A Woman with Black Beads in Her Stomach: Severe Gastric Ulceration Caused by Yttrium-90 Radioembolization

Case Reports in Medicine
Indu S VorugantiEdward Feller

Abstract

Radioembolization (RE) is a selective internal radiation therapy (SIRT) delivering targeted, high-dose, intra-arterial radiation directly to the vascular supply of liver tumors. Complications can occur due to aberrant deposition or migration of radiation microspheres into nontarget locations, including normal hepatic parenchyma, lungs, pancreas, and upper gastrointestinal (UGI) tract. We report a case of gastric ulcers due to yttrium-90 (90Y) seed migration to the stomach to alert clinicians to this rare cause of gastric injury. A 57-year-old woman with stage IV breast cancer with liver and lung metastases presented to the hospital with 2 months of worsening nausea and vomiting. Two months prior, she had received SIRT with 90Y microspheres without complications. Upper GI endoscopy showed diffuse gastritis and extensive antral ulceration. Biopsies revealed black, spherical foreign bodies, consistent with 90Y microspheres, documenting radiation injury. Radiation-induced UGI ulceration is caused by direct radiation injury from beta-radiation. Delay in diagnosis may be due to the nonspecificity of symptoms and temporal delay of symptom onset from SIRT, which was 2 months in our patient. Also, complaints may be attributed erroneousl...Continue Reading

References

Feb 17, 2005·Journal of Vascular and Interventional Radiology : JVIR·James E GoinKenneth Thurston
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Apr 29, 2015·World Journal of Hepatology·Cristina MosconiRita Golfieri

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Citations

Feb 6, 2019·The American Journal of Surgical Pathology·Christina A ArnoldLysandra Voltaggio
Aug 10, 2019·World Journal of Radiology·Markus ZimmermannPhilipp Bruners
Oct 3, 2021·Virchows Archiv : an International Journal of Pathology·Federica GrilloLuca Mastracci

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Methods Mentioned

BETA
biopsies
biopsy

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