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|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|
|Clin. DDx||cancer recurrence, infection, new malignancy, post-surgical changes|
- History of radiation treatment/exposure.
- Clinical symptoms dependent on site.
- +/-Erythema (early)
- +/-Fibrotic appearing tissue (late).
- Cytoplasmic vacuolation - usually abundant.
- Enlarged nucleus - but normal NC ratio.
- No nuclear membrane irregularies.
- Chromatin: "smudgy".
- +/-Fibrosis (chronic change).
- +/-Edema (acute change).
- 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!
- Pleomorphic tumours.
- Well-differentiated carcinoma, e.g. postradiation prostatic carcinoma, may go unnoticed in the background of radiation-associated nuclear changes.
- Atypia associated with drugs.
- "Giant cell cystitis" - benign mesenchymal atypia with or without inflammation.
Radiation proctitis - low mag. (WC)
Glioblastoma with RC (WC/jensflorian)
- Pankeratin -ve.
- KI-67 low.
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
Scattered rare large atypical cells with a preserved nucleus-to-cytoplasm ratio are present. Fibrosis is present.
- Radiation colitis.
- Radiation esophagitis.
- Radiation changes in cervical cytology.
- Radiation changes of the endocervical epithelium.
- Radiation oncology.
- Endometrium post-ablation.