Radiation colitis

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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

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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 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.