Postirradiation pseudosclerodermatous panniculitis with involvement of breast parenchyma: a dramatic example of a rare entity and a pitfall in diagnosis.

Postirradiation pseudosclerodermatous panniculitis is a rare complication of external beam radiotherapy. This inflammatory process typically presents as an erythematous indurated plaque in a previously irradiated region of skin. To date, 13 cases have been reported worldwide. We present a case of a 70-year-old female who received breast irradiation following conservation surgery for invasive breast carcinoma. In her third year of follow-up, she developed an enlarging mass, involving the subcutis and underlying breast tissue, associated with mammographically detected coarse calcifications and density, at the surgical site. This was deemed highly suspicious of recurrent malignancy. Following several benign needle core biopsies, she had an excision of the mass. This revealed a lobular panniculitis and irradiation-induced vascular changes affecting subcutaneous fat and underlying breast tissue. This is the 14th reported case of this rare entity. It is unique in the degree of involvement, affecting breast parenchyma as well as subcutaneous fat, and in its corresponding dramatic clinical and radiographic manifestations.

Deposition of cigar smoke particles in the lung: evaluation with ventilation scan using (99m)Tc-labeled sulfur colloid particles.

UNLABELLED: This study examined the degree to which cigar smokers inhale when they smoke cigars. A second objective was to assess the level of association between self-reported inhalation and observable cigar particle deposition in the lung. We hypothesized that cigar smokers with a history of cigarette smoking would show a greater amount of smoke deposition than would cigar smokers with no history of cigarette smoking. We conjectured that self-reported cigar smoke inhalation would be a reliable predictor of observable smoke particle deposition in the lung. METHODS: Twenty-four male cigar smokers were recruited to participate in the study. Twelve of the participants were current or past regular cigarette smokers, and the remaining 12 participants had no history of cigarette smoking. The volunteers completed an anonymous questionnaire commenting on the frequency of their current cigarette and cigar use as well as the degree to which they inhale when they smoke cigars. Volunteers smoked a cigar through a holder that permitted cigar smoke to mix with a radioaerosol of (99m)Tc-labeled sulfur colloid particles. The total radioactivity administered to each volunteer was 100 MBq. Lung ventilation scanning was subsequently performed. RESULTS: Total lung counts showed that volunteers inhaled the cigar smoke to varying degrees, although 100% of nonsmokers and 58% of smokers in the study reported that they never or rarely inhaled when they smoked cigars. With respect to total lung counts, smokers as a group inhaled less than their nonsmoking counterparts; however, this difference reflected a trend in the data and did not reach statistical significance. CONCLUSION: Contrary to the widely held belief that cigar smokers do not inhale when they smoke cigars, we concluded that cigar smoke is inhaled regardless of self-reported inhalation and smoking history.