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Contribution to the pathogenesis of radiation-induced injury to large arteries

Published online by Cambridge University Press:  29 June 2007

Nina Zidar ,
Dušan Ferluga ,
Asta Hvala ,
Mara Popovć  and
Erika Šoba
Nina Zidar*
Affiliation:
Institute of Pathology, Medical Faculty, Korytkova 2, 1105 Ljubljana, Slovenia.
Dušan Ferluga
Affiliation:
Institute of Pathology, Medical Faculty, Korytkova 2, 1105 Ljubljana, Slovenia.
Asta Hvala
Affiliation:
Institute of Pathology, Medical Faculty, Korytkova 2, 1105 Ljubljana, Slovenia.
Mara Popovć
Affiliation:
Institute of Pathology, Medical Faculty, Korytkova 2, 1105 Ljubljana, Slovenia.
Erika Šoba
Affiliation:
Institute of Oncology, Zaloška cesta 2, 1105 Ljubljana, Slovenia.
*
Address for correspondence: Nina Zidar, M.D., Institute of Pathology, Medical Faculty, Korytkova 2, 1105 Ljubljana, Slovenia. Fax: +386 61 301 816
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Abstract

We report a case of a 35-year-old man who died of a brain infarct 20 months after radiotherapy for carcinoma of the tonsil with metastases to the cervical lymph nodes. Histology revealed mild atherosclerosis, necrotizing vasculitis, and occlusive thrombosis of the internal carotid artery. Significant changes were observed in the vasa vasorum: swelling and detachment of the endothelium, subendothelial oedema, hyaline change, fibrinoid necrosis of the vessel walls with mononuclear cellular infiltration, accompanied by focal haemorrhages and chronic inflammation in the periadventitial soft tissue. We believe that these changes of the vasa vasorum and necrotizing vasculitis are causally related and that vasculitis represents focal ischaemic necroses with inflammatory reaction. Our findings support the hypothesis, based on experimental studies, that injury to the vasa vasorum is an important mechanism in the development of radiation-induced vasculopathy of large arteries. They also suggest an evolution of the injury to the vasa vasorum and periadventitial tissue from the early lesions described in our patient, to late stages resulting in dense periadventitial fibrosis as reported previously. We suggest that injury to the vasa vasorum and the consequent ischaemic lesions of the arterial wall are morphological features distinguishing radiation-induced arterial injury from spontaneous atherosclerosis.

Keywords

Radiation injury, pathogenesisArtery

Information

Type
Pathology in Focus
Information
The Journal of Laryngology & Otology , Volume 111 , Issue 10 , October 1997 , pp. 988 - 990
Copyright
Copyright © JLO (1984) Limited 1997

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