IPLab:Lab 12:Radiation Fibrosis: Difference between revisions - Pathology Education Instructional Resource

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== Clinical Summary ==

This 56-year-old female was diagnosed with breast cancer and underwent a lumpectomy followed by radiation therapy. After 5 years without problems, the patient developed decreased exercise tolerance, dyspnea on exertion, shortness of breath, and an unintentional 15 pound weight loss. Recurrence of the breast cancer was identified but the patient opted for palliative therapy and subsequently expired at home.

This 60-year-old white female had developed retraction of her left nipple six years earlier, at which time breast carcinoma was found. A radical mastectomy was performed. Examination of the surgical specimens showed metastases in regional lymph nodes and local irradiation was thus administered. Two years later, carcinoma of the right breast was found. Following a modified mastectomy, more irradiation was given. A year later the patient developed recurrences for which chemotherapy (cytoxan and adriamycin) was given. After a two year period without problems, the patient developed decreased exercise tolerance, dyspnea on exertion, shortness of breath, paroxysmal nocturnal dyspnea, and orthopnea increasing in severity over 10 days. Chest examination revealed decreased breath sounds with dullness over the left base. Chest x-ray showed a globose cardiac silhouette and left pleural effusion. A pericardiectomy was done because of suspected cardiac tamponade; however, the patient died soon after the operation.

At autopsy there was metastatic carcinoma in the pericardium, chest wall, diaphragm, both lungs, and mediastinal lymph nodes. Areas of pleural thickening with adhesions and interstitial fibrosis were found involving the anterior aspect of both lungs.

~~== Autopsy Findings ==~~

~~There~~ was metastatic carcinoma in the pericardium, chest wall, diaphragm, both lungs, and mediastinal lymph nodes~~. Severe nonobstructive cardiomyopathy, probably secondary to adriamycin, was found~~. Areas of pleural thickening with adhesions and interstitial fibrosis were found involving the anterior aspect of both lungs.

== Images ==

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File:IPLab12RadiationFibrosis13.jpg|This is a high-power photomicrograph of a recanalized blood vessel in the lung. Notice the anthracotic pigment adjacent to the vessel (arrows).

</gallery>

== Virtual Microscopy ==

<peir-vm>IPLab12RadiationFibrosis</peir-vm>

== Study Questions ==

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Subtle genetic injuries, such as DNA strand breaks, are responsible for translocations and deletions. These changes lead to the mutagenic, teratogenic, and carcinogenic potentials of ionizing radiation that become evident many years after the radiation exposure. During this long time interval, sequential mitotic divisions are occurring that will ultimately lead to these untoward consequences. This phenomenon is known as radiation "latency."</spoiler>

== Additional Resources ==

=== Reference ===

* [http://emedicine.medscape.com/article/301337-overview eMedicine Medical Library: Interstitial (Nonidiopathic) Pulmonary Fibrosis]

* [http://www.merckmanuals.com/professional/injuries_poisoning/radiation_exposure_and_contamination/radiation_exposure_and_contamination.html Merck Manual: Radiation Exposure and Contamination]

=== Journal Articles ===

* White P. [http://www.ncbi.nlm.nih.gov/pubmed/11525052 Evaluation of pulmonary infiltrates in critically ill patients with cancer and marrow transplant]. ''Crit Care Clin'' 2001 Jul;17(3):647-70.

=== Images ===

* [{{SERVER}}/library/index.php?/tags/2170-radiation_fibrosis PEIR Digital Library: Radiation Fibrosis Images]

* [http://library.med.utah.edu/WebPath/LUNGHTML/LUNGIDX.html#10 WebPath: Interstitial Lung Diseases]

[[Category: IPLab:Lab 12]]

@@ Line 1: / Line 1: @@
 == Clinical Summary ==
+This 56-year-old female was diagnosed with breast cancer and underwent a lumpectomy followed by radiation therapy.  After 5 years without problems, the patient developed decreased exercise tolerance, dyspnea on exertion, shortness of breath, and an unintentional 15 pound weight loss.  Recurrence of the breast cancer was identified but the patient opted for palliative therapy and subsequently expired at home.
-This 60-year-old white female had developed retraction of her left nipple six years earlier, at which time breast carcinoma was found. A radical mastectomy was performed. Examination of the surgical specimens showed metastases in regional lymph nodes and local irradiation was thus administered. Two years later, carcinoma of the right breast was found. Following a modified mastectomy, more irradiation was given. A year later the patient developed recurrences for which chemotherapy (cytoxan and adriamycin) was given. After a two year period without problems, the patient developed decreased exercise tolerance, dyspnea on exertion, shortness of breath, paroxysmal nocturnal dyspnea, and orthopnea increasing in severity over 10 days. Chest examination revealed decreased breath sounds with dullness over the left base. Chest x-ray showed a globose cardiac silhouette and left pleural effusion. A pericardiectomy was done because of suspected cardiac tamponade; however, the patient died soon after the operation.
+At autopsy there was metastatic carcinoma in the pericardium, chest wall, diaphragm, both lungs, and mediastinal lymph nodes. Areas of pleural thickening with adhesions and interstitial fibrosis were found involving the anterior aspect of both lungs.
-== Autopsy Findings ==
-There was metastatic carcinoma in the pericardium, chest wall, diaphragm, both lungs, and mediastinal lymph nodes. Severe nonobstructive cardiomyopathy, probably secondary to adriamycin, was found. Areas of pleural thickening with adhesions and interstitial fibrosis were found involving the anterior aspect of both lungs.
 == Images ==
@@ Line 23: / Line 20: @@
 File:IPLab12RadiationFibrosis13.jpg|This is a high-power photomicrograph of a recanalized blood vessel in the lung. Notice the anthracotic pigment adjacent to the vessel (arrows).
 </gallery>
+== Virtual Microscopy ==
+<peir-vm>IPLab12RadiationFibrosis</peir-vm>
 == Study Questions ==
@@ Line 35: / Line 35: @@
 Subtle genetic injuries, such as DNA strand breaks, are responsible for translocations and deletions. These changes lead to the mutagenic, teratogenic, and carcinogenic potentials of ionizing radiation that become evident many years after the radiation exposure. During this long time interval, sequential mitotic divisions are occurring that will ultimately lead to these untoward consequences. This phenomenon is known as radiation "latency."</spoiler>
+== Additional Resources ==
+=== Reference ===
+* [http://emedicine.medscape.com/article/301337-overview eMedicine Medical Library: Interstitial (Nonidiopathic) Pulmonary Fibrosis]
+* [http://www.merckmanuals.com/professional/injuries_poisoning/radiation_exposure_and_contamination/radiation_exposure_and_contamination.html Merck Manual: Radiation Exposure and Contamination]
+=== Journal Articles ===
+* White P.  [http://www.ncbi.nlm.nih.gov/pubmed/11525052 Evaluation of pulmonary infiltrates in critically ill patients with cancer and marrow transplant].  ''Crit Care Clin'' 2001 Jul;17(3):647-70.
+=== Images ===
+* [{{SERVER}}/library/index.php?/tags/2170-radiation_fibrosis PEIR Digital Library: Radiation Fibrosis Images]
+* [http://library.med.utah.edu/WebPath/LUNGHTML/LUNGIDX.html#10 WebPath: Interstitial Lung Diseases]
 {{IPLab 12}}
 [[Category: IPLab:Lab 12]]