Ewha Med J.  2013 Mar;36(1):58-61. 10.12771/emj.2013.36.1.58.

Angiogenic Inhibitor Induced Complicated Reflux Esophagitis

• Ryu JI
• Jung HK
• Cho MS
• Lee MJ
• Song ME
• Oh DY
• Song HE

• KMID: 2284016
• DOI: http://doi.org/10.12771/emj.2013.36.1.58

Abstract

Sunitinib an inhibitor of the vascular endothelial growth factor receptor, is highly effective against renal cell carcinoma and is now widely used in patients with metastatic disease. Gastroesophageal reflux disease (GERD) is rarely reported as a side effect of sunitinib. We report two cases of GERD with upper gastrointestinal bleeding related to sunitinib administration. Both cases responded well to conservative management. Microscopic findings in both cases showed cellular atypia such as hyperchromasia, increases in nuclear size, and multinucleation. The cellular atypia of the squamous mucosa appears to be associated with reparative processes.

Keyword

Angiogenesis inhibitor; Gastroesophageal reflux; Metastatic renal cell carcinoma; Sunitinib

MeSH Terms

Carcinoma, Renal Cell
Esophagitis, Peptic
Gastroesophageal Reflux
Hemorrhage
Humans
Indoles
Mucous Membrane
Pyrroles
Receptors, Vascular Endothelial Growth Factor
Indoles
Pyrroles
Receptors, Vascular Endothelial Growth Factor

Figure

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  Fig. 1 Endoscopic finding. Linear mucosal breaks are noted at the distal esophagus, with some confluence.

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  Fig. 2 Microscopic finding. (A) Mucosa show granulation tissue covered with necroinflammatory exudates due to ulceration (H&E, ×100). (B) The squamous epithelial cells reveal enlarged, hyperchromatic nuclei with a few multinucleations (H&E, ×100).

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  Fig. 3 Endoscopic finding. (A) The shallow, bleeding ulcerations are shown in the underlying salmon-reddish mucosal projection. (B) After spraying with Lugol's solution, the Barrett's mucosa is detected with hiatal hernia.

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  Fig. 4 Microscopic finding. The squamous mucosa adjacent to the ulcer reveals basal cell hyperplasia, increased mitotic figures, and infiltration of inflammatory cells (H&E, ×400).

Reference

1. Chow LQ, Eckhardt SG. Sunitinib: from rational design to clinical efficacy. J Clin Oncol. 2007. 25:884–896.

2. Atkins M, Jones CA, Kirkpatrick P. Sunitinib maleate. Nat Rev Drug Discov. 2006. 5:279–280.

3. Motzer RJ, Hutson TE, Tomczak P, Michaelson MD, Bukowski RM, Rixe O, et al. Sunitinib versus interferon alfa in metastatic renal-cell carcinoma. N Engl J Med. 2007. 356:115–124.

4. Porta C, Paglino C, Imarisio I, Bonomi L. Uncovering. Clin Exp Med. 2007. 7:127–134.

5. Di Lorenzo G, Buonerba C, Biglietto M, Scognamiglio F, Chiurazzi B, Riccardi F, et al. The therapy of kidney cancer with biomolecular drugs. Cancer Treat Rev. 2010. 36:Suppl 3. S16–S20.