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The pathology of multi-organ involvement: two autopsy cases from the Tokai-mura criticality accident

Departments of ¹ Pathology and ² Radiology, Graduate School of Medicine, The University of Tokyo, ³ Tokyo Metropolitan Medical Examiner's Office, ⁴ Ibaraki Research Laboratory of Public Health and ⁵ Kanto Central Hospital, Japan

We briefly report the pathological findings of two victims of the Tokai-mura criticality accident. Patients A and B were exposed to 17–24 Gy Eq and 8–12 Gy Eq, respectively. They received initial and intensive treatments, including blood transplantation and skin grafting, but both died, on day 82 and day 210, respectively. In Patient A the skin showed wide ulcerations on the anterior side of the whole body. The alimentary tract showed almost total loss of the epithelium. Other findings included hypocellular bone marrow with donor chimerism, oedema and congestion of the lungs without fibrosis, and markedly degenerated skeletal muscles. The skin of Patient B showed fibrosis and atrophy on the anterior side. His small intestine had segmental erosions caused by thrombotic microangiopathy (TMA). The bone marrow showed autologous recovery but remained hypocellular. His muscles showed degeneration, especially in the anterior sections. Pneumonia made it difficult to determine the radiation injury. These cases had relatively long survival times for the high absorbed doses, owing to the initial and intensive treatments. Patient A showed the early phase of radiation injury and Patient B showed early to chronic phase of the injury. Our cases displayed some notable findings, including the absence of lung fibrosis in both patients and TMA in the small intestine of patient B. It is still uncertain whether these findings were due to the quality and quantity of irradiation or to the therapies.