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A Woman with Black Beads in Her Stomach: Severe Gastric Ulceration Caused by
Yttrium-90 Radioembolization
#MMPMID29849654
Voruganti IS
; Godwin JL
; Adrain A
; Feller E
Case Rep Med
2018[]; 2018
(?): 1413724
PMID29849654
show ga
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 ((90)Y) 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 (90)Y microspheres without complications. Upper GI
endoscopy showed diffuse gastritis and extensive antral ulceration. Biopsies
revealed black, spherical foreign bodies, consistent with (90)Y 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 erroneously to
adjuvant chemotherapy or widespread metastatic disease. Clinicians must consider
radiation-associated toxicity in any SIRT-treated patient developing abdominal
symptoms.
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