Images in Clinical Medicine
Paclitaxel and Cell Division
N Engl J Med 2001; 344:815March 15, 2001
- Article
Figure 1 A 47-year-old woman had been given a diagnosis of a malignant ovarian tumor in 1995. Initial treatment included a radical hysterectomy and postoperative chemotherapy with cisplatin and radiotherapy of the pelvis. Diffuse peritoneal relapse of the tumor was diagnosed in 1997, and treatment with paclitaxel and carboplatin was begun. Because of diarrhea, upper endoscopy and colonoscopy were performed while the patient was receiving a 24-hour infusion of paclitaxel. The last dose of carboplatin had been given one month earlier, and the next dose was to be given hours after endoscopy. Upper endoscopy showed proximal submucosal hemorrhage of the stomach and patchy duodenal erythema. The colon was unremarkable. Analysis of biopsy specimens of the small bowel and colon demonstrated prominent arrest of cell division in the small bowel (Panel A; hematoxylin and eosin, ×40) and colonic epithelium (Panel B; hematoxylin and eosin, ×100). No evidence of cancer was found.
Microtubules have an important role in the mitotic spindle apparatus, maintaining an equilibrium between a polymer form and a soluble dimer form. Paclitaxel interacts with microtubule polymers and inhibits depolymerization of the microtubule, thus blocking the cell cycle.
Kevin Wu, M.D.
Mayo Clinic, Jacksonville, FL 32216Jonathan A. Leighton, M.D.
Mayo Clinic Scottsdale, Scottsdale, AZ 85259
