IPLab:Lab 12:Radiation Changes

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.

Autopsy Findings

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

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  This is a low-power photomicrograph of the surgical specimen of the ileum. The normal ileum is to the left (1). The area of stricture consists of dense fibrous connective tissue (2) and there is loss or marked atrophy of the epithelium (3).
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  This is a higher-power photomicrograph of the surgical specimen of the ileum showing the transition from the normal epithelium (1) to the atrophied epithelium (2) in the area of radiation injury.
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  This is a higher-power photomicrograph showing the atrophied epithelium in the area of radiation injury. There are some epithelial cells deep within the mucosa (1). Note the dense fibrous connective tissue (2) within the wall of the ileum.
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  This is a high-power photomicrograph showing the atrophied epithelium in the area of radiation injury (1). Note the dense fibrous connective tissue within the wall of the ileum and the congested blood vessels (2).
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  This is a high-power photomicrograph of the wall of the ileum showing a blood vessel that has suffered radiation-induced damage and is completely occluded (arrows).
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  This high-power photomicrograph of the wall of the ileum shows areas of fibrosis (1), inflammatory cells (2), and abnormal pleomorphic cells (3) in the area of radiation injury. The abnormal morphology of these cells is radiation-induced. These cells are often difficult to distinguish from recurrent tumor cells.
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  This high-power photomicrograph of the wall of the ileum shows more examples of pleomorphic cells (arrows) due to radiation injury.
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  This high-power photomicrograph of the wall of the ileum shows more examples of pleomorphic cells caused by radiation injury (arrows).

Parametrectomy is the surgical removal of supporting tissues that surround the uterus.