Postiradiacijska morfea – redek pozni zaplet obsevanja po ohranitveni operaciji raka dojk Radiation-induced morphea – a rare late effect of adjuvant radiation therapy following breast conserving surgery

prikaz primera

Povzetek

V prispevku opisujemo primer bolnice z lokalizirano morfeo ali sklerodermo (angl. post-irradiation morphea, PIM), ki je redek in slabo prepoznan pozni zaplet obsevanja. Najpogosteje se pojavi po obsevanju dojke. PIM se pojavi po obdobju brez težav, ki lahko traja od nekaj mesecev do več let. Etiopatogeneza ni pojasnjena. Diagnozo lahko postavimo šele, ko smo izključili druge bolezni, ki jo lahko posnemajo. Diferencialno diagnostično v poštev prihaja vnetni rak dojk, okužbe (predvsem v zgodnji fazi PIM), limfedem, druge dermatološke ali avtoimune bolezni ter postiradiacijska fibroza. Za izključitev ostalih bolezni so potrebni natančna anamneza, ustrezne slikovne in laboratorijske preiskave in biopsija prizadetega mesta, s katero lahko, ob ustrezni klinični sliki, diagnozo morfee tudi potrdimo. Zdravljenje PIM je najbolj uspešno, če bolezen pravočasno prepoznamo še v akutni fazi, ko lahko upočasnimo ali ustavimo prehod v fibrozo in tako preprečimo slab kozmetski rezultat lokalnega zdravljenja dojke.

Abstract (Eng)

We present a case report of radiation-induced morphea (PIM) or circumscribed localized scleroderma that most often occurs following radiation therapy of the breast. PIM is a rare and underrecognized local side-effect of radiation therapy. Typically, the symptoms of PIM manifest following a variable period of asymptomatic latency, lasting from few months to few years. The etiopathogenesis is unclear. PIM is a clinical diagnosis of exclusion. Differential diagnoses include inflammatory breast cancer, cellulitis or mastitis, breast lymphedema, other dermatological or autoimmune disorders and post-irradiation fibrosis. Careful patient assessment with thorough medical history, physical examination, laboratory tests and surgical biopsy of the affected area is needed to confirm PIM. Early recognition of the acute inflammatory phase is crucial to subsequent disease management in order to prevent late irreversible fibrosis and poor cosmetic outcome of the treated breast.