Difference between revisions of "IPLab:Lab 12:Radiation Changes"

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(Autopsy Findings)
 
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== Clinical Summary ==
 
== Clinical Summary ==
This 46-year-old white female was found to have prolapse of the uterus two years earlier for which a vaginal hysterectomy had been performed. Study of the specimen demonstrated invasive squamous cell carcinoma of the cervix. Subsequently, she underwent a radical parametrectomy, removal of both tubes and ovaries, and partial resection of the bladder. Six months later, a recurrence of the tumor was treated by 6000 rads to the whole pelvis. Subsequently, the patient developed intermittent small bowel obstruction which resulted in the resection of a segment of ileum. She did well following surgery.
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This 46-year-old white female was diagnosed with invasive squamous cell carcinoma of the cervix and subsequently received radiation therapy. Three years later the patient developed several episodes of small bowel obstruction which necessitated resection of a segment of ileum. She did well following surgery.
  
== Autopsy Findings ==
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The surgical specimen consisted of a 13-cm segment of ileum having a luminal circumference of 5 cm. There was a full-thickness tear measuring 2.5 cm in the center of the specimen. On opening the bowel, the mucosa was ulcerated and showed a perforation.
The surgical specimen consisted of a 13-cm segment of ileum having a luminal circumference of 5 cm. There was a full-thickness tear measuring 2.5 cm in the center of the specimen. On opening the bowel, the mucosa was ulcerated and showed a perforation.  
 
  
 
== Images ==
 
== Images ==
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File:IPLab12RadiationChanges8.jpg|This high-power photomicrograph of the wall of the ileum shows more examples of pleomorphic cells caused by radiation injury (arrows).  
 
File:IPLab12RadiationChanges8.jpg|This high-power photomicrograph of the wall of the ileum shows more examples of pleomorphic cells caused by radiation injury (arrows).  
 
</gallery>
 
</gallery>
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== Virtual Microscopy ==
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<peir-vm>IPLab12RadiationChanges</peir-vm>
  
 
== Study Questions ==
 
== Study Questions ==
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* <spoiler text="Why are the small intestine and colon so susceptible to radiation injury?">The gastrointestinal tract is very radiosensitive and is frequently affected in all forms of deep radiation. The intestinal epithelium (crypt cells) are particularly radiosensitive due to their high turnover rate. These cell often show nuclear and cellular pleomorphism, mitotic abnormalities, and cell necrosis. Later, ulcerations may appear, along with vascular and connective tissue changes. The late effects of intestinal injury comprise mucosal and submucosal atrophy and fibrosis, occasionally producing intestinal strictures.</spoiler>
 
* <spoiler text="Why are the small intestine and colon so susceptible to radiation injury?">The gastrointestinal tract is very radiosensitive and is frequently affected in all forms of deep radiation. The intestinal epithelium (crypt cells) are particularly radiosensitive due to their high turnover rate. These cell often show nuclear and cellular pleomorphism, mitotic abnormalities, and cell necrosis. Later, ulcerations may appear, along with vascular and connective tissue changes. The late effects of intestinal injury comprise mucosal and submucosal atrophy and fibrosis, occasionally producing intestinal strictures.</spoiler>
 
* <spoiler text="Are patients who have been treated with radiation more susceptible to formation of new cancers?">Yes, due to the above-mentioned alterations in nuclear and mitotic activity.</spoiler>
 
* <spoiler text="Are patients who have been treated with radiation more susceptible to formation of new cancers?">Yes, due to the above-mentioned alterations in nuclear and mitotic activity.</spoiler>
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== Additional Resources ==
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=== Reference ===
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* [http://emedicine.medscape.com/article/180084-overview eMedicine Medical Library: Intestinal Radiation Injury]
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* [http://emedicine.medscape.com/article/265956-overview eMedicine Medical Library: Radiation Therapy in Gynecology]
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* [http://www.merckmanuals.com/professional/injuries_poisoning/radiation_exposure_and_contamination/radiation_exposure_and_contamination.html Merck Manual: Radiation Exposure and Contamination]
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=== Journal Articles ===
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* Reis ED, Vine AJ, Heimann T.  [http://www.ncbi.nlm.nih.gov/pubmed/12780647 Radiation damage to the rectum and anus: pathophysiology, clinical features and surgical implications].  ''Colorectal Dis'' 2002 Jan;4(1):2-12.
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=== Images ===
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* [{{SERVER}}/library/index.php?/tags/56-radiation PEIR Digital Library: Radiation Images]
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* [http://library.med.utah.edu/WebPath/GIHTML/GIIDX.html#5 WebPath: Small Intestine Images]
  
 
{{IPLab 12}}
 
{{IPLab 12}}
  
 
[[Category: IPLab:Lab 12]]
 
[[Category: IPLab:Lab 12]]

Latest revision as of 21:12, 9 July 2020

Clinical Summary

This 46-year-old white female was diagnosed with invasive squamous cell carcinoma of the cervix and subsequently received radiation therapy. Three years later the patient developed several episodes of small bowel obstruction which necessitated resection of a segment of ileum. She did well following surgery.

The surgical specimen consisted of a 13-cm segment of ileum having a luminal circumference of 5 cm. There was a full-thickness tear measuring 2.5 cm in the center of the specimen. On opening the bowel, the mucosa was ulcerated and showed a perforation.

Images

Virtual Microscopy

Study Questions


Additional Resources

Reference

Journal Articles

Images