CAP TODAY Pathology/Laboratory Medicine/Laboratory Management
Injury patterns and diagnostic pitfalls linked to radiation and radiochemotherapy in the stomach and gastroesophageal junction
Chemoradiation-associated injury may cause marked epithelial and stromal changes in gastric specimens. The authors characterized these histologic features in a retrospective series of cases. Nineteen cases of radiochemotherapy-associated gastropathy were identified, including 16 in-house cases and three from consultation material. Patient charts and H&E-stained slides were reviewed. Most patients were male (79 percent), with a median age of 66 years. All patients had a documented history of radiation, and 15 patients had also received chemotherapy. The median time from treatment to biopsy or resection was 2.3 months. Gross and endoscopic findings included erythematous, hemorrhagic, or ulcerated mucosa. Mucosal eosinophilia was seen in 16 (84 percent) cases, and 10 (53 percent) cases had acute inflammation, including neutrophilic microabscesses. Epithelial changes included increased apoptosis (six cases, 32 percent) and marked epithelial atypia (10 cases, 53 percent), potentially mimicking malignancy in some cases. However, the atypical cells featured voluminous eosinophilic cytoplasm with low nuclear-to-cytoplasmic ratio, a clue to their benign nature. Neuroendocrine cell nests were seen in four (21 percent) cases and were loosely aggregated in one case, potentially mimicking a well-differentiated neuroendocrine tumor or enterochromaffin-like cell hyperplasia in autoimmune gastritis. Eleven (58 percent) cases had vascular changes that included vessel dilation, hobnailed endothelial cells, and fibrin thrombi. Stromal changes were seen in 11 (58 percent) cases and included lamina propria hyalinization, submucosal fibrosis, and myofibroblast atypia. Injury associated with radiochemotherapy is histologically varied and may affect epithelial, stromal, and vascular compartments.
Birkness-Gartman JE, Hutchings DA, Montgomery EA, at al. Injury patterns and potential diagnostic pitfalls associated with radiation and radio-chemotherapy in the stomach and gastroesophageal junction. Hum Pathol. 2023;131:17–25.
Correspondence: Dr. Lysandra Voltaggio at lvoltag1@jhmi.edu