Radiation port xanthogranuloma: Solitary xanthogranuloma occurring within the irradiated skin of a breast cancer patient-report and review of cutaneous neoplasms developing at the site of radiotherapy
The University of Houston Health Center, University of Houston, Houston, TX, USA. Journal of Cutaneous Pathology
(Impact Factor: 1.58).
02/2010; 37(8):891-4. DOI: 10.1111/j.1600-0560.2010.01524.x
Xanthogranulomas are benign lesions composed of macrophages in which some of the cells have vacuolated cytoplasm. They commonly occur in children, referred to as juvenile xanthogranulomata, and are histopathologically characterized by the presence of Touton giant cells. Xanthogranuloma can also occur in adults. A woman who developed a solitary xanthogranuloma within the field of radiotherapy following treatment of her breast cancer is reported. In addition to xanthogranuloma, other benign lesions of keratinocytes, mast cells, endothelial cells and lymphatic cells have been observed at the site of radiation treatment. Also, several malignancies, including hematopoietic cancers, sarcomas, metastatic cancers and common skin cancers, have been observed within radiation ports. A causal relationship in the development of our patient's xanthogranuloma is suggested by the temporal association between the treatment with radiotherapy and the subsequent appearance of a xanthogranuloma directly within the radiation field.
Available from: Akira Hashimoto
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ABSTRACT: Breast carcinoma remains one of the most common sources of skin metastases in women. Cutaneous breast carcinoma metastases have variable clinical and histopathologic presentations that can make diagnosis challenging. We report a unique case of metastatic breast carcinoma with prominent clear cell features, thus mimicking a xanthomatous process. Dermatopathologists should be aware of this entity given its resemblance to other clear cell infiltrates and neoplasms.
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ABSTRACT: : To better define the spectrum of neoplastic and inflammatory diseases that affect female breast skin and the nipple-areola complex, we searched an institutional dermatopathology database and identified 500 specimens of female "breast" (from consecutive records accessioned January 2009-March 2011), 143 specimens of "areola," 124 specimens of "nipple" (records from the latter 2 groups were from patients evaluated June 1992-March 2011), and 500 control specimens of "abdomen" (accessioned January 2010-March 2011). Most specimens obtained from breast skin (76%) represented melanocytic or epithelial proliferations (eg, nevi, seborrheic keratoses, and cysts), as did those from the abdomen, whereas many from the nipple (41%) and areola (60%) were of inflammatory dermatoses. A striking finding was eosinophilic spongiosis (ES) in most areola specimens with spongiotic dermatitis (78%); in contrast, ES was identified in 50% and 31% of spongiotic dermatitis specimens from nipple and breast skin, respectively. ES was associated with a clinical diagnosis of dermatitis in all patients except one (who had pemphigus). Metastatic breast cancer was identified in 28 of 767 specimens (4%), including 6 of 124 (5%) from the nipple. Five of 124 specimens from the nipple (4%) and 1 of 143 from the areola (1%) showed Paget disease. All but one patient with Paget disease showed acantholytic features and none had tissue eosinophils. Abnormalities categorized as complications of radiotherapy, including mild fibrosis and vascular ectasias, morphea, and angiosarcoma, constituted a minority of cases. Our data and the literature indicate that few disorders specifically affect breast skin, but the nipple-areola complex should be approached with a different set of diagnostic considerations.
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