Experimental Study of Gross and Histopathological Changes after Extravasation of Adriamycin and Efficacy of Intralesional Injection of Steroid

Yoo, Min Seok; Ahn, Sung Ku; Cho, Eung Ho; Lee, Seung Hun

Abstract

BACKGROUND: Extravasation of chemotherapeutic agents during intravenous infusion may cause extensive inflammatory reaction, ulceration, crust formation, and skin necrosis. But the exact mechanism of cutaneous reactions after extravasation of adriamycin remains unknown.
OBJECTIVE
Our purpose was to evaluate the clinical and histological features in rabbits after injection of adriamycin and a mixed solution of adriamycin and triamcinolone.
METHODS
Three rabbits were divided into three groups and were subcutaneously injected with the following materials on the back:adriamycin, a mixed solution of adriamycin and triamcinolone and 0.9% saline respectively. The injection sites including the skin and subcustaneouskfat were excised and fixed with natural huffered formalin. The biopsied specimens were stained with hematoxylin and eosin.
RESULTS
l. In the adriamycin injected group, there were induration, crust formation and ulceration after three weeks. After seven weeks crust and focal ulceration were found. Histologically, after one day mild epidermal necrosis, dermal inflammatory infiltration, destruction of epidermal appendag es, edema and hemorrhage were seen. After one week collagen necrosis was advanced and granulation tissue formation and calcium deposition were found. After seven weeks granulation tissue formation and calcium d position still remained. 2. In the adriamycin and triamcinolone injected group, focal healing ulceration was seen after three weeks. After seven weeks the ulceration healed and normal gross finding was seen. Histologically, destructior of epidermal appendages and edema were found after one day. After three weeks granulation tissue formation and fatty changes in the dermis were seen. After five weeks normal histologic findings were seen in the epidermis. Collagen necrosis became less prominent and hyalinizationand transepidermal elimination were found. After seven weeks nearly normal histological findings in the epidermis and dermis were seen.
CONCLUSION
We conclude that there was a marked difference in the gross and histological findings between two groups of adriamycin injected and a mixed solution of adriamycin and triamcinolone injected rabbits. Therefore, we suggest triamcinolone can be used as an adjuvant mode in the treatment of lesions where adriamycin is extravasated.