title: Microvascular injury in persistent gastric ulcers after yttrium-90 microsphere radioembolization for liver malignancies.
abstract: Yttrium-90 microsphere radioembolization ((90)Y MRE) is a therapy for liver malignancies by permanently implanting (90)Y-containing microspheres into tumors via hepatic artery. The etiology of persistent gastric ulcerations in patients presenting months after treatment remains unclear. Three patients who presented with gastric ulceration 4 to 13 months after (90)Y MRE were examined by esophagogastroduodenoscopy and biopsies. Pathological examinations showed multiple (90)Y microspheres scattered within the lamina propria and submucosa. Most of the microspheres were distributed in a linear fashion, consistent with an intravascular location; however, the vascular lumen and endothelial cells were not present. The microspheres were surrounded by fibrotic tissue infiltrated by chronic inflammatory cells and rare neutrophils. Epithelial granulation without pititis and miniaturized glands with intervening fibrosis were noted, compatible with chronic ischemic changes. These findings suggest that the persistent gastric ulceration is a result of localized ischemic injury in response to (90)Y MRE-induced vascular damage.
authors.affiliation: Department of Pathology, University of Illinois Hospital & Health Sciences System, Chicago, IL 60612.
authors.forename: Belinda
authors.initials: B
authors.lastname: Sun
authors.affiliation: Laboratory/Pathology, Advocate Dreyer Medical Clinic, Aurora, IL 60505.
authors.forename: Shawn R
authors.initials: SR
authors.lastname: Lapetino
authors.affiliation: Department of Pathology, Loyola University Medical Center, Maywood, IL 60153.
authors.forename: Sameer A L
authors.initials: SA
authors.lastname: Diffalha
authors.affiliation: Department of Pathology, University of Illinois College of Medicine at Peoria, IL 60612.
authors.forename: Sherri
authors.initials: S
authors.lastname: Yong
authors.affiliation: Department of Radiology, University of Illinois Hospital & Health Sciences System, Chicago, IL 60612.
authors.forename: Ron C
authors.initials: RC
authors.lastname: Gaba
authors.affiliation: Department of Radiology, University of Illinois Hospital & Health Sciences System, Chicago, IL 60612.
authors.forename: James T
authors.initials: JT
authors.lastname: Bui
authors.affiliation: Department of Medicine, Gastroenterology and Hepatology, University of Illinois Hospital & Health Sciences System, Chicago, IL 60612.
authors.forename: Sean
authors.initials: S
authors.lastname: Koppe
authors.affiliation: Department of Pathology, University of Illinois Hospital & Health Sciences System, Chicago, IL 60612.
authors.forename: Steven
authors.initials: S
authors.lastname: Garzon
authors.affiliation: Department of Pathology, University of Illinois Hospital & Health Sciences System, Chicago, IL 60612. Electronic address: GraceGuz@uic.edu.
authors.forename: Grace
authors.initials: G
authors.lastname: Guzman
mesh_terms: D000368:Aged; D001706:Biopsy; D002196:Capillaries / Q000737:chemistry / Q000473:pathology / Q000528:radiation effects*; D002908:Chronic Disease; D004621:Embolization, Therapeutic / Q000009:adverse effects* / Q000379:methods; D016145:Endoscopy, Digestive System; D005260:Female; D005355:Fibrosis; D005753:Gastric Mucosa / Q000098:blood supply / Q000473:pathology / Q000528:radiation effects*; D006801:Humans; D007150:Immunohistochemistry; D007511:Ischemia / Q000209:etiology* / Q000473:pathology; D008113:Liver Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D008297:Male; D008863:Microspheres; D008875:Middle Aged; D019408:Platelet Endothelial Cell Adhesion Molecule-1 / Q000032:analysis; D011832:Radiation Injuries / Q000209:etiology* / Q000473:pathology; D019275:Radiopharmaceuticals / Q000008:administration & dosage / Q000009:adverse effects*; D013276:Stomach Ulcer / Q000209:etiology* / Q000473:pathology; D013997:Time Factors; D016896:Treatment Outcome; D015021:Yttrium Radioisotopes / Q000008:administration & dosage / Q000009:adverse effects*
chemical_list: D019408:Platelet Endothelial Cell Adhesion Molecule-1; D019275:Radiopharmaceuticals; D015021:Yttrium Radioisotopes
keywords: Chronic ischemia; Gastritis; Persistent gastric ulceration; Vascular injury; Yttrium-90 ((90)Y) microsphere radioembolization