Injury patterns and potential diagnostic pitfalls associated with radiation and radio-chemotherapy in the stomach and gastroesophageal junction

Chemoradiation-associated injury may cause marked epithelial and stromal changes in gastric specimens. We characterized these histologic features in a retrospective series of cases. Nineteen cases of radiochemotherapy-associated gastropathy were identified, including 16 from our institution and 3 fr...

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Bibliographic Details
Published in:Human pathology 2023-01, Vol.131, p.17-25
Main Authors: Birkness-Gartman, Jacqueline E., Hutchings, Danielle A., Montgomery, Elizabeth A., Voltaggio, Lysandra
Format: Article
Language:English
Subjects:
Aged
Biopsy
Chemotherapy
Endothelial Cells - pathology
Esophagogastric Junction - pathology
Female
Gastritis
Gastritis - pathology
Gastropathy
Humans
Male
Radiation
Retrospective Studies
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Summary:Chemoradiation-associated injury may cause marked epithelial and stromal changes in gastric specimens. We characterized these histologic features in a retrospective series of cases. Nineteen cases of radiochemotherapy-associated gastropathy were identified, including 16 from our institution and 3 from consultation material. Patient charts and hematoxylin and eosin-stained slides were reviewed. Most patients were men (79%) with a median age of 66 years. All patients had a documented history of radiation and 15 patients also received chemotherapy. The median time from treatment to biopsy or resection was 2.3 months. Gross and endoscopic findings included erythematous, hemorrhagic, or ulcerated mucosa. Mucosal eosinophilia was seen in 16 cases (84%) while 10 cases (53%) featured acute inflammation including neutrophilic microabscesses. Epithelial changes included increased apoptosis (6 cases, 32%) and marked epithelial atypia (10 cases, 53%), potentially mimicking malignancy in some cases. However, the atypical cells featured voluminous eosinophilic cytoplasm with low nuclear-to-cytoplasmic ratio, a clue to their benign nature. Neuroendocrine cell nests were seen in 4 cases (21%) and loosely aggregated in 1 case, potentially mimicking a well-differentiated neuroendocrine tumor or enterochromaffin-like (ECL) cell hyperplasia in autoimmune gastritis. Eleven cases (58%) featured vascular changes that included vessel dilation, hobnailed endothelial cells, and fibrin thrombi. Stromal changes were seen in 11 cases (58%) and included lamina propria hyalinization, submucosal fibrosis, and myofibroblast atypia. Injury associated with radiochemotherapy is histologically varied and may affect epithelial, stromal, and vascular compartments. Familiarity with these features is important as a subset of these findings may provoke concern for neoplasia. •Radiochemotherapy-related injury may affect epithelial, stromal, and vascular compartments.•Reactive atypia can mimic malignancy, but shows preserved nuclear-to-cytoplasmic ratio.•Neuroendocrine cell nests can be seen in a subset of cases.
ISSN:0046-8177
1532-8392
DOI:10.1016/j.humpath.2022.12.002