The problem of chronic suppurating foci is met frequently in the practice of surgery. Chronic osteomyelitis is one of the most common examples of such a condition. Every surgeon is cognizant of the difficulties of successful treatment and of the necessity for persistent cooperation on the part of the patient. Inadequate observation and therapy may result in eventual permanent disability or even loss of life. As the disease progresses, extensive local changes take place in the tissues owing to the constant irritative effects of the discharging suppurative material. Chronic irritation, both physical and chemical in nature, has long been accepted as a factor in the production of malignant growth. Carcinoma as an end result of a chronic suppurative process has been reported by Benedict (1), Blanco (2), Collins (4), Devars (5), Wakeley (9) and others. But that this condition is rare is shown by the fact that of 365 cases of osteomyelitis cared for at this hospital in twenty-two years, only one has been accompanied by malignant growth. The tendency for such a growth to remain localized for a long time is shown in the case herein described and in the others reported in the literature. The growth may progress, however, to such an extent as to undermine the vitality of the patient in a marked degree. Case Report A forty-seven-year-old woman, unmarried, was admitted to the Peter Bent Brigham Hospital complaining of weakness and inability to walk, owing to a sore leg. Eighteen years previously she had struck the left leg above the ankle against a table. Several weeks later she was taken to a hospital where incision and drainage were performed for what was apparently an acute osteomyelitis. During the ensuing year four additional operations were undertaken for drainage. Spontaneous drainage occurred intermittently after these procedures. Further professional aid was not sought because of the patient9s faith in Christian Science. She could walk with the help of a cane until one year prior to admission, when a fracture of the tibia occurred and she was compelled to use crutches. At that time the narrow opening of the sinus became larger, and ulceration slowly extended up the leg toward the knee. A sinus also developed in the upper third of the tibia. At the same time the patient became weaker and lost weight. Three weeks before admission to the hospital she fell and fractured the left tibia below the knee.

Epidermoid Carcinoma in Osteomyelitis: Case Report

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