Localized Gastric Amyloidosis Research Articles

Localized gastric amyloidosis successfully treated with endoscopic submucosal dissection

Rationale:Amyloidosis is a general term that refers to the extracellular deposition of amyloid. The amyloid can also be deposited in a single organ. However, cases of localized gastric amyloidosis have rarely been reported. Here, we report a case of localized gastric amyloidosis that was successfully treated with endoscopic submucosal dissection.Patient concern:A 60-years-old man underwent esophagogastroduodenoscopy as part of a regular check-up without any comorbidities or symptoms.Diagnostics:A 12 mm-sized, round, elevated lesion with a central depression, which was covered with normal mucosa, and located on the greater curvature of the lower body of the stomach was discovered during endoscopy. Subsequently, endoscopic ultrasonography was performed, which revealed a 11.7 mm-sized, hypoechoic, heterogeneous lesion located in the muscularis mucosa and submucosa. A biopsy was performed, and amyloid deposition was confirmed. Although other investigations for checking systemic amyloidosis were performed, there were no specific findings. Therefore, the final diagnosis was localized gastric amyloidosis.Interventions:Endoscopic submucosal dissection was performed according to the patient's request and the lesion was completely removed.Outcomes:The patient was followed-up for 3 years without any recurrence.Conclusions:Endoscopic submucosal dissection can be good diagnostic and treatment option for localized gastric amyloidosis.

2787 Gastric Amyloidosis With Arteriovenous Malformation: A Rare Etiology of Upper GI Bleeding

INTRODUCTION: Amyloidosis refers to group of conditions caused by a build-up of amyloid fibrils in organs and tissues throughout the body. We present a very rare case of localized amyloidosis of the stomach presenting with an upper gastrointestinal bleeding (UGIB) due to arteriovenous malformation (AVM). CASE DESCRIPTION/METHODS: An 81-year-old female with past medical history significant for hypertension presented with hematemesis of one day duration. Vital signs were within normal limits. Physical exam was significant for epigastric tenderness. Initial lab work revealed hemoglobin 8.4 g/dL, mcv 83 fL, wbc 11.2 K/cm, platelets 513 K/cmm. Complete metabolic panel was within normal limits. Esophagogastroduodenoscopy (EGD) demonstrated oozing of blood on contact with air insufflation from the lesser curvature, body and fundus of the stomach with normal duodenum. Interventional radiology angiogram and computed tomography angiography were performed and were unable to localize source of bleeding. EGD was attempted four days later and recurrent oozing of blood on mucosal contact with air insufflation occurred. She was subsequently placed on total parenteral therapy (TPN) and sucralfate for ten days to help heal the cause of the inflammation. A third endoscopy showed similar findings. Thus, biopsies were taken. Hemoglobin remained stable with no recurrent hematemesis episodes and patient was discharged on PPI, sucralfate and liquid diet. CD34 staining on biopsy reveals dilated and congested blood vessels suggestive of AVM and special stain (Congo Red) portraying apple green birefringence confirming diagnosis of amyloidosis (Figures 1 and 2). Serum protein electrophoresis exhibited gamma globulin spike portraying AL amyloidosis. DISCUSSION: A single case of intraabdominal arteriovenous malformation and localized amyloidosis of an abdominal mass has been reported. This is the first reported case of localized gastric amyloidosis with AVM presenting with an UGIB. The association between AVM and amyloidosis is hypothesized to be due to amyloid proteins deposition predilection around leaky vasculatures, which was proven in mice. AVM causes amplified plasma flow and increased amyloid deposition leading to vessel friability and ischemia, ultimately resulting in mucosal ulcerations with delayed healing. This is our postulated mechanism as to why our patient had persistent gastric ulcer bleeding not amenable to multiple therapeutic/follow-up EGDs.

A case of asymptomatic localized gastric amyloidosis

A case of asymptomatic localized gastric amyloidosis

Localized Gastric Amyloidosis with Kappa and Lambda Light Chain Co-Expression.

Esophagogastroduodenoscopy for cancer screening was performed in a 55-year-old woman as part of a health screening program, and revealed a depressed lesion approximately 20 mm in diameter in the lesser curvature of the mid-gastric body. Several biopsy specimens were collected as the lesion resembled early gastric cancer; however, histopathologic evaluation revealed chronic active gastritis with an ulcer and amorphous eosinophilic material deposition. Congo red staining identified amyloid proteins, and apple-green birefringence was shown using polarized light microscopy. Immunohistochemical staining revealed the presence of kappa and lambda chain-positive plasma cells. There was no evidence of underlying plasma cell dyscrasia or amyloid deposition in other segments of the gastrointestinal tract. Echocardiography and computed tomography of the chest, abdomen, and pelvis did not show any significant findings. Thus, the patient was diagnosed with localized gastric amyloidosis with kappa and lambda light chain coexpression.

Endoscopic removal of localized gastric amyloidosis

Endoscopic removal of localized gastric amyloidosis

Localized gastric amyloidosis differentiated histologically from scirrhous gastric cancer using endoscopic mucosal resection: a case report

IntroductionAmyloidosis most often manifests as a systemic involvement of multiple tissues and organs, and an amyloidal deposit confined to the stomach is extremely rare. It is sometimes difficult to provide a definitive diagnosis of localized gastric amyloidosis by biopsy specimen and diagnosis of amyloidosis in some cases has been finalized only after surgical resection of the stomach.Case presentationA 76-year-old Japanese woman with epigastric discomfort underwent an esophagogastroduodenoscopy procedure. The esophagogastroduodenoscopy revealed gastric wall thickening, suggesting scirrhous gastric carcinoma, at the greater curvature from the upper to the lower part of the gastric corpus. A biopsy specimen revealed amyloid deposits in the submucosal layer with no malignant findings. We resected a representative portion of the lesion by endoscopic mucosal resection using the strip biopsy method to obtain sufficient tissue specimens, and then conducted a detailed histological evaluation of the samples. The resected specimens revealed deposition of amyloidal materials in the gastric mucosa and submucosa without any malignant findings. Congo red staining results were positive for amyloidal protein and exhibited green birefringence under