Postirradiation Morphea of the Breast Presentation of Two Cases and Review of the Literature

Schaffer, Julie V.; Carroll, Carolyn B.; Dvoretsky, Israel; Huether, Michael J.; Girardi, Michael

doi:10.1159/000018322

Cited by 93 publications

(82 citation statements)

References 10 publications

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“…9 Analyzing the reported cases of PIM, we found an interval between the first radiotherapy dose and the appearance of PIM of 1 month 8 to 32 years. 14 In the literature few other skin disease associated with PIM were reported such as 2 cases with PIM and lichen sclerosus et atrophicans. 18 One patient developed PIM with subcutaneous polyarteritis nodosa.…”

Section: Resultsmentioning

confidence: 99%

“…TGF-ß strongly induces fibroblast activation, collagen synthesis and excessive fibrosis. [14][15] 2. Alteration of the fibroblast population includes an increase of the myofibroblast subset.…”

Section: Discussionmentioning

confidence: 99%

“…14 The treatment options are similar to those for idiopathic morphea which includes oral and systemic antibiotics, topical, intralesional and systemic corticosteroids. Multiple treatments for PIM with varying degrees of success have been achieved using topical steroids, 6,14,18 topical hyaluronidase 21 and methotrexate. 4 One patient mildly improved using phonophoresis with hyaluronidase and PUVA bath therapy.…”

Section: Discussionmentioning

confidence: 99%

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Post-Irradiation Morphea: Case report and review of the literature

Alhathlool

Hein²,

Andrés³

et al. 2012

J Dermatol Case Rep

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Background/Purpose: Post-irradiation morphea (PIM) is an entity documented in the literature although still not mentioned in most of the dermatological textbooks with a frequency approximately 2 out of every 1000 patients who received radiotherapy. Most of the cases are misdiagnosed as recurrent or metastatic carcinoma. Main observations:We report on a 64-year-old woman who was treated with radiotherapy for breast cancer. Two years and eight months after the first dose of radiotherapy, she developed localized morphea in the irradiated area. Conclusion:We report on a new case with a literature review and discuss pathogenesis, treatment modalities and post irradiation subcutaneos reactions mimicking PIM. Around 54 cases of post-irradiation morphea (PIM) were identified in the literature. (J Dermatol Case Rep. 2012; 6(3): 73-77)

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Post-Irradiation Morphea: Case report and review of the literature

Alhathlool

Hein²,

Andrés³

et al. 2012

J Dermatol Case Rep

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“…Postirradiation morphea of the breast is a distinct entity that could occur from months to years after radiation therapy, with an average of 2 years (1 month to 32 years). All lesions begin in the irradiated area and in 25% of the reported cases, lesions spread beyond the irradiated area, and the severity is not correlated with the irradiation dose [13]. In contrast to PPAI, histopathological changes are limited to the dermis [8].…”

Section: Discussionmentioning

confidence: 99%

Pseudosclerodermatous Panniculitis after Irradiation and Bronchiolitis obliterans Organizing Pneumonia: Simultaneous Onset Suggesting a Common Origin

Dalle¹,

Skowron²,

Ronger-Savlé³

et al. 2004

Dermatology

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Due to the technical evolution of radiation therapy of breast carcinoma, new manifestations occur as side effects. Newly described unexpected cutaneous events are morphea of the breast and pseudosclerodermatous panniculitis after irradiation (PPAI). They appear as specific consequences of megavoltage radiation. Radiotherapy-induced bronchiolitis obliterans organizing pneumonia (R-BOOP) is one of the pulmonary manifestations due to recent advances in radiotherapy of breast carcinoma. We report a case of PPAI and R-BOOP of simultaneous onset in a 60-year-old woman 6 months after megavoltage radiation therapy for breast carcinoma. We also noted an improvement of both unexpected reactions with systemic corticosteroid therapy and a common relapse when tapering the treatment. Only eight cases of PPAI have previously been reported. We believe that this entity is often underdiagnosed. The symmetrical onset and parallel evolution suggest a common origin for PPAI and BOOP in our case: the megavoltage radiation therapy. The pathogeny of R-BOOP is not direct toxicity of irradiation because untreated areas can also be affected. Pathogenesis of PPAI remains unknown, but a simultaneous onset with R-BOOP suggests a similar mechanism. While a cumulative dose of irradiation does not seem to be determinant an immune reaction to neoantigens induced by radiation could be an hypothesis.

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“…A proposed mechanism includes a T-cell reaction to neoantigens formed during the irradiation process (33). Therefore, SSe patients have to be considered to be more sensitive to irradiation compared to the general population and SSe should be viewed as a relative contraindication to breast radiotherapy.…”

Section: Mechanismsmentioning

confidence: 99%

Systemic Sclerosis and Cancer

Marasini

Conciato

Belloli

et al. 2009

Int J Immunopathol Pharmacol

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To review recent advances and current controversies on the association between systemic sclerosis (SSc) and cancer, PUBMED was searched from 1966 to the present using the terms: systemic sclerosis, cancer, morphoea, sclerotic diseases. Malignancies, mainly in lung and breast, coexist with idiopathic SSc or with SSc-like disorders, but not with localized forms of scleroderma (morphoea), with the exception of squamous cell carcinoma in patients with pansclerotic morphoea and skin ulcers. The mechanisms connecting SSc and malignancies are unknown. The occurrence of different cancer types with SSc or SSc-like disorders suggest different underlying mechanisms, including altered immune response, common genetic and environmental links, disease-dependent factors, tumor-derived biologic substances and therapies. The process of sclerosis itself may favour cancer in certain sites, and a reaction between T cells and neoantigens formed during irradiation has been suggested to explain the frequent development of morphoea after breast irradiation. Radiotherapy, especially when used for breast cancer, may trigger idiopathic SSc or morphoea and influence the severity of preexisting SSc, with the consequence that SSc is considered a relative contraindication to breast radiotherapy. In conclusion, cancer and SSc may be associated, but it is still controversial as to whether there is a causal relationship. Continuing interest in these associations, in particular in the different modalities of associations, may help to understand the underlying biological mechanisms and to identify patients at risk.

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Postirradiation Morphea of the Breast Presentation of Two Cases and Review of the Literature

Cited by 93 publications

References 10 publications

Post-Irradiation Morphea: Case report and review of the literature

Post-Irradiation Morphea: Case report and review of the literature

Pseudosclerodermatous Panniculitis after Irradiation and Bronchiolitis obliterans Organizing Pneumonia: Simultaneous Onset Suggesting a Common Origin

Systemic Sclerosis and Cancer

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