Parastomal squamous cell carcinoma in an ileostomy 44 years after proctocolectomy

Abstract

A 67-year-old man presented with a painful 10-cm peristomal skin lesion (A). After diagnosis of ulcerative colitis at age 18, he underwent proctocolectomy with skin-grafted end ileostomy in 1952 and completion proctectomy in 1955. In 1993, stricture of the skin-grafted ostomy led to its excision, and the stoma rematured by eversion. A parastomal ulcer appeared in 1994 and subsequently gradually increased in size. Biopsy in 1996 revealed welldifferentiated keratinizing squamous cell carcinoma (B, wide arrow). The carcinoma invaded beneath the adjacent hyperplastic epidermis (B, narrow arrow). Ileostomy resection was performed with wide excision of abdominal wall soft tissue and stoma translocation. The surgical margins were free of tumor. His recovery was uneventful but he died 1 year after surgery of unrelated causes. At that time, there was no evidence of recurrent squamous carcinoma. The occurrence of squamous cell carcinoma in relation to an ileostomy has been reported only once before. The development of cancer in this setting may be related to chronic injury. Treatment by wide excision and stoma relocation is probably adequate therapy in the absence of lymphadenopathy. Biopsy of chronic stomal ulcers is recommended to facilitate early diagnosis of this rare complication.