Microvascular injury in persistent gastric ulcers after yttrium-90 microsphere radioembolization for liver malignancies

• Published in: Human pathology 2016-04, Vol.50, p.11-14
• Main Authors: Sun, Belinda, MD, PhD, Lapetino, Shawn R., MD, Diffalha, Sameer A.L., MD, Yong, Sherri, MD, Gaba, Ron C., MD, Bui, James T., MD, Koppe, Sean, MD, Garzon, Steven, MD, Guzman, Grace, MD
• Format: Article
• Language: English
• Subjects: Aged; Biopsy; Capillaries - chemistry; Capillaries - pathology; Capillaries - radiation effects; Chronic Disease; Chronic ischemia; Embolization, Therapeutic - adverse effects; Embolization, Therapeutic - methods; Endoscopy, Digestive System; Female; Fibrosis; Gastric Mucosa - blood supply; Gastric Mucosa - pathology; Gastric Mucosa - radiation effects; Gastritis; Humans; Immunohistochemistry; Ischemia; Ischemia - etiology; Ischemia - pathology; Liver Neoplasms - pathology; Liver Neoplasms - radiotherapy; Male; Microspheres; Middle Aged; Pathogenesis; Pathology; Patients; Persistent gastric ulceration; Platelet Endothelial Cell Adhesion Molecule-1 - analysis; Radiation Injuries - etiology; Radiation Injuries - pathology; Radiopharmaceuticals - administration & dosage; Radiopharmaceuticals - adverse effects; Stomach Ulcer - etiology; Stomach Ulcer - pathology; Time Factors; Treatment Outcome; Tumors; Ulcers; Vascular injury; Veins & arteries; Yttrium Radioisotopes - administration & dosage; Yttrium Radioisotopes - adverse effects; Yttrium-90 (90Y) microsphere radioembolization
• ISSN: 0046-8177; 1532-8392
• DOI: 10.1016/j.humpath.2015.10.016

Summary Yttrium-90 microsphere radioembolization (90 Y MRE) is a therapy for liver malignancies by permanently implanting90 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 after90 Y MRE were examined by esophagogastroduodenoscopy and biopsies. Pathological examinations showed multiple90 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 to90 Y MRE–induced vascular damage.