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Gastrectomy for the treatment of refractory gastric ulceration after radioembolization with 90Y microspheres.

Yim SY, Kim JD, Jung JY, Kim CH, Seo YS, Yim HJ, Um SH, Ryu HS, Kim YH, Kim CS, Shin E - Clin Mol Hepatol (2014)

Bottom Line: Transcatheter arterial radioembolization (TARE) with Yttrium-90 ((90)Y)-labeled microspheres has an emerging role in treatment of patients with unresectable hepatocellular carcinoma.Although complication of TARE can be minimized by aggressive pre-evaluation angiography and preventive coiling of aberrant vessels, radioembolization-induced gastroduodenal ulcer can be irreversible and can be life-threatening.Treatment of radioembolization-induced gastric ulcer is challenging because there is a few reported cases and no consensus for management.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea.

ABSTRACT
Transcatheter arterial radioembolization (TARE) with Yttrium-90 ((90)Y)-labeled microspheres has an emerging role in treatment of patients with unresectable hepatocellular carcinoma. Although complication of TARE can be minimized by aggressive pre-evaluation angiography and preventive coiling of aberrant vessels, radioembolization-induced gastroduodenal ulcer can be irreversible and can be life-threatening. Treatment of radioembolization-induced gastric ulcer is challenging because there is a few reported cases and no consensus for management. We report a case of severe gastric ulceration with bleeding that eventually required surgery due to aberrant deposition of microspheres after TARE.

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Related in: MedlinePlus

Resected specimen and microscopic observation of the lesion after subtotal gastrectomy. Grossly diffuse ulcerative mucosal surface (arrowheads) is noted (A). Gastric ulceration and scattered microspheres (arrows) are found within whole gastric layers (hematoxylin and eosin [HE] stain; original magnification, ×200; (B) mucosa and submucosa, (C) subserosa). Deposition of microspheres (arrows) is also shown in perigastric lymph node (D) with reactive hyperplasia of lymph node (HE stain; original magnification, ×200).
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Figure 4: Resected specimen and microscopic observation of the lesion after subtotal gastrectomy. Grossly diffuse ulcerative mucosal surface (arrowheads) is noted (A). Gastric ulceration and scattered microspheres (arrows) are found within whole gastric layers (hematoxylin and eosin [HE] stain; original magnification, ×200; (B) mucosa and submucosa, (C) subserosa). Deposition of microspheres (arrows) is also shown in perigastric lymph node (D) with reactive hyperplasia of lymph node (HE stain; original magnification, ×200).

Mentions: Surgical intervention was recommended due to persisting excruciating abdominal pain and refractory endoscopic findings, and finally, subtotal gastrectomy was performed three months after TARE. Gross pathologic specimen revealed diffuse ulceration with multiple scattered microspheres deposited in the whole gastric layers, vessels and perigastric lymph nodes (Fig. 4). The patient's symptom resolved after surgery and he was discharged two weeks later without any complication. The patient remains in good health without HCC recurrence after 30 months of gastrectomy.


Gastrectomy for the treatment of refractory gastric ulceration after radioembolization with 90Y microspheres.

Yim SY, Kim JD, Jung JY, Kim CH, Seo YS, Yim HJ, Um SH, Ryu HS, Kim YH, Kim CS, Shin E - Clin Mol Hepatol (2014)

Resected specimen and microscopic observation of the lesion after subtotal gastrectomy. Grossly diffuse ulcerative mucosal surface (arrowheads) is noted (A). Gastric ulceration and scattered microspheres (arrows) are found within whole gastric layers (hematoxylin and eosin [HE] stain; original magnification, ×200; (B) mucosa and submucosa, (C) subserosa). Deposition of microspheres (arrows) is also shown in perigastric lymph node (D) with reactive hyperplasia of lymph node (HE stain; original magnification, ×200).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4197179&req=5

Figure 4: Resected specimen and microscopic observation of the lesion after subtotal gastrectomy. Grossly diffuse ulcerative mucosal surface (arrowheads) is noted (A). Gastric ulceration and scattered microspheres (arrows) are found within whole gastric layers (hematoxylin and eosin [HE] stain; original magnification, ×200; (B) mucosa and submucosa, (C) subserosa). Deposition of microspheres (arrows) is also shown in perigastric lymph node (D) with reactive hyperplasia of lymph node (HE stain; original magnification, ×200).
Mentions: Surgical intervention was recommended due to persisting excruciating abdominal pain and refractory endoscopic findings, and finally, subtotal gastrectomy was performed three months after TARE. Gross pathologic specimen revealed diffuse ulceration with multiple scattered microspheres deposited in the whole gastric layers, vessels and perigastric lymph nodes (Fig. 4). The patient's symptom resolved after surgery and he was discharged two weeks later without any complication. The patient remains in good health without HCC recurrence after 30 months of gastrectomy.

Bottom Line: Transcatheter arterial radioembolization (TARE) with Yttrium-90 ((90)Y)-labeled microspheres has an emerging role in treatment of patients with unresectable hepatocellular carcinoma.Although complication of TARE can be minimized by aggressive pre-evaluation angiography and preventive coiling of aberrant vessels, radioembolization-induced gastroduodenal ulcer can be irreversible and can be life-threatening.Treatment of radioembolization-induced gastric ulcer is challenging because there is a few reported cases and no consensus for management.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea.

ABSTRACT
Transcatheter arterial radioembolization (TARE) with Yttrium-90 ((90)Y)-labeled microspheres has an emerging role in treatment of patients with unresectable hepatocellular carcinoma. Although complication of TARE can be minimized by aggressive pre-evaluation angiography and preventive coiling of aberrant vessels, radioembolization-induced gastroduodenal ulcer can be irreversible and can be life-threatening. Treatment of radioembolization-induced gastric ulcer is challenging because there is a few reported cases and no consensus for management. We report a case of severe gastric ulceration with bleeding that eventually required surgery due to aberrant deposition of microspheres after TARE.

Show MeSH
Related in: MedlinePlus