Postirradiation Pseudosclerodermatous Panniculitis

Abstract

Pseudosclerodermatous panniculitis is an unusual variant of panniculitis that results as a complication of megavoltage radiotherapy. Four women developed this unusual entity on the anterior chest and abdominal skin after receiving megavoltage therapy for either breast carcinoma or painful bone metastases from breast carcinoma. Histopathologically, the epidermis and dermis of the involved area showed little or no evidence of radiodermatitis. The main findings were confined to the subcutaneous tissue and consisted of thickened, sclerotic septa composed of both thick and thin collagen bundles, and a lobular panniculitis characterized by lipophagic granulomas and scattered lymphocytes and plasma cells. Additionally, one of the cases showed markedly dilated vascular spaces with the appearance of lymphatics in the upper part of the dermis. Pseudosclerodermatous panniculitis after irradiation is an unusual cutaneous complication of megavoltage radiotherapy that should be distinguished from subcutaneous metastatic disease, cellulitis, or connective tissue diseases involving the subcutaneous fat. The differential diagnosis can be established on the basis of the characteristic histopathologic features of postirradiation pseudosclerodermatous panniculitis.

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

“…The first description by Winkelmann of 4 cases in 1993 was followed by additional 4 cases in 2001. 19,20 These cases were characterized by erythematous indurated plaques in the field of radiation. Biopsies of the affected areas revealed significant changes in the subcutaneous tissues revealing a lobular panniculitis, thickened septae, and an inflammatory infiltrate.…”

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

“…According to Winkelmann et al [6], classical radiodermatitis may also be observed. But for Carrasco et al [8], histopathological findings are essentially limited to the subcutaneous tissue. This could probably be explained by the level of the concentration of the megavoltage therapy.…”

“…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]. Borrelia lymphocytoma could have a similar appearance, but the blood test is usually positive and histological features are different.…”

“…Lobular panniculitis composed of lymphocytes and hyaline degeneration of the fat tissue with lymphoid follicle in the subcutaneous septa is a characteristic feature of lupus panniculitis [14]. Epidermal and dermal changes consistent with discoid lupus erythematosus could also be observed [8]. …”

A Case of Localized Acne Following Megavoltage Radiotherapy

“…Akut radyodermatit, radyoterapiden ortalama 3-6 gün sonra ortaya ç›kan eritemli, ödemli, vezikülobüllöz ve erode lezyonlarla karakterizedir. ‹yonize radyasyona uzun süre suberitem dozlar›nda kronik maruziyet, birkaç aydan 10-30 y›la kadar de¤iflen latent periyot içerisinde atrofi, telenjiektazi, skleroz, hipo-hiperpigmentasyon, bazal hücreli karsinom, 9 gibi dermatozlara yol açt›¤› yönünde anektodal vaka raporlar› mevcuttur. ‹rradyasyon sonras›nda ortaya ç›kan akneiform lezyonlar oldukça nadir görülmekte ve 6 aya kadar uzayabilen latent periyot sonras›nda ortaya ç›kabilmektedir.…”