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Autopsy report of a late delayed radiation injury after a period of 45 years
Author(s) -
Tanikawa Satoshi,
Kato Yasutaka,
Tanino Mishie,
Terasaka Shunsuke,
Kurokawa Yasuo,
Arai Nobutaka,
Nagashima Kazuo,
Tanaka Shinya
Publication year - 2019
Publication title -
neuropathology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.701
H-Index - 61
eISSN - 1440-1789
pISSN - 0919-6544
DOI - 10.1111/neup.12528
Subject(s) - medicine , autopsy , pathology , pallor , coagulative necrosis , radiation injury , white matter , radiation therapy , radiology , magnetic resonance imaging , surgery
For delayed radiation injury, image analysis has considerably advanced, but neuropathological findings are still required to establish diagnosis. A patient who had received radiation therapy for pineal germinoma at age 14 developed neurological and psychiatric abnormalities after 15 years as a late delayed radiation injury. Autopsy at age 59 revealed diffuse changes in the white matter consisting in order of severity of myelin pallor, demyelination, and necrosis which were characterized by a lack of glial reaction. The cerebral cortex was relatively well preserved. As delayed radiation injuries, hyalinous changes in the vascular wall, angiomatous lesions and, fresh and old petechial hemorrhages were found. Moreover, vascular changes associated with arteriosclerosis were also present. Furthermore, a focal glial nodule was detected which was considered to be a new radiation‐induced neoplasia. These findings suggest that late delayed radiation injury may slowly develop over 30 years and may involve damage to neuroglial stem cell compensation. It is also evident that arteriosclerotic changes and newly induced neoplasia may develop in delayed radiation injury cases.