PMC9868898_01
Change in facial lesions before and after radiotherapy. (A), The facial lesions appeared as "crater-like" ulcers before the treatment; (B), By the end of radiotherapy, the facial lesions regressed significantly and formed dry scabs; (C), One year after radiotherapy, the facial lesions basically disappeared; (D), Two years after radiotherapy, the edge of the lesions flattened compared to the first year.
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Physical examination after admission: a "crater"-like ulcer was found on the skin of the right face, with a size of about 3.5 x 3.5 cm, protruding from the body surface, the surface was uneven and hard, and the formation of keratin plugs was seen in the middle of the ulcer, accompanied by ulceration, exudation, crusting, and a clear boundary, accompanied by pain and itching, without any swollen lymph nodes around (Figure 1A). The patient's facial tumor was dry and subsided by the end of radiotherapy (Figure 1B). The facial tumor subsided significantly two years after radiotherapy, and the damaged skin on the face recovered and flattened (Figures 1C, D).
Plain scan of superficial soft tissue on MRI. (A), T1WI showing slightly hyperintensity; (B), T2WI showing slightly hyperintensity; (C), DWI and brain parenchyma were isointense.
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Diagnosis prompt: right facial mass (Figure 2).
Light microscopic findings: atypical hyperplasia of squamous epithelium with suppurative inflammation.
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The pathological findings indicated that the changes were consistent with keratoacanthoma (Figure 3).
The patient's IMRT treatment plan. (A), In order to make each part of the lesion receive uniform irradiation, we used IMRT treatment plan with 6 radiation fields. (B), The red line on the outer layer represents the area to be irradiated, and the gradient color image from blue to red represents the 100% prescription dose range. It can be seen that the two are highly consistent.
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According to the patient's condition, 6 MV X-ray was used for intensity modulated radiotherapy (IMRT) at the beginning of treatment(Figure 4).
Some important time points for the treatment and follow-up of the patient after admission.
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Figure 5 summarizes the important events of this patient according to the timeline.