Radiation Induced Exacerbation of Bullous Pemphigoid in Rectal Cancer

Here, we report an unusual case of sarcomatoid carcinoma mimicking extraskeletal osteosarcoma that manifested as recurrent rectal cancer. Five years earlier, a 76-year-old male patient had undergone neoadjuvant chemoradiotherapy followed by a laparoscopic low anterior resection due to adenocarcinoma of the rectum. He was admitted because of pain in the anus and left hip. He underwent abdominal computed tomography that revealed a newly developed left perirectal mass with gluteus maximus invasion measuring up to 8 cm, and therefore, an abdominoperineal resection was performed. Histologically, the tumor revealed sheets of spindled or epithelioid cells, an absence of gland formation, mucicarmine and periodic acid–Schiff stain negativity, and prominent intercellular deposits of osteoid-like calcified tissue. Tumor cells were diffusely immunoreactive for vimentin and cytokeratins. Ultrastructural examination demonstrated microvilli on the surface or within intercellular spaces. In this report, we also discuss the possible pathogenesis as well as the differential diagnosis.

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Recurrent Intestinal Obstruction after Radiation Therapy: A Case Report and Review of the Literature

Case Reports in Surgery ◽

10.1155/2019/5198958 ◽

2019 ◽

Vol 2019 ◽

pp. 1-3

Author(s):

James Nguyen ◽

Amani Jambhekar ◽

Ziyad Nasrawi ◽

Prasad Gudavalli

Keyword(s):

Rectal Cancer ◽

Case Report ◽

Small Bowel ◽

Intestinal Obstruction ◽

Loop Ileostomy ◽

Neoadjuvant Chemoradiation ◽

Ileocolic Anastomosis ◽

Neoadjuvant Radiotherapy ◽

Diverting Loop Ileostomy ◽

Radiation Induced

Introduction. In patients who have undergone resection for rectal cancer after neoadjuvant radiotherapy, loop ileostomy is commonly performed with few serious complications. In rare cases, if this irradiated small bowel is strictured, reversal of the affected ileostomy can have dire consequences. We present a case of a 62-year-old male with recurrent intestinal obstruction after closure of his loop ileostomy. Case Report. RC is a 62-year-old male who initially presented with rectal cancer and underwent neoadjuvant chemoradiation prior to a laparoscopic low anterior resection with diverting loop ileostomy. He underwent elective reversal of his ileostomy and developed persistent postoperative obstruction. He underwent resection of the prior reversal site with normal-appearing dilated proximal bowel loops and collapsed distal bowel loops. He again developed an obstructive picture and underwent resection of the prior anastomosis with creation of an ileocolic anastomosis, after which he recovered well postoperatively. Conclusion. In patients who receive radiation adjuvant therapy for colon cancer, radiation-induced stricture should be considered as a cause of small bowel obstruction postoperative. In the setting of a longstanding ileostomy, evaluation of a defunctionalized distal ileum may be necessary to evaluate potential obstruction from radiation changes.

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Bullous pemphigoid development during the course of breast cancer: a radiation induced or a radiation recall dermatitis?

Journal of Radiotherapy in Practice ◽

10.1017/s1460396920000825 ◽

2020 ◽

pp. 1-3

Author(s):

Mouna Ben Rejeb ◽

Rim Moujahed ◽

Alia Zehani ◽

Lotfi Kochbati

Keyword(s):

Breast Cancer ◽

Bullous Pemphigoid ◽

Radical Mastectomy ◽

Trigger Factor ◽

Radiation Recall ◽

Adjuvant Trastuzumab ◽

Oral Corticosteroids ◽

Radiation Induced ◽

Radiation Recall Dermatitis ◽

Recall Dermatitis

Abstract Background: Bullous pemphigoid (BP) is the most common autoimmune bullous disease, which is usually seen in older ages. Rarely, radiotherapy (RT) has been reported as a localised trigger factor for BP. Case: We present a case of a 64-year-old woman who underwent radical mastectomy and radiation therapy for breast cancer. Two months after the completion of RT with adjuvant Trastuzumab, a BP eruption developed in the irradiated area, spreading thereafter to other skin areas. The patient was treated with oral corticosteroids and the lesions evolved favourably. Conclusion: This case demonstrates a relatively benign skin reaction that could develop during the course of cancer treatment, which required co-management by oncologists, pathologists and dermatologists.

