What happened, in summary

A 51-year-old woman was diagnosed in 2005 with a 1.3 cm high-grade ductal carcinoma in situ in the left breast. She underwent lumpectomy followed by accelerated partial-breast radiation to the surgical cavity and surrounding margin. Radiation delivered 38.5 Gy in 10 fractions over five days. She had only mild localized redness and tenderness during treatment and later completed 3.5 years of tamoxifen.

In 2018, 13 years after radiation, she returned for routine follow-up with swelling and a violaceous-pink ring of redness and visible small vessels around the left areola. The breast felt diffusely firm, especially along the inner side, but she had no nipple discharge or discrete mass.

Because the changes could have represented recurrence, she underwent mammography, ultrasound, breast MRI, and two skin punch biopsies. Imaging found no cancer, and pathology showed mild dermal sclerosis and thickened collagen rather than malignancy. The findings initially appeared compatible with post-radiation morphea, although the breast cleared completely one month later, which was unusual for that condition.

Over seven months, fullness and redness continued to wax and wane and improved somewhat with massage. With repeated cancer evaluation remaining negative, clinicians considered lymphatic swelling and vascular congestion the most likely explanation. The workup showed no evidence of recurrent breast cancer.