title: Gastric mucosal injury after hepatic arterial infusion chemotherapy with floxuridine. A clinical and pathologic study.
abstract: BACKGROUND
  Hepatic arterial infusion chemotherapy (HAIC) of liver metastases of colon cancer with an implantable pump is associated with liver and gastrointestinal complications.
  
  
  METHODS
  The authors retrospectively studied the clinical features and gastric histopathology of nine patients who received HAIC and had gastritis develop and in whom biopsy specimens were available.
  
  
  RESULTS
  Gastritis was heralded in these patients by epigastric pain and tenderness, nausea, vomiting, weakness, and anorexia. In seven patients, 18 gastric ulcers were endoscopically detected. Mucosal damage developed despite prophylactic antiulcer therapy and healed only upon cessation of HAIC. These observations suggest that the predominant drug given, floxuridine, was the responsible toxic agent. Seventeen biopsy specimens were reviewed, and all exhibited varied histologic evidence of inflammation, reactive glandular changes, and cell necrosis. These mucosal changes were present even in tissues obtained from patients without ulcers. In addition, floxuridine-induced glandular atypia was noted in eight biopsy samples from six patients. The crowded glands were distorted and lined by large cells that included bizarre forms with pleomorphic nuclei.
  
  
  CONCLUSIONS
  Gastric injury in HAIC appeared analogous to the general features encountered in reactive gastritis resulting from chemical irritants. The glandular atypia is peculiar to HAIC, and although the changes were morphologically alarming, in this clinical situation care should be exercised not to interpret floxuridine-induced atypia as carcinoma.
authors.affiliation: Department of Pathology, University of Chicago, Illinois.
authors.forename: M I
authors.initials: MI
authors.lastname: Doria
authors.forename: L K
authors.initials: LK
authors.lastname: Doria
authors.forename: J
authors.initials: J
authors.lastname: Faintuch
authors.forename: B
authors.initials: B
authors.lastname: Levin
mesh_terms: D000328:Adult; D000368:Aged; D001706:Biopsy; D003110:Colonic Neoplasms / Q000473:pathology*; D005260:Female; D005467:Floxuridine / Q000008:administration & dosage* / Q000009:adverse effects*; D005753:Gastric Mucosa / Q000187:drug effects* / Q000473:pathology; D005756:Gastritis / Q000139:chemically induced* / Q000473:pathology; D006499:Hepatic Artery; D006801:Humans; D015918:Infusion Pumps, Implantable; D007261:Infusions, Intra-Arterial; D008113:Liver Neoplasms / Q000188:drug therapy* / Q000556:secondary*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012189:Retrospective Studies; D013276:Stomach Ulcer / Q000139:chemically induced* / Q000473:pathology
chemical_list: D005467:Floxuridine