title: Composite cutaneous atypical vascular lesion and Langerhans cell histiocytosis after radiation for breast carcinoma: can radiation induce Langerhans cell histiocytosis?
abstract: Atypical vascular lesions (AVLs) refer to small vascular proliferations in radiated skin that may progress to angiosarcoma and typically develop after breast-conserving therapy for breast carcinoma. We present a case of composite AVL and Langerhans cell histiocytosis (LCH) in a 57-year-old woman who received surgery and radiation therapy for ductal carcinoma of the breast. The patient developed AVLs 4 years after radiation. Biopsies of multiple erythematous nodules at the same site one year later revealed intermixed AVL and LCH, some of which coexisted within the same lesion. To our knowledge, LCH has not been recorded at the site of radiation in the English language literature. Our case not only highlights the importance of close cutaneous surveillance and a low threshold for biopsy in patients with breast-conserving surgery and radiation therapy, but also raises the possibility of radiation as the inducement of cutaneous LCH.
authors.affiliation: Department of Pathology, University of Alabama at Birmingham, Birmingham, Alabama, USA.
authors.forename: Zenggang
authors.initials: Z
authors.lastname: Pan
authors.forename: Kirby I
authors.initials: KI
authors.lastname: Bland
authors.forename: Shi
authors.initials: S
authors.lastname: Wei
mesh_terms: D001706:Biopsy; D001943:Breast Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D018270:Carcinoma, Ductal, Breast / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D003872:Dermatitis / Q000175:diagnosis / Q000209:etiology*; D005260:Female; D006646:Histiocytosis, Langerhans-Cell / Q000175:diagnosis / Q000209:etiology*; D006801:Humans; D008875:Middle Aged; D011832:Radiation Injuries / Q000150:complications*; D016896:Treatment Outcome