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Radiation-Induced Apoptosis of Peripheral Blood Lymphocytes is Correlated with Histological Regression of Rectal Cancer in Response to Preoperative Chemoradiotherapy

Annals of Surgical Oncology ◽

10.1245/s10434-011-2057-9 ◽

2011 ◽

Vol 19 (4) ◽

pp. 1192-1198 ◽

Cited By ~ 11

Author(s):

Soichiro Ishihara ◽

Hisae Iinuma ◽

Yoshihisa Fukushima ◽

Takuya Akahane ◽

Atsushi Horiuchi ◽

...

Keyword(s):

Rectal Cancer ◽

Peripheral Blood ◽

Preoperative Chemoradiotherapy ◽

Peripheral Blood Lymphocytes ◽

Blood Lymphocytes ◽

Radiation Induced ◽

Induced Apoptosis ◽

Histological Regression

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A case of radiation-induced rectal cancer after an irradiation for cervical cancer.

Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association) ◽

10.3919/jjsa.63.954 ◽

2002 ◽

Vol 63 (4) ◽

pp. 954-957 ◽

Cited By ~ 1

Author(s):

Masakazu IKENAGA ◽

Mitsugu SEKIMOTO ◽

Hirofumi YAMAMOTO ◽

Masataka IKEDA ◽

Yasuhiro MIYAKE ◽

...

Keyword(s):

Cervical Cancer ◽

Rectal Cancer ◽

Radiation Induced

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Faculty Opinions recommendation of Radiation-induced bullous pemphigoid: a systematic review of an unusual radiation side effect.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.1123842.581165 ◽

2008 ◽

Author(s):

Aimee Payne

Keyword(s):

Systematic Review ◽

Bullous Pemphigoid ◽

Side Effect ◽

Radiation Induced

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Changes in circulating lymphocyte counts and tumor-infiltrating lymphocyte subpopulations among patients receiving endorectal brachytherapy for rectal adenocarcinoma.

Journal of Clinical Oncology ◽

10.1200/jco.2014.32.3_suppl.500 ◽

2014 ◽

Vol 32 (3_suppl) ◽

pp. 500-500 ◽

Cited By ~ 2

Author(s):

Susannah G. Ellsworth ◽

Sabrina C. Sopha ◽

Charles G. Drake ◽

Jian Li Campian ◽

Susan Gearhart ◽

...

Keyword(s):

Rectal Cancer ◽

Background Radiation ◽

Radiation Treatment ◽

Rectal Adenocarcinoma ◽

Causal Association ◽

Median Dose ◽

Tumor Infiltrating Lymphocyte ◽

Circulating Lymphocytes ◽

Radiation Induced ◽

A Prospective Study

500 Background: Radiation-induced lymphopenia (RIL) is common in patients with rectal cancer and is associated with worse outcomes in rectal cancer and other solid tumors. We investigated whether endorectal brachytherapy (EB) is associated with milder RIL than external radiation treatment (XRT) in patients with rectal cancer and whether EB is associated with altered tumor-infiltrating lymphocyte (TIL) subpopulations. Methods: Records from 11 patients enrolled in a prospective study of EB for T2-3, N0-1 rectal cancer were reviewed; total lymphocyte counts (TLC) at baseline and 2 months after treatment were recorded. EB was given to tumor alone (6.5Gy x 4). XRT was given to the whole pelvis (median dose 50.4Gy). All patients underwent proctectomy after EB/XRT. TLCs from EB patients were compared to 62 rectal cancer patients receiving pelvic XRT + capecitabine. Proctectomy specimens were immunostained for TIL (CD3, CD4, CD8, FoxP3, and CD25) subtypes. Results: Median baseline TLC in EB patients was 1930 vs 1570 cells/uL in XRT patients (p>0.05). Two months after treatment, median TLC was 1550 in EB patients vs 520 in XRT patients (p<0.01). EB patients had higher absolute numbers of CD3, CD4, CD8, and FoxP3+ TILs (Table). Conclusions: EB spares circulating lymphocytes and is associated with increased TIL expression after therapy. Further investigation is needed to determine if there is a causal association between these phenomena and if the increased TIL expression in EB patients is associated with better outcomes in these patients. [Table: see text]

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