J Korean Soc Radiol.  2016 May;74(5):344-349. 10.3348/jksr.2016.74.5.344.

MR Findings of Squamous Cell Carcinoma Arising from Chronic Osteomyelitis of the Tibia: A Case Report

• Han D
• Lee J
• Cho WH
• Kim JH
• Jeong MJ
• Kim SH
• Kim JY
• Kim SH
• Kang MJ
• Bae KE

• KMID: 2164833
• DOI: http://doi.org/10.3348/jksr.2016.74.5.344

Abstract

Malignant transformation is a rare and late complication of untreated chronic osteomyelitis. Known radiographic findings of the malignant transformation of chronic osteomyelitis are osteolytic or mixed sclerotic and osteolytic lesions with or without soft tissue mass. But its magnetic resonance (MR) imaging findings are rarely described in the literature. We experienced a case of an 82-year-old man diagnosed with squamous cell carcinoma arising from long standing chronic osteomyelitis of the tibia. Our case indicates that radiologists should consider the possibility of malignant transformation in patients with untreated chronic osteomyelitis, with enhancing soft tissue mass invading and extending through underlying bone cortex and medulla on MR imaging.

MeSH Terms

Aged, 80 and over
Carcinoma, Squamous Cell*
Humans
Leg Ulcer
Magnetic Resonance Imaging
Osteomyelitis*
Tibia*

Figure

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  Fig. 1 Anteroposterior (A) and lateral (B) views of the wound. Wound with pus-like discharge is shown on the anterior aspect of the shin. This wound is connected with the medullary cavity of tibia via a draining sinus in the inferior portion of the wound. The wound is accompanied by skin elevation around the wound.

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  Fig. 2 Simple radiographs of anteroposterior (A) and lateral (B) views of tibia show a partially-defined heterogeneous osteolytic lesion with cortical defect in the anterior aspect of diaphysis of the tibia. Irregular thick solid periosteal reaction is also noted (arrows).

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  Fig. 3 MR images of the right lower leg. Sagittal T2-weighted fat suppressed image (A), sagittal T1-weighted image (B), axial T2-weighted fat suppressed image (C), axial T1-weighted image (D) and T1-weighted fat-suppressed image with gadolinium enhancement (E). Hyperintense soft tissue mass is seen on the anterior aspect of tibia on T2-weighted images (A, C, arrows). The lesion is isointense or slightly hyperintense than the muscle on T1-weighted image (B, D, arrows). Soft tissue mass extends through the cortical defect and then protrudes over subcutaneous tissue and skin (C, arrow). After enhancement, this lesion shows heterogeneously strong enhancement (E, arrow). Surrounding bone marrow edema is also noted. Edema and mild enhancement are also seen in the anterior and deep posterior compartment muscles of the lower leg, and on the anteromedial aspect of subcutaneous tissue and skin.

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  Fig. 4 Pathology. Squamous cell carcinoma is noted between bone fragments (A) and skin (B) (hematoxylin and eosin stain, × 40).

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