Recall phenomenon with the unusual presence of eccrine squamous syringometaplasia

Abstract

The recall phenomenon is an inflammatory reaction limited to a previously X-irradiated field when the patient is treated months or years later with certain drugs. Only a few cases have been reported in dermatological journals. We report a patient with lymphoma who was treated with low-dose abdominal irradiation and high-dose irradiation to the knees and who, 2 months later, when chemotherapy was started, developed a pronounced inflammatory reaction limited to the areas treated with high-dose irradiation. A skin biopsy specimen showed features of radiation damage, marked epidermal changes and extensive eccrine squamous syringometaplasia. This case of the recall phenomenon is of interest because we have found that there is apparently a radiation dose threshold for this event, and because this is the first report of its association with eccrine squamous syringometaplasia.

Chemotherapy-related bilateral dermatitis associated with eccrine squamous syringometaplasia: Reappraisal of epidemiological, clinical, and pathological features

“…This entity must be differentiated from other conditions in which ESS represents an incidental histopathological finding (Table I) as this feature has been found in the setting of other well-defined chemotherapy-related entities, such as acral erythema, 10,11 extravasation injuries, 12 and recall reactions. 13 However, despite the overlap with previously described entities, we consider that the finding of ESS and epidermal changes of chemotherapy, along with the clinical presentation of a bilateral, intertriginous cutaneous eruption exhibiting onset within 30 days of cytotoxic chemotherapy induction, denotes a specific entity that deserves better description and clarification in the literature.…”

Syringometaplasia: variants and underlying mechanisms

“…1). [2][3][4][5][6][7][8][9][10][11] Depending on the associated condition, the superficial and/or deep portion of the eccrine ducts and/or glands may be affected. This metaplastic change leads to loss of immunohistochemical expression of low molecular weight cytokeratins such as CAM 5.2, which are normally expressed in normal eccrine ducts and glands.…”

“…2 Other uncommonly reported accompanying microscopic features include focal necrosis of eccrine ductal epithelium, periductal stromal edema, and fibroblastic proliferation. [2][3][4][5][6][7][8][9][10][11] Types and associations Squamous syringometaplasia is the most common type of metaplasia affecting the eccrine glands and ducts. Two types of SSM have been described, of which one occurs with chemotherapeutic treatment and the other without this association.…”

“…Type 1 SSM represents an uncommon clinicopathological entity that has been described in association with several chemotherapeutic agents, including carmustine, cytarabine, cyclophosphamide, daunorubicin, cisplatin, 5fluorouracil, doxorubicin, etoposide, methotrexate, busulfan, melphalan, mitoxantrone, suramin, and thiotepa (Table 3). [2][3][4][5][6][7][8][9][10][11] This type is characterized by a clinical eruption of erythematous macules, papules, plaques, or vesicles in a localized or generalized distribution that appears 2-39 days after chemotherapy is started and commonly clears spontaneously within four weeks. [2][3][4][5][6][7][8][9][10][11] Recently, other therapeutic agents (Table 3), including tyrosine kinase inhibitors (imatinib, sunitinib), vemurafenib (a selective BRAF inhibitor used to treat patients with metastatic melanoma with V600E mutation), and tamoxifen, have also been associated with the first type of SSM in manifestations that show generally similar clinicopathological features (Fig.…”

“…1,2 In the skin, different types of metaplasia in the eccrine duct and gland (termed syringometaplasia) have been described including squamous, mucinous, and adenomatous types ( Table 1). [3][4][5][6][7][8][9][10] These metaplastic changes have been described in association with chemotherapeutic agents, as well as a variety of skin disorders including multiple infectious, neoplastic, and inflammatory skin diseases ( Table 2).…”