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Microvascular injury in persistent gastric ulcers after yttrium-90 microsphere radioembolization for liver
Belinda Sun1, Shawn R Lapetino2, Sameer A L Diffalha3
1Department of Pathology, University of Illinois Hospital & Health Sciences System, Chicago, IL 60612.
Abstract:
Yttrium-90 microsphere radioembolization ((90)Y MRE) is a therapy for liver malignancies by permanently implanting (90)Y-containing microspheres into tumors via hepatic artery. The etiology of persistent gastric ulcerations in patients presenting months after treatment remains unclear. Three patients who presented with gastric ulceration 4 to 13 months after (90)Y MRE were examined by esophagogastroduodenoscopy and biopsies. Pathological examinations showed multiple (90)Y microspheres scattered within the lamina propria and submucosa. Most of the microspheres were distributed in a linear fashion, consistent with an intravascular location; however, the vascular lumen and endothelial cells were not present. The microspheres were surrounded by fibrotic tissue infiltrated by chronic inflammatory cells and rare neutrophils. Epithelial granulation without pititis and miniaturized glands with intervening fibrosis were noted, compatible with chronic ischemic changes. These findings suggest that the persistent gastric ulceration is a result of localized ischemic injury in response to (90)Y MRE-induced vascular damage.
Insights
Persistent gastric ulcerations after Yttrium-90 microsphere radioembolization ((90)Y MRE) may result from localized ischemic injury. Examination revealed (90)Y microspheres in gastric tissue, suggesting vascular damage caused the ulcerations.
Area of Science:
- Interventional Radiology
- Gastroenterology
- Oncology
Background:
- Yttrium-90 microsphere radioembolization ((90)Y MRE) is a treatment for liver tumors.
- The cause of persistent gastric ulcers after (90)Y MRE is not well understood.
Observation:
- Three patients developed gastric ulcers 4-13 months post-(90)Y MRE.
- Esophagogastroduodenoscopy and biopsies were performed.
- Pathology revealed (90)Y microspheres in the gastric lamina propria and submucosa.
Findings:
- Microspheres were primarily intravascular but lacked vascular structures.
- Surrounding tissue showed fibrosis, chronic inflammation, and ischemic changes.
- Findings suggest localized ischemic injury due to (90)Y MRE-induced vascular damage.
Implications:
- This study clarifies a potential complication of (90)Y MRE.
- Understanding the mechanism of gastric ulceration can inform patient management.
- Further research may explore preventative strategies for gastrointestinal complications.
