Boncher Julia, Bergfeld Wilma F
Department of Anatomic Pathology, Cleveland Clinic, Cleveland, OH 44195, USA.
J Cutan Pathol. 2012 Jan;39(1):63-7. doi: 10.1111/j.1600-0560.2011.01754.x. Epub 2011 Jul 14.
Fluoroscopy-induced chronic radiation dermatitis (FICRD) can be a challenging diagnosis for the dermatopathologist, as often a history of radiation exposure is not provided. With the expanded use of minimally invasive procedures, there is increased fluoroscopic exposure and a high index of suspicion for FICRD is prudent. Recognition of characteristic clinical and histopathological features can be helpful in distinguishing chronic radiation dermatitis from entities in the histological differential diagnosis such as morphea and lichen sclerosus. We present a brief review of the literature as well as two additional cases of FICRD. Case 1 is a 44-year-old man with an atrophic lateral back patch for several years. Chart review revealed a history of cardiac radiofrequency ablation and congenital heart disease with correction. Case 2 is a 64-year-old woman with an ulcerated, atrophic left flank plaque, with a history of mesenteric artery angiography and stent placement. In our two cases, as well as the cases in the literature, a diagnosis of FICRD is associated with key features. In the evaluation of a sclerosing process, chronic radiation dermatitis should be suspected histologically by the findings of ulceration, prominent telangiectasias, atypical stellate fibroblasts, absence of a lymphocytic infiltrate/inflammation and/or presence of hyperkeratosis.
荧光镜检查引起的慢性放射性皮炎（FICRD）对皮肤病理学家来说可能是一个具有挑战性的诊断，因为通常患者不会提供辐射暴露史。随着微创操作的广泛应用，荧光镜检查的暴露增加，因此对FICRD保持高度怀疑是谨慎的做法。认识其特征性的临床和组织病理学特征有助于将慢性放射性皮炎与组织学鉴别诊断中的其他疾病，如硬斑病和硬化性苔藓区分开来。我们简要回顾了文献，并介绍另外两例FICRD病例。病例1是一名44岁男性，其侧背部有一块萎缩性斑片数年。病历回顾显示有心脏射频消融术史和先天性心脏病矫正史。病例2是一名64岁女性，其左侧腹有一块溃疡、萎缩性斑块，有肠系膜动脉血管造影和支架置入史。在我们的两个病例以及文献中的病例中，FICRD的诊断都与关键特征相关。在评估硬化性病变过程中，组织学上若发现溃疡、明显的毛细血管扩张、非典型星状成纤维细胞、无淋巴细胞浸润/炎症和/或存在角化过度，则应怀疑为慢性放射性皮炎。
