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One case of multi-year scalp trichilemmal carcinoma successfully rescued by our Neurosurgery Department - Scalp hotness and pruritus for 10 years, radical elimination just after 13 hours

39Admin2018-12-19from:Hunan Cancer Hospital

Tian ** came from Guizhou Province. She had a scalp trichilemmal carcinoma. In the past over 10 years, she was vexed by the scalp hotness and pruritus. After several surgeries at local hospitals, the scalp hotness and pruritus was not relieved, but there were such symptoms as exudation. She was almost broken down. Fortunately, she visited the Neurosurgery Department of Hunan Cancer Hospital. Under the assistance of Prof. He Zhengwen (a famous neurosurgeon), a tumor total resection and scalp reconstruction was performed. Then, these vexing symptoms also disappeared, and she restored the hope for life. Recently, she mailed a letter of thanks to Prof. He Zhengwen.

At a day of July 2018, Tian ** visited the clinic of Prof. He Zhengwen. She was haggard, at a middle age, but not of sickness look. However, when she removed the wig and took the ice bag off scalp, a startling condition was found. The whole scalp was basically ulcerated; there were several surgical scars; the lesion scalp was gray-red and of high temperature; and some scalps were concave due to the deficiency of skull. The skull MRI showed an invasion of brain with the mass of pigeon egg size. She was warmly received by Director He who thought that although the illness was complicated, a best effect could be achieved by the coordinated surgery with other disciplines and through the comprehensive treatment. Her relatives were excited to say that she has been refused by many large hospitals in China, but now she finally finds a savior at Hunan Cancer Hospital. 

In 2006, due to the scalp hotness and pruritus, Tian ** visited a local hospital, and was diagnosed as scalp cyst. Then, a cyst resection was performed, which initiated the onset of nightmare. Soon after the surgery, the scalp hotness and pruritus appeared again, and there was a localized exudation. After the progression of scalp lesion, she could not rest at normal state. She ever visited the local hospitals for many times. After a total of three surgeries, the pathological outcome was not achieved. In 2016, she was admitted into the First People’s Hospital of Zunyi. Due to the multiple scalp tumor, a scalp tumor resection and flap transplantation was performed; and she was diagnosed as malignant scalp trichilemmal carcinoma. Soon thereafter, the scalp hotness and pruritus appeared again. In order to completely cure the scalp tumor, she visited various famous hospitals in Beijing, Guangzhou and Shanghai, but then she returned with disappointment.

After the admission of Tian **, several experts from the Head and Neck Surgery Department, Head and Neck Radiotherapy Department, Head and Neck Oncology Department and Medical Section were organized for multi-discipline discussion by the Neurosurgery Department. Since a scalp trichilemmal carcinoma was definitely diagnosed which was not sensitive to the radiotherapy or chemotherapy, the radiotherapy or chemotherapy was not suggested. Since the scalp tumor of dozens of years brought about various inconveniences for the patient’s life and work, a radical scalp tumor extended resection and double-flap transplantation with scalp reconstruction could not be performed after the intracranial tumor resection. However, the scalp tumor could not be essentially cured by just the scalp tumor resection and flap transplantation with scalp reconstruction.

After the detailed discussion for about 13 hours, the surgery was assigned as follows: resection of scalp, skull and intracranial tumor (by the team of Prof. He Zhengwen at the Neurosurgery Department); flap transplantation, scalp reconstruction, and total resection of scalp, skull and intracranial tumor (by the team of Prof. Huang Wenxiao at the Head and Neck Surgery Department). After the above surgeries, the whole scalp was reconstructed successfully.

A careful care was implemented every day by the nursing team of Neurosurgery Department: nursing of flap in reconstructed scalp; heat preservation; prevention of ischemia and necrosis in the transplanted blood vessels; and correction of incorrect posture of the patient. At over 10 days after the surgery, she was discharged with pleasure. After the National Day, Tian ** and her relatives came from Guizhou Province to give thanks to Prof. He Zhengwen for bringing about a great prospect. At 3 months after the surgery, the scalp hotness and pruritus did not recur. Through this surgery, she shook off the vexation of exudation from scalp hotness and pruritus, she became reborn, and she opened a happy page of life. 

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