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Presented by Dora Lam-Himlin, M.D. and prepared by Hillary Ross, M.D.
Case 4: A 46 year-old woman with a history of vaginal cancer.
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1. Question
Week 434: Case 4
A 46 year-old woman with a history of vaginal cancer and extensive peritoneal involvement by metastatic disease presented with diarrhea. Colon biopsies are shown below.images/1alex/05032010case4image1.jpg
images/1alex/05032010case4image2.jpgCorrect
Answer: Ring mitoses, consistent with paclitaxel (Taxol) effect
Histology: The colonic biopsy shows an abnormality in the epithelial cells at the base of the crypts. There is maturation of the surface epithelial cells, but the cells in the proliferative compartment of the crypts show numerous ring mitoses. In addition, there are markedly increased apoptotic bodies.
Discussion: Ring mitoses can be seen as a result of both colchicine and paclitaxel (Taxol) use. In the setting of colchicine, the presence of ring mitoses is an indicator of toxicity. However, in the setting of Taxol, the ring mitoses are seen in therapeutic doses and are not an indicator of drug toxicity.
Taxol chemotherapy has been associated with dramatic gastrointestinal mucosal changes, accompanied by an increase in apoptosis. Taxol binds to microtubules, thus promoting polymerization and inhibiting depolymerization. This central core of polymerized microtubules surrounded by dispersed chromatin results in a ‘‘ring’’ structure during metaphase. The mitotic arrest peaks at 3 to 12 hours after Taxol administration, and is followed by an increase in apoptosis 6 to 36 hours later.
The patient from this case was being treated with Taxol for her peritoneal carcinomatosis. She had received an infusion of Taxol the day prior to her colonoscopy with biopsy.
Reference(s):
– Daniels, J.A., et al., Gastrointestinal tract epithelial changes associated with taxanes: marker of drug toxicity versus effect. Am J Surg Pathol. 2008 Mar;32(3):473-7.Incorrect
Answer: Ring mitoses, consistent with paclitaxel (Taxol) effect
Histology: The colonic biopsy shows an abnormality in the epithelial cells at the base of the crypts. There is maturation of the surface epithelial cells, but the cells in the proliferative compartment of the crypts show numerous ring mitoses. In addition, there are markedly increased apoptotic bodies.
Discussion: Ring mitoses can be seen as a result of both colchicine and paclitaxel (Taxol) use. In the setting of colchicine, the presence of ring mitoses is an indicator of toxicity. However, in the setting of Taxol, the ring mitoses are seen in therapeutic doses and are not an indicator of drug toxicity.
Taxol chemotherapy has been associated with dramatic gastrointestinal mucosal changes, accompanied by an increase in apoptosis. Taxol binds to microtubules, thus promoting polymerization and inhibiting depolymerization. This central core of polymerized microtubules surrounded by dispersed chromatin results in a ‘‘ring’’ structure during metaphase. The mitotic arrest peaks at 3 to 12 hours after Taxol administration, and is followed by an increase in apoptosis 6 to 36 hours later.
The patient from this case was being treated with Taxol for her peritoneal carcinomatosis. She had received an infusion of Taxol the day prior to her colonoscopy with biopsy.
Reference(s):
– Daniels, J.A., et al., Gastrointestinal tract epithelial changes associated with taxanes: marker of drug toxicity versus effect. Am J Surg Pathol. 2008 Mar;32(3):473-7.
