Surgical Excision of Sarcoma Disguised by Long-Standing Chronic Fibrotic Hurley Stage III Hidradenitis Suppurativa (HS): A Case Study

Introduction: Hidradenitis suppurativa (HS) is a chronic inflammatory skin condition marked by the formation of painful, purulent lesions in intertriginous regions, which can lead to the development of sinus tracts and fibrotic scarring. Diagnosis of HS relies primarily on clinical evaluation. Delays in diagnosis and treatment result in progression of this inflammatory disease. Chronic inflammation is known to predispose tissues to malignant transformation over time, thus with chronic, Hurley Stage III disease, there may be potential to develop cancerous changes in affected tissue. This case report highlights the surgical excision of a hidden sarcoma discovered in a patient with chronic Hurley stage III HS, emphasizing the importance of early diagnosis, timely intervention, and coordination of care managing this complex condition.Methods:A 59-year-old female, with a remote history of necrotizing fasciitis requiring surgical debridement, presents with chronic Hurley stage III hidradenitis of the lower abdomen, pubis, groin, thigh, and vulva. She required extensive resection of the fibrotic and densely scarred bilateral thighs and groin. During the right inguinal resection of tunneled fibrotic HS, a large, irregular, pedunculated mass was encountered. General surgery assisted in excision of the mass, which was sent for frozen section. Pathology revealed a sarcoma, with positive tumor margins. General surgery assisted in wide re-excision of margins. Surgical clips were placed along the perimeter and base of resection to guide future radiotherapy. Post-operative care involves a multidisciplinary treatment team, including plastic surgery, infectious disease, wound care, and oncology. Results:Minor wound healing complications arose post operatively, requiring the patient to undergo conservative wound management. Close follow up, consistent wound care, and appropriate medical therapy and antibiotics mitigate these complications.Discussion: This case underscores the importance of a timely diagnosis and comprehensive multidisciplinary management of HS patients. Chronic inflammation and scarring lead to local tissue destruction and distortion, which may have contributed to delayed diagnosis. Timely intervention and a multidisciplinary approach are crucial in the treatment of chronic, fibrotic Hurley stage III HS.References:Jung JM, Lee KH, Kim YJ, Chang SE, Lee MW, Choi JH, Won CH, Lee WJ. Assessment of Overall and Specific Cancer Risks in Patients With Hidradenitis Suppurativa. JAMA Dermatology. 2020 Aug 1;156(8):844-853. doi: 10.1001/jamadermatol.2020.1422. PMID: 32459291; PMCID: PMC7254443. Radons J. The Role of Inflammation in Sarcoma. Advances in Experimental Medicine and Biology. 2014 Jan 1;816:259-313. doi: 10.1007/978-3-0348-0837-8_11. PMID: 24818727.