Imaging Surveillance of the Breast in a Patient Diagnosed with Scleroderma after Breast-Conserving Surgery and Radiotherapy

Abstract

Collagen vascular disease (CVD), particularly scleroderma, is a contraindication to radiation therapy because of increased risk of fibrosis. We report a patient with early stage breast cancer diagnosed with scleroderma after breast-conserving surgery and radiation. She developed marked breast fibrosis, rendering mammographic, sonographic, and clinical surveillance ineffective. She has subsequently been followed with magnetic resonance imaging (MRI) of the breast. We illustrate this case and review the literature relating to CVD and radiation therapy. MRI may be a suitable surveillance method in this situation.

Localized Morphea – a Rare but Significant Secondary Complication Following Breast Cancer Radiotherapy

“…When they are wrongly induced and are activated continually in scleroderma, this leads to a thickening and hardening of the connective tissue, clinically expressed as sclerosis [37]. Various authors [12,29,30] point out imaging difficulties during aftercare for breast cancer patients with morphea -often making differential diagnosis problematic when distinguishing between morphea and carcinoma recurrence. As a rule, for these patients, magnetic resonance mammography also needs to be used to provide imagery, alongside ultrasound.…”

Irradiation-Induced Morphea: X-Rays as Triggers of Autoimmunity

“…The coexistence of diseases with an autoimmune pathogenesis, such as morphea, lichen sclerosus, lichen planus and lupus erythematosus are well-known [35,36,37]. Patients with preexisting scleroderma are at increased risk of experiencing a worsening of their condition after radiotherapy, as are patients with other conditions from the spectrum of autoimmune diseases [15]. In our patient 3 (with preexisting LS), a Koebner phenomenon could be postulated as LS and morphea are considered to belong to a single disease spectrum.…”

“…This can sometimes be difficult as the tissue fibrosis cannot be distinguished from recurrence clinically and even by mammography. MRI is more reliable in these cases [15]. Also a second tumor different from breast cancer has to be thought of, as patients are at risk of a second malignancy in the irradiated field.…”

Scleroderma and Breast Cancer

“…Proven prognostic factors for scleroderma patients developing toxicity effects are curative treatment, multi organ involvement of scleroderma for acute toxicity and negative antinuclear antibodies for late toxicity. 51 . However these results reach statistical importance for mild toxicity only (Grade 1 and 2 according to Common Terminology Criteria for Adverse Events version 3.0 grading scales).…”