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Radiation induced ulceration
Haematoxylin & Eosin (H&E)
63 years
Male patient with non-small cell lung cancer. Treatment consists of radiation and chemotherapy. He now reports dysphagia. Endoscopically, moderate inflammation is seen in the esophagus with the question of post-radiation alterations.
Several fragments of non-keratinizing squamous epithelium showing evidence of ulceration. Formation of granulation tissue is seen. In these areas, stromal and endothelial cells tend to show some atypia. In addition, there is homogenisation of the subepithelial stroma (so called hyalinisation). Note the retained nuclear to cytoplasmic ratio despite nuclear enlargement.
Post-radiation changes can look worrisome and sometimes be difficult to distinguish from residues of malignancy. Changes include atypia of stromal, endothelial and/ or epithelial cells; stromal hyalinisation; or even, as in this case, ulceration. Typically, despite nuclear enlargement, the nuclear to cytoplasmic ratio is retained.
Philippe Brunner, University of Basel
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