITH EPIDERMAL HYPERPLASIA, AND DERMAL AND SUBCUTANEOUS TISSUE WITH
CHRONIC INFLAMMATION.
- NEGATIVE FOR DYSPLASIA AND NEGATIVE FOR MALIGNANCY.
LESION ("SACRAL ULCER"), EXCISION:
- ULCERATED SKIN AND SUBCUTANEOUS TISSUE WITH REACTIVE CHANGES, MICROABSCESS
AND GRANULATION TISSUE.
- NEGATIVE FOR DYSPLASIA AND NEGATIVE FOR MALIGNANCY.
Micro
The sections show skin with acanthosis, hypergranulosis, compact hyperkeratosis and focal full thickness loss of the epidermis, associated with a mixed inflammatory infiltrate. The dermis has reactive fibroblasts with moderate grey cytoplasm, nuclear enlargement and round small nucleoli. Fibroblast nuclei have regular nuclear membranes and a bland chromatin pattern. Small clusters of neutrophils are present.
There is no epidermal nuclear atypia. Mitotic activity is not apparent.
References
- ↑ Nthumba, PM. (2010). "Marjolin's ulcers: theories, prognostic factors and their peculiarities in spina bifida patients.". World J Surg Oncol 8: 108. doi:10.1186/1477-7819-8-108. PMID 21129225.
- ↑ Schessel, ES.; Ger, R.; Oddsen, R. (Feb 2012). "The costs and outcomes of treating a deep pressure ulcer in a patient with quadriplegia .". Ostomy Wound Manage 58 (2): 41-6. PMID 22316632.
- ↑ Olesen, CG.; de Zee, M.; Rasmussen, J. (Jun 2010). "Missing links in pressure ulcer research--an interdisciplinary overview.". J Appl Physiol 108 (6): 1458-64. doi:10.1152/japplphysiol.01006.2009. PMID 20299616.
- ↑ Hamanami, K.; Tokuhiro, A.; Inoue, H. (Feb 2004). "Finding the optimal setting of inflated air pressure for a multi-cell air cushion for wheelchair patients with spinal cord injury.". Acta Med Okayama 58 (1): 37-44. PMID 15157010.
- ↑ Beldon, P. (Dec 2008). "Problems encountered managing pressure ulceration of the sacrum.". Br J Community Nurs 13 (12): S6, S8, 10 passim. PMID 19060829.
- ↑ Zayour, M.; Lazova, R. (Apr 2011). "Pseudoepitheliomatous hyperplasia: a review.". Am J Dermatopathol 33 (2): 112-22; quiz 123-6. doi:10.1097/DAD.0b013e3181fcfb47. PMID 21399447.
- ↑ Simmons, MA.; Edwards, JM.; Nigam, A. (Dec 2000). "Marjolin's ulcer presenting in the neck.". J Laryngol Otol 114 (12): 980-2. PMID 11177375.