Radiation colitis

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

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:

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RECTUM, BIOPSY:
- RECTAL MUCOSA WITH ACTIVE INFLAMMATION, ULCERATION AND  
  REGENERATIVE CHANGES.
- LARGE ATYPICAL STROMAL CELLS COMPATIBLE WITH RADIATION CHANGES.
- 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.