PMC4531575_01
Small bowel series shows multifocal luminal narrowing with thumb-printing appearance of lesions (empty arrow) in the ileum.
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The small bowel series showed multifocal thumb-printing lesions in the ileum with delayed passage (Figure 1).
Barium enema shows diffuse luminal narrowing with the loss of haustral markings (empty arrow) in the rectum and sigmoid colon.
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On the barium enema, there was diffuse luminal narrowing with the loss of haustral markings in the rectum and sigmoid colon. (Figure 2).
Histological findings showing the delayed change of radiation- induced colitis (colonoscopic biopsy) (A) Low-power magnification shows mucosal fibrosis (black arrows) and thickening of muscularis mucosa with irregular arrangement of muscle fibers (H&E, x100). (B), (C) The mucosa shows increased collagen, atypical fibroblasts (small arrows) and collections of foam cells (arrow heads and inset) of the lamina propria, and atrophic glands with goblet cell depletion (H&E, x400). (D) High-power magnification of the submucosa reveals atypical cellular change of stromal fibroblasts (small arrows), increased and dilated capillaries with atypical endothelial cells, and the edematous stroma containing lymphocytes and eosinophils (H&E, x400).
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The sigmoidoscope findings were diffuse mucosal friability and vascular ectasia, which were gross and microscopic findings compatible with radiation colitis (Figure 3).
(A) 99mTc-human serum albumin scintigraphy shows localized radioactivity in the upper ascending colon on the delay image. (B) 99mTc-human dextran lymphoscintigraphy reveals the decreased uptake in the left ileac lymph nodes with delayed migration and collateral circulations, suggesting lymphatic obstruction.
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CT scan showed liver cysts (size: 2x2 cm and 0.8x0.8 cm) in segments 4 and 6, respectively. Cystoscopic examination showed the mucosal thickening with edema and vascular ectasia, but there was no evidence of tumor recurrence. 99mTc-human serum albumin scintigraphy showed localized radioactivity in upper abdomen (Figure 4A) on the 24hr delay image, which meant there was a small amount of bowel leakage of radiolabeled albumin in the ascending colon. 99mTc-labeled dextran lymphoscintigraphy showed a decreased inguinal uptake in the left ileac lymph nodes with delayed migration and collateral circulations (Figure 4B), suggesting lymphatic obstruction in that area.