Gastroduodenitis associated with yttrium 90-microsphere selective internal radiation: an iatrogenic complication in need of recognition.
BACKGROUND
Selective internal radiation (SIR) therapy (SIRT) with yttrium 90 microspheres is increasingly used as an alternative therapeutic modality for patients with inoperable liver tumors. During administration of microspheres via the hepatic artery branches, some may on occasion be misdirected and be caught in the capillary bed of the duodenal and/or stomach.


OBJECTIVE
To better characterize the histopathologic features of these complications.


METHODS
We report herein our experience with 3 patients who received SIR and developed gastroduodenal complications.


RESULTS
SIR-microsphere-induced gastroduodenitis was diagnosed from 10 days to 5 months after treatment. In all 3 cases, purple particles measuring about 40 microm in diameter were observed. An array of changes ranging from mucosal ulceration to epithelial changes were seen. Fibrinopurulent exudate was admixed with granulation tissue and reactive stromal cells. Epithelial changes included apoptosis and mucin depletion. Glandular cystic dilatation and epithelial flattening were also common as well as foveolar hyperplasia, suggestive of reparative changes in one case. Capillary ectasia and prominent plump endothelial cells were also present.


CONCLUSIONS
The spectrum of the alterations is consistent with radiotherapy-induced changes. Given the recent approval by the US Food and Drug Administration for the use of SIRT, it is anticipated that more patients will be treated with this modality. Pathologists should become aware of the adverse effects associated with its use.
Ogawa
Fumihiro
F
Gastrointestinal Pathology Service, Department of Pathology, Massachusetts General Hospital, Harvard Medical School, MA 02114-2696, USA.
Mino-Kenudson
Mari
M
Shimizu
Michio
M
Ligato
Saverio
S
Lauwers
Gregory Y
GY
D000328:Adult; D001918:Brachytherapy / Q000009:adverse effects*; D004382:Duodenitis / Q000175:diagnosis / Q000209:etiology*; D005260:Female; D005500:Follow-Up Studies; D005753:Gastric Mucosa / Q000473:pathology / Q000528:radiation effects; D005756:Gastritis / Q000175:diagnosis / Q000209:etiology*; D006801:Humans; D007049:Iatrogenic Disease; D007413:Intestinal Mucosa / Q000473:pathology / Q000528:radiation effects; D008297:Male; D008863:Microspheres; D008875:Middle Aged; D009092:Mucous Membrane / Q000473:pathology / Q000528:radiation effects; D015021:Yttrium Radioisotopes / Q000009:adverse effects*
D015021:Yttrium Radioisotopes