26. PERSISTENT MICROSPHERE-INDUCED GASTRIC ULCERATION AFTER SELECTIVE INTERNAL RADIATION THERAPY: A CASE REPORT. (February 2015)

• Record Type: Journal Article
• Authors: Kasem, Kais; Ma, Li; Lam, Alfred; Weinstein, Stephen
• Is Part Of: Pathology. Volume 47(2015)Supplement 1
• Publication Date: 2015-02
• Subjects: Pathology -- Periodicals; 616.0705
• DOI: 10.1097/01.PAT.0000461635.35535.c8
• Languages: English
• ISSNs: 0031-3025

Abstract

Abstract : Radioactive microsphere-based selective internal radiation therapy has emerged as an effective therapeutic modality for treatment of primary and secondary malignant liver tumours. However, a number of treatment-related complications have been described. This report describes a case of persistent pre-pyloric gastric ulceration in a 65 year old man with a history of recent selective internal radiation therapy for metastatic appendiceal adenocarcinoma to the liver. The patient was presented with epigastric abdominal pain after the radiation therapy. Two endoscopic examinations over the course of 4 months revealed a persistent gastric ulcer of maximum dimension of 30 mm in the pre-pyloric region. In both examinations, biopsies from the area showed reactive changes, inflammation and ulceration of surface epithelium. In addition, multiple symmetrical, uniform, round, purple, PAS positive spherules within the gastric mucosa and the lamina propria are identified. Their identical regular appearance suggested foreign material, which when correlated with the clinical history confirmed their nature as radio-microsphere used to treat hepatic malignancy. Previous cases of persistent microsphere-induced gastrointestinal ulceration have been described with potential life-threatening outcomes. Hence, both gastroenterologists and pathologists must be aware of this important complication, given its characteristic endoscopic and pathognomonic microscopic features.