Difference between revisions of "Radiation changes"

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{{ Infobox diagnosis
{{ Infobox diagnosis
| Name      = {{PAGENAME}}
| Name      = {{PAGENAME}}
| Image      = Radiation changes -- high mag.jpg
| Image      = Radiation changes -- high mag.jpg  
| Width      =
| Width      =
| Caption    = Radiation changes. [[H&E stain]].
| Caption    = Radiation changes. [[H&E stain]].  
| Micro      = cytoplasmic vacuolation (usually abundant), enlarged nuclei - but usu. normal [[NC ratio]], no nuclear membrane irregularies, chromatin "smudgy", +/-multinucleation, +/-fibrosis (chronic change), +/-edema (acute change)
| Micro      = cytoplasmic vacuolation (usually abundant), enlarged nuclei - but usu. normal [[NC ratio]], no nuclear membrane irregularies, chromatin "smudgy", +/-multinucleation, +/-fibrosis (chronic change), +/-edema (acute change)
| Subtypes  =
| Subtypes  =
| LMDDx      = [[pleomorphic tumours]] - esp. [[sarcoma]]s, poorly differentiated carcinomas, drug/toxin effect, well-differentiated tumours in the background of radiation changes
| LMDDx      = [[pleomorphic tumours]] - esp. [[sarcoma]]s, poorly differentiated carcinomas, drug/toxin effect, well-differentiated tumours in the background of radiation changes, "[[giant cell cystitis]]"
| Stains    =
| Stains    =
| IHC        = Ki-67 low, pankeratin -ve (usu.)
| IHC        = Ki-67 low, pankeratin -ve (usu.)
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*Well-differentiated carcinoma, e.g. [[postradiation prostatic carcinoma]], may go unnoticed in the background of radiation-associated nuclear changes.
*Well-differentiated carcinoma, e.g. [[postradiation prostatic carcinoma]], may go unnoticed in the background of radiation-associated nuclear changes.
*Atypia associated with [[drug toxicity|drugs]].
*Atypia associated with [[drug toxicity|drugs]].
*"[[Giant cell cystitis]]" - benign mesenchymal atypia with or without inflammation.


===Images===
===Images===
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Image: Prostate with radiation changes -- intermed mag.jpg | Prostate with RC - intermed. mag.
Image: Prostate with radiation changes -- intermed mag.jpg | Prostate with RC - intermed. mag.
Image: Prostate with radiation changes -- high mag.jpg | Prostate with RC - high mag.
Image: Prostate with radiation changes -- high mag.jpg | Prostate with RC - high mag.
</gallery>
====Brain====
<gallery>
File:Glioblastoma-radiation changes HE.jpg | [[Glioblastoma]] with RC (WC/jensflorian)
File:Pathology Brain Radiation Necrosis 1.jpg | Radiation necrosis (WC/Tdvorak)
File:Pathology Brain Radiation Necrosis 2.jpg | Radiation necrosis and gliosis (WC/Tdvorak)
</gallery>
</gallery>


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==See also==
==See also==
*[[Radiation colitis]].
*[[Radiation colitis]].
*[[Radiation esophagitis]].
*[[Radiation changes in cervical cytology]].
*[[Radiation changes in cervical cytology]].
*[[Radiation changes of the endocervical epithelium]].
*[[Radiation changes of the endocervical epithelium]].

Latest revision as of 21:36, 2 November 2016

Radiation changes
Diagnosis in short

Radiation changes. H&E stain.
LM cytoplasmic vacuolation (usually abundant), enlarged nuclei - but usu. normal NC ratio, no nuclear membrane irregularies, chromatin "smudgy", +/-multinucleation, +/-fibrosis (chronic change), +/-edema (acute change)
LM DDx pleomorphic tumours - esp. sarcomas, poorly differentiated carcinomas, drug/toxin effect, well-differentiated tumours in the background of radiation changes, "giant cell cystitis"
IHC Ki-67 low, pankeratin -ve (usu.)
Site pretty much anywhere
Clinical history history of radiation treatment/exposure - important for the diagnosis
Prognosis benign
Clin. DDx cancer recurrence, infection, new malignancy, post-surgical changes

Radiation changes, also radiation effects, are seen occasionally by pathologists. They are usually a result of prior (radiation) treatments. The history is important in making this diagnosis.

General

  • History of radiation treatment/exposure.
  • Clinical symptoms dependent on site.

Gross

  • +/-Erythema (early)
  • +/-Fibrotic appearing tissue (late).

Microscopic

Features:[1]

  • Cytoplasmic vacuolation - usually abundant.
  • Nucleus:
    • Enlarged nucleus - but normal NC ratio.
    • No nuclear membrane irregularies.
    • Chromatin: "smudgy".
    • +/-Multinucleation.
  • +/-Fibrosis (chronic change).
  • +/-Edema (acute change).

Important note:

  • The atypical cells are stromal cells; these survive the radiation. The epithelium is usually normal in the context of chronic changes.
  • Pleomorphism is often suggestive of malignancy. Paradoxically, in the context of radiation, less pleomorphic (clonal-appearing) cells may be malignant!

DDx:

Images

Rectum

  • Radiation proctitis - low mag. (WC)

  • Radiation proctitis - intermed. mag. (WC)

  • Radiation proctitis - high mag. (WC)

  • Radiation proctitis - very high mag. (WC)

  • Radiation proctitis - intermed. mag. (WC)

  • Radiation proctitis - high mag. (WC)

  • Radiation proctitis - high mag. (WC)

Prostate gland

  • Prostate with RC - low mag.

  • Prostate with RC - intermed. mag.

  • Prostate with RC - high mag.

Brain

  • Glioblastoma with RC (WC/jensflorian)

  • Radiation necrosis (WC/Tdvorak)

  • Radiation necrosis and gliosis (WC/Tdvorak)

IHC

  • Pankeratin -ve.
  • KI-67 low.

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RECTUM, BIOPSY:
- SQUAMOUS MUCOSA WITH MARKED ACUTE INFLAMMATION AND REACTIVE CHANGES.
- GRANULATION TISSUE.
- LARGE ATYPICAL STROMAL CELLS AND FIBROSIS, COMPATIBLE WITH THE HISTORY
  OF RADIATION TREATMENT.
- NEGATIVE FOR DYSPLASIA AND NEGATIVE FOR MALIGNANCY.

URINARY BLADDER, TRIGONE, BIOPSY:
- INFLAMED UROTHELIAL MUCOSA WITH SQUAMOUS METAPLASIA, ULCERATION AND 
  GRANULATION TISSUE FORMATION.
- RADIATION CHANGES (STROMA).
- NEGATIVE FOR DYSPLASIA AND NEGATIVE FOR MALIGNANCY.

Urinary bladder, biopsy:
- Urothelial mucosa with evidence of ulceration (fibrin, 
  necroinflammatory debris), mild stromal atypia and chronic 
  inflammation, compatible with radiation cystitis
- Negative for dysplasia 
- Negative for malignancy

Micro

Scattered rare large atypical cells with a preserved nucleus-to-cytoplasm ratio are present. Fibrosis is present.

See also

References

  1. ↑ Gupta, S.; Mukherjee, K.; Gupta, YN.; Kumar, M. (Aug 1987). "Sequential radiation changes in cytology of vaginal smears in carcinoma of cervix uteri during radiotherapy.". Int J Gynaecol Obstet 25 (4): 303-8. PMID 2887465.
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