Difference between revisions of "Radiation colitis"

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'''Radiation colitis''' is inflammation of the [[colon]] due to radiation.
{{ Infobox diagnosis
| Name      = {{PAGENAME}}
| Image      = Radiation_proctitis_-_2_alt_--_high_mag.jpg
| Width      =
| Caption    = Radiation proctitis. [[H&E stain]].
| Synonyms  =
| Micro      = ''acute'': mucosal changes ([[necrosis]] of epithelium, "ghost cells" = cells without nuclei, hemorrhage), submucosa edema with neutrophilic infiltrate, +/-fibrin thrombi; ''chronic'': nuclear atypia - esp. of the stromal cells, fibrosis - esp. of the submucosa
| Subtypes  =
| LMDDx      = [[inflammatory bowel disease]], [[Infectious colitis]], [[ischemic colitis]], pseudosarcomatous stromal changes, [[sarcoma]]
| Stains    =
| IHC        =
| EM        =
| Molecular  =
| IF        =
| Gross      =
| Grossing  =
| Site      = [[colon]] and [[rectum]] (''radiation proctitis'')
| Assdx      =
| Syndromes  =
| Clinicalhx = history of radiation, history of [[cancer]]
| Signs      =
| Symptoms  =
| Prevalence = uncommon
| Bloodwork  =
| Rads      =
| Endoscopy  =
| Prognosis  =
| Other      =
| ClinDDx    = cancer recurrence, colitis/proctitis (idiopathic, infection, ischemic, radiation)
| Tx        =
}}
'''Radiation [[colitis]]''' is inflammation of the [[colon]] due to radiation. It is usually iatrogenic.  This article also covers '''radiation proctitis''' (abbreviated '''RP''').


==General==
*[[Diagnosis]] should be supported by the clinical history.
General DDx for a [[colitis]]:
*Idiopathic, e.g. [[inflammatory bowel disease]].
*[[Infectious colitis|Infection]].
*[[Ischemic colitis|Ischemia]].
*Radiation.
==Gross==
*Superficial bowel wall injury - shallow ulceration.<ref name=pmid9378391/>
*Telangiectatic lesions.
===Image===
*[http://www.nature.com/nrgastro/journal/v5/n1/fig_tab/ncpgasthep1005_F4.html#figure-title Telangiectatic lesions (nature.com)].<ref name=pmid18174905>{{Cite journal  | last1 = Nielsen | first1 = OH. | last2 = Vainer | first2 = B. | last3 = Rask-Madsen | first3 = J. | title = Non-IBD and noninfectious colitis. | journal = Nat Clin Pract Gastroenterol Hepatol | volume = 5 | issue = 1 | pages = 28-39 | month = Jan | year = 2008 | doi = 10.1038/ncpgasthep1005 | PMID = 18174905 }}</ref>
==Microscopic==
==Microscopic==
Features - acute:<ref name=pmid9378391>{{Cite journal  | last1 = Yano | first1 = Y. | last2 = Yao | first2 = H. | last3 = Aoyagi | first3 = K. | last4 = Kawakubo | first4 = K. | last5 = Nakamura | first5 = S. | last6 = Doi | first6 = K. | last7 = Ibayashi | first7 = S. | last8 = Fujishima | first8 = M. | title = Photochemically induced colonic ischaemic lesions: a new model of ischaemic colitis in rats. | journal = Gut | volume = 41 | issue = 3 | pages = 354-7 | month = Sep | year = 1997 | doi =  | PMID = 9378391 }}</ref>
Features - acute:<ref name=pmid9378391>{{Cite journal  | last1 = Yano | first1 = Y. | last2 = Yao | first2 = H. | last3 = Aoyagi | first3 = K. | last4 = Kawakubo | first4 = K. | last5 = Nakamura | first5 = S. | last6 = Doi | first6 = K. | last7 = Ibayashi | first7 = S. | last8 = Fujishima | first8 = M. | title = Photochemically induced colonic ischaemic lesions: a new model of ischaemic colitis in rats. | journal = Gut | volume = 41 | issue = 3 | pages = 354-7 | month = Sep | year = 1997 | doi =  | PMID = 9378391 }}</ref>
Line 10: Line 56:
*+/-Fibrin thrombi.
*+/-Fibrin thrombi.


Image:
Features - chronic:
*Nuclear atypia - esp. of the stromal cells.
**The epithelium is shed and regenerates... therefore usually does not have the changes.
*Fibrosis - esp. of the submucosa.
 
DDx:
*[[Ischemic colitis]].
*[[Inflammatory bowel disease]].
*Infectious colitis.
 
===Images===
<gallery>
Image: Radiation proctitis -- very low mag.jpg | RP - very low mag.
Image: Radiation proctitis -- low mag.jpg | RP - low mag.
Image: Radiation proctitis - alt -- low mag.jpg | RP - low mag.
Image: Radiation proctitis -- intermed mag.jpg | RP - intermed. mag.
Image: Radiation proctitis -- high mag.jpg | RP - high mag.
Image: Radiation proctitis -- very high mag.jpg | RP - very high mag.
Image: Radiation proctitis - 2 -- intermed mag.jpg | RP - intermed. mag.
Image: Radiation proctitis - 2 -- high mag.jpg | RP - high mag.
Image: Radiation proctitis - 2 alt -- high mag.jpg | RP - high mag.
 
Image: Proctitis with reactive changes -- intermed mag.jpg | PRC - intermed. mag.
Image: Proctitis with reactive changes -- high mag.jpg | PRC - high mag.
Image: Proctitis with reactive changes - alt -- high mag.jpg | PRC - high mag.
</gallery>
www:
*[http://gut.bmj.com/content/41/3/354/F2.large.jpg Radiation colitis - rat model (bmj.com)].<ref name=pmid9378391/>
*[http://gut.bmj.com/content/41/3/354/F2.large.jpg Radiation colitis - rat model (bmj.com)].<ref name=pmid9378391/>
*[http://www.nature.com/nrgastro/journal/v5/n1/fig_tab/ncpgasthep1005_F5.html#figure-title Radiation colitis (nature.com)].<ref name=pmid18174905>{{Cite journal  | last1 = Nielsen | first1 = OH. | last2 = Vainer | first2 = B. | last3 = Rask-Madsen | first3 = J. | title = Non-IBD and noninfectious colitis. | journal = Nat Clin Pract Gastroenterol Hepatol | volume = 5 | issue = 1 | pages = 28-39 | month = Jan | year = 2008 | doi = 10.1038/ncpgasthep1005 | PMID = 18174905 }}</ref>
==Sign out==
<pre>
RECTUM, BIOPSY:
- RECTAL MUCOSA WITH ACTIVE INFLAMMATION, ULCERATION AND 
  REGENERATIVE CHANGES.
- LARGE ATYPICAL STROMAL CELLS COMPATIBLE WITH RADIATION CHANGES.
- NO EVIDENCE OF DYSPLASIA AND NO EVIDENCE OF MALIGNANCY.
COMMENT:
The immunostains done (pankeratin, p53, Ki-67) are in keeping
with regeneration and radiation changes.
</pre>


==See also==
==See also==
*[[Inflammatory bowel disease]].
*[[Inflammatory bowel disease]].
*[[Colon]].
*[[Colon]].
*[[Radiation changes]].


==References==
==References==
{{Reflist|1}}
{{Reflist|2}}


[[Category:Gastrointestinal pathology]]
[[Category:Gastrointestinal pathology]]
[[Category:Diagnosis]]
[[Category:Diagnosis]]

Latest revision as of 04:56, 28 December 2014

Radiation colitis
Diagnosis in short

Radiation proctitis. H&E stain.
LM acute: mucosal changes (necrosis of epithelium, "ghost cells" = cells without nuclei, hemorrhage), submucosa edema with neutrophilic infiltrate, +/-fibrin thrombi; chronic: nuclear atypia - esp. of the stromal cells, fibrosis - esp. of the submucosa
LM DDx inflammatory bowel disease, Infectious colitis, ischemic colitis, pseudosarcomatous stromal changes, sarcoma
Site colon and rectum (radiation proctitis)
Clinical history history of radiation, history of cancer
Prevalence uncommon
Clin. DDx cancer recurrence, colitis/proctitis (idiopathic, infection, ischemic, radiation)

Radiation colitis is inflammation of the colon due to radiation. It is usually iatrogenic. This article also covers radiation proctitis (abbreviated RP).

General

  • Diagnosis should be supported by the clinical history.

General DDx for a colitis:

Gross

  • Superficial bowel wall injury - shallow ulceration.[1]
  • Telangiectatic lesions.

Image

Microscopic

Features - acute:[1]

  • Mucosal changes:
    • Necrosis of epithelium.
      • "Ghost cells" = cells without nuclei.
    • Hemorrhage.
  • Submucosa edema with neutrophilic infiltrate.
  • +/-Fibrin thrombi.

Features - chronic:

  • Nuclear atypia - esp. of the stromal cells.
    • The epithelium is shed and regenerates... therefore usually does not have the changes.
  • Fibrosis - esp. of the submucosa.

DDx:

Images

  • RP - very low mag.

  • RP - low mag.

  • RP - low mag.

  • RP - intermed. mag.

  • RP - high mag.

  • RP - very high mag.

  • RP - intermed. mag.

  • RP - high mag.

  • RP - high mag.

  • PRC - intermed. mag.

  • PRC - high mag.

  • PRC - high mag.

www:

Sign out

RECTUM, BIOPSY:
- RECTAL MUCOSA WITH ACTIVE INFLAMMATION, ULCERATION AND  
  REGENERATIVE CHANGES.
- LARGE ATYPICAL STROMAL CELLS COMPATIBLE WITH RADIATION CHANGES.
- NO EVIDENCE OF DYSPLASIA AND NO EVIDENCE OF MALIGNANCY.

COMMENT:
The immunostains done (pankeratin, p53, Ki-67) are in keeping 
with regeneration and radiation changes.

See also

References

  1. ↑ 1.0 1.1 1.2 Yano, Y.; Yao, H.; Aoyagi, K.; Kawakubo, K.; Nakamura, S.; Doi, K.; Ibayashi, S.; Fujishima, M. (Sep 1997). "Photochemically induced colonic ischaemic lesions: a new model of ischaemic colitis in rats.". Gut 41 (3): 354-7. PMID 9378391.
  2. ↑ 2.0 2.1 Nielsen, OH.; Vainer, B.; Rask-Madsen, J. (Jan 2008). "Non-IBD and noninfectious colitis.". Nat Clin Pract Gastroenterol Hepatol 5 (1): 28-39. doi:10.1038/ncpgasthep1005. PMID 18174905.
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