Pressure ulcer

From Libre Pathology
(Redirected from Sacral ulcer)
Jump to navigation Jump to search

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

  • Common, esp. in spina bifida,[1] individuals with spinal cord injuries.[2]

Etiology:

Gross

Typical locations:

  • Ischial tuberosity.
  • Sacrum.[5]

Microscopic

Features:

DDx:

Sign out

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

  1. 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.
  2. 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.
  3. 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.
  4. 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.
  5. Beldon, P. (Dec 2008). "Problems encountered managing pressure ulceration of the sacrum.". Br J Community Nurs 13 (12): S6, S8, 10 passim. PMID 19060829.
  6. 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.
  7. Simmons, MA.; Edwards, JM.; Nigam, A. (Dec 2000). "Marjolin's ulcer presenting in the neck.". J Laryngol Otol 114 (12): 980-2. PMID 11177375.

See also