Breast pseudotumoral radionecrosis as a late radiation-induced injury: a case report

Abstract

Introduction: New therapies and treatment protocols have led to improved survival rates in many cancers. The improved rates are such that patients are now living long enough to experience some negative long-term side effects of the initial therapy.

Case presentation: We report the case of a 65-year-old Caucasian woman who presented with a rare case of pseudotumoral radionecrosis, a late radiation-induced injury, after combined surgical and cobalt radiation therapy for the treatment of adenocarcinoma of the right breast. The patient underwent resection of this benign, yet progressively growing and painful tumor. A cosmetically satisfying result was achieved by reconstruction of the thoracic wall with a polypropylene mesh and a latissimus dorsi muscle flap.

Conclusion: With improved overall survival, new management strategies for late side effects of therapy are becoming of crucial importance for affected patients. In the future, improving toxicity-free survival will be as important as achieving disease-free survival or local tumor control.

Figure 1

Pre- and postoperative macroscopic presentation. (A) Calcific subcutaneous, painful, progressively growing tumor on the right breast 23 years after 60 Gy cobalt radiation before the corrective operation. (B) Post-corrective surgery: after reconstruction of the thoracic wall with a double layer polypropylene mesh and switching of a flap of latissimus dorsi muscle to the thoracic wall.

Figure 2

Pre-operative imaging studies of the tumor. Computed tomographic scan of the thorax (A) and respective 3-D image (B) exhibiting a large area of costal and muscular radionecrosis. The pleura was not affected.

Figure 3

Intra-operative situs and steps in the surgical procedure. (A) Operative field; (B) placement of two thoracic drains after resection of the tumor; (C, D) reconstruction of the thoracic wall with a double layer polypropylene mesh; (E) mobilization and switching of the latissimus dorsi flap to the thoracic wall; (F) wound closure.

Figure 4

Histological characteristics of the specimen. Wide, almost scarred, radionecrosis and fibrosis of muscle, fat and bone, and extended dystrophic calcifications corresponding to a radiation-induced vasculopathy.