GASTRIC-MUCOSAL INJURY AFTER HEPATIC ARTERIAL INFUSION CHEMOTHERAPY WITH FLOXURIDINE - A CLINICAL AND PATHOLOGICAL-STUDY

Background. Hepatic arterial infusion chemotherapy (HAIC) of liver met astases of colon cancer with an implantable pump is associated with li ver and gastrointestinal complications. Methods. The authors retrospec tively studied the clinical features and gastric histopathology of nin e patients who received HAIC and had gastritis develop and in whom bio psy specimens were available. Results. Gastritis was heralded in these patients by epigastric pain and tenderness, nausea, vomiting, weaknes s, and anorexia. In seven patients, 18 gastric ulcers were endoscopica lly detected. Mucosal damage developed despite prophylactic antiulcer therapy and healed only upon cessation of HAIC. These observations sug gest that the predominant drug given, floxuridine, was the responsible toxic agent. Seventeen biopsy specimens were reviewed, and all exhibi ted varied histologic evidence of inflammation, reactive glandular cha nges, and cell necrosis. These mucosal changes were present even in ti ssues obtained from patients without ulcers. In addition, floxuridine- induced glandular atypia was noted in eight biopsy samples from six pa tients. The crowded glands were distorted and lined by large cells tha t included bizarre forms with pleomorphic nuclei. Conclusions. Gastric injury in HAIC appeared analogous to the general features encountered in reactive gastritis resulting from chemical irritants. The glandula r atypia is peculiar to HAIC, and although the changes were morphologi cally alarming, in this clinical situation care should be exercised no t to interpret floxuridine-induced atypia as carcinoma.