Malignancy in chronic osteomyelitis of the femur: a case report

Introduction Chronic osteomyelitis is a common disease, but malignancy is its rare and late complication. The aim is to present a clinical case of malignant transformation 34 years after the diagnosis of chronic osteomyelitis of the hip. Materials and methods The medical case history was studied and pathomorphological examination of the surgical material of patient D. with chronic osteomyelitis of the femur was conducted. Results Patient D., after a comminuted fracture of the left femur as a result of an accident, at the age of 25 years, developed chronic osteomyelitis, the surgical interventions did not lead to a long-term remission of the process. The course of the disease was complicated by malignancy and pathological fracture. The treatment ended with the amputation of the limb. The pathohistological examination revealed structural changes in bone tissue: necrosis, bone marrow fibrosis, bone microsequestration, inflammatory infiltrate with a high content of neutrophils that corresponded to the morphological signs of chronic osteomyelitis in the acute stage. Signs of pseudocarcinomatous hyperplasia, mass appearance of "horny pearls", invasion of the squamous epithelium of the bone tissue, squamous epithelial cells seemed to be highly differentiated. Discussion The pathomorphological picture of the surgical material was characterized as pseudocarcinomatous hyperplasia, the prolonged existence of which could cause the occurrence of squamous cell carcinoma of the femur. It is not clinically and histologically possible to establish when the reactive proliferation of the epidermis acquires fundamentally different biological properties of a malignant tumor. It is a serious problem in the timely diagnosis. Conclusion A thorough pathoanatomical assessment of the material from the affected areas (ulcers, fistulous tracts, bone marrow space) is necessary for the early detection of malignant neoplasms that may occur in osteomyelitis. The presence of long-term dynamics of pseudocarcinomatous hyperplasia requires vigilance in relation to the process of malignancy.