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'''Radiation changes''', also '''radiation | {{ Infobox diagnosis | ||
| Name = {{PAGENAME}} | |||
| Image = Radiation changes -- high mag.jpg | |||
| Width = | |||
| 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) | |||
| Subtypes = | |||
| 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 = | |||
| IHC = Ki-67 low, pankeratin -ve (usu.) | |||
| EM = | |||
| Molecular = | |||
| IF = | |||
| Gross = | |||
| Grossing = | |||
| Site = pretty much anywhere | |||
| Assdx = | |||
| Syndromes = | |||
| Clinicalhx = history of radiation treatment/exposure - important for the diagnosis | |||
| Signs = | |||
| Symptoms = | |||
| Prevalence = | |||
| Bloodwork = | |||
| Rads = | |||
| Endoscopy = | |||
| Prognosis = benign | |||
| Other = | |||
| ClinDDx = cancer recurrence, infection, new malignancy, post-surgical changes | |||
}} | |||
'''Radiation changes''', also '''radiation effects''', are seen occasionally by [[pathologist]]s. 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== | ==Gross== | ||
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Important note: | 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! | *Pleomorphism is often suggestive of malignancy. Paradoxically, in the context of radiation, less pleomorphic (clonal-appearing) cells may be malignant! | ||
DDx: | DDx: | ||
*[[Pleomorphic tumours]]. | *[[Pleomorphic tumours]]. | ||
*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]]. | |||
*"[[Giant cell cystitis]]" - benign mesenchymal atypia with or without inflammation. | |||
===Images=== | |||
====Rectum==== | |||
<gallery> | |||
Image: Radiation proctitis - alt -- low mag.jpg | [[Radiation proctitis]] - low mag. (WC) | |||
Image: Radiation proctitis -- intermed mag.jpg | Radiation proctitis - intermed. mag. (WC) | |||
Image: Radiation proctitis -- high mag.jpg | Radiation proctitis - high mag. (WC) | |||
Image: Radiation proctitis -- very high mag.jpg | Radiation proctitis - very high mag. (WC) | |||
Image: Radiation proctitis - 2 -- intermed mag.jpg | Radiation proctitis - intermed. mag. (WC) | |||
Image: Radiation proctitis - 2 -- high mag.jpg | Radiation proctitis - high mag. (WC) | |||
Image: Radiation proctitis - 2 alt -- high mag.jpg | Radiation proctitis - high mag. (WC) | |||
</gallery> | |||
====Prostate gland==== | |||
<gallery> | |||
Image: Prostate with radiation changes -- low mag.jpg | Prostate with RC - low 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. | |||
</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> | |||
==IHC== | ==IHC== | ||
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OF RADIATION TREATMENT. | OF RADIATION TREATMENT. | ||
- NEGATIVE FOR DYSPLASIA AND NEGATIVE FOR MALIGNANCY. | - NEGATIVE FOR DYSPLASIA AND NEGATIVE FOR MALIGNANCY. | ||
</pre> | |||
<pre> | |||
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. | |||
</pre> | |||
<pre> | |||
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 | |||
</pre> | </pre> | ||
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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 oncology]]. | *[[Radiation oncology]]. | ||
*[[Endometrium post-ablation]]. | |||
==References== | ==References== |
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