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      Radiation-induced Vulvar Angiokeratoma Along with Other Late Radiation Toxicities after Carcinoma Cervix: A Rare Case Report

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          Abstract

          Angiokeratoma including vulvar angiokeratoma is a very rare complication of radiation. Exact incidence is still unknown, we report a case that developed radiation-induced angiokeratoma of skin in the vulvar region along with other late radiation sequelae in the form of bone fracture, new bone formation, bone marrow widening, muscle hypertrophy, and subcutaneous fibrosis, 18 years after radiotherapy to the pelvic region for the treatment of carcinoma cervix. All these late radiation sequel are rare to be seen in a single patient, and none of the case reports could be found in the world literature.

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          Most cited references10

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          Postirradiation atrophic changes of bone and related complications.

          The sequence of radiographically visible changes about the shoulder girdle following irradiation was analyzed in 49 patients who received 200 kV irradiation, in 50 who received 25 MeV betatron photon irradiation, and in 20 who received cobalt-60 irradiation. The changes were dose related and were most evident in the kilovoltage group, but also occurred following megavoltage therapy. Atrophic changes may be complicated by fracture, true necrosis, true osteitis or sarcoma. These atrophic changes have clinical significance similar to the atrophic changes that occur in skin and mucous membranes. The terms radionecrosis and radiation osteitis as applied to these changes should be abandoned since they imply a more serious process than is actually present. Biopsy should be avoided if possible since trauma and secondary infection could lead to true necrosis.
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            Angiokeratoma of the vulva: diagnosis and review of the literature.

            Angiokeratomas of the vulva are uncommon benign lesions. They are usually unilateral, multiple in number, and occur before the age of 50 years. Angiokeratomas are papular lesions measuring less than 1 cm in diameter and are purple in color. In most patients the lesions are asymptomatic; however, intermittent bleeding, pruritus, and pain have been reported. Histologically, hyperkeratosis, papillomatosis, acanthosis, and dilated vasculature in the papillary dermis are characteristic features. Degenerative changes in the perivascular elastic tissue is observed and may contribute to the pathogenesis of vulvar angiokeratomas. In asymptomatic patients, management need only include reassurance and follow-up observation; surgical excision, electrodesiccation, or argon laser for local removal of the lesions may be useful in symptomatic women. Clinically, infections, inflammatory lesions, vascular conditions, and epithelial tumors must be differentiated.
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              [Angiokeratoma. Apropos of 93 cases].

              A description of 93 cases of angiokeratoma [Mibelli (3 cases), Fordyce (13 cases), circumscriptum naeviformis (12 cases) and solitary (65 cases)], confirmed histologically and observed during the last 30 years (1955-1985) in the Department of Medicine and Surgery of the School of Medicine of the University of Granada is presented. We carry out a detailed histological and ultrastructural study.
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                Author and article information

                Journal
                Indian J Dermatol
                Indian J Dermatol
                IJD
                Indian Journal of Dermatology
                Medknow Publications & Media Pvt Ltd (India )
                0019-5154
                1998-3611
                Mar-Apr 2016
                : 61
                : 2
                : 235
                Affiliations
                [1] From the Department of Radiation Oncology, Sri Aurobindo Medical College and PG Institute, Indore, Madhya Pradesh, India
                Author notes
                Address for correspondence: Dr. Virendra Bhandari, 401, Samyak Towers, 16/3 Old Palasia, Indore - 452 001, Madhya Pradesh, India. E-mail: virencancer@ 123456yahoo.co.in
                Article
                IJD-61-235d
                10.4103/0019-5154.177791
                4817470
                27057045
                4b982496-221e-471c-bd05-fe4bdfef9043
                Copyright: © 2016 Indian Journal of Dermatology

                This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

                History
                : August 2015
                : December 2015
                Categories
                E-IJD Case Report

                Dermatology
                late radiation toxicity,pelvis,vulvar angiokeratoma
                Dermatology
                late radiation toxicity, pelvis, vulvar angiokeratoma

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