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Case Reports
. 2016 Apr:50:11-4.
doi: 10.1016/j.humpath.2015.10.016. Epub 2015 Nov 11.

Microvascular injury in persistent gastric ulcers after yttrium-90 microsphere radioembolization for liver malignancies

Belinda Sun  1 , Shawn R Lapetino  2 , Sameer A L Diffalha  3 , Sherri Yong  4 , Ron C Gaba  5 , James T Bui  5 , Sean Koppe  6 , Steven Garzon  1 , Grace Guzman  7
Affiliations
Case Reports

Microvascular injury in persistent gastric ulcers after yttrium-90 microsphere radioembolization for liver malignancies

Belinda Sun et al. Hum Pathol. 2016 Apr.

Abstract

Yttrium-90 microsphere radioembolization ((90)Y MRE) is a therapy for liver malignancies by permanently implanting (90)Y-containing microspheres into tumors via hepatic artery. The etiology of persistent gastric ulcerations in patients presenting months after treatment remains unclear. Three patients who presented with gastric ulceration 4 to 13 months after (90)Y MRE were examined by esophagogastroduodenoscopy and biopsies. Pathological examinations showed multiple (90)Y microspheres scattered within the lamina propria and submucosa. Most of the microspheres were distributed in a linear fashion, consistent with an intravascular location; however, the vascular lumen and endothelial cells were not present. The microspheres were surrounded by fibrotic tissue infiltrated by chronic inflammatory cells and rare neutrophils. Epithelial granulation without pititis and miniaturized glands with intervening fibrosis were noted, compatible with chronic ischemic changes. These findings suggest that the persistent gastric ulceration is a result of localized ischemic injury in response to (90)Y MRE-induced vascular damage.

Keywords: Chronic ischemia; Gastritis; Persistent gastric ulceration; Vascular injury; Yttrium-90 ((90)Y) microsphere radioembolization.

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