IPLab:Lab 12:Radiation Changes
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.
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.
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.
Radiation damage caused fibrosis of the bowel wall and atrophy of the mucosa. This probably led to an area of poor peristalsis and a physiologic obstruction. The fibrosis in the wall can also lead to a physical obstruction (stricture).
Due to the atrophy of the mucosa, the fibrosis, and the poor blood flow to this area (chronic vascular occlusive lesions), this area of bowel would be more susceptible to rupture, as happened in this case.
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.
Yes, due to the above-mentioned alterations in nuclear and mitotic activity.
- eMedicine Medical Library: Intestinal Radiation Injury
- eMedicine Medical Library: Radiation Therapy in Gynecology
- Merck Manual: Radiation Exposure and Contamination
- Reis ED, Vine AJ, Heimann T. Radiation damage to the rectum and anus: pathophysiology, clinical features and surgical implications. Colorectal Dis 2002 Jan;4(1):2-12.
Parametrectomy is the surgical removal of supporting tissues that surround the uterus.