Large solitary rectal ulcer as a complication of prostate brachytherapy

Abstract

View Large Image Figure Viewer Download Hi-res image View Large Image Figure Viewer Download Hi-res image View Large Image Figure Viewer Download Hi-res image A 67-year-old man was admitted with hematochezia 1 day after receiving a dose of leuprolide as an adjuvant agent for T1cN0M0 prostate cancer. Treatment for his prostate cancer began 16 months earlier and consisted of external beam radiation followed by cesium-131 brachytherapy. Eight months later, a colonoscopy was performed for anemia and was remarkable only for diverticulosis; rectal mucosa was normal (A). To determine the site of lower GI bleeding during the most recent admission, flexible sigmoidoscopy was performed and revealed a large (>3 cm), deeply-cratered rectal ulcer (B). Endoscopic biopsy specimens (C, H&E, orig. mag. ×100) showed areas of mucosal necrosis. The underlying connective tissue contained thick-walled vessels (thin arrows) and areas of dense fibrosis. Atypical fibroblasts (arrowheads), characteristic of radiation effect, also were noted. Fragments of viable mucosa (D, H&E, orig. mag. ×400) were notable for mild architectural disarray and fibrosis, and focal small-vessel thrombosis (arrow) was seen. Surgical consultation was obtained, and the decision was made to perform a diverting colostomy for a grade 3 rectal complication of prostate brachytherapy. View Large Image Figure Viewer Download Hi-res image View Large Image Figure Viewer Download Hi-res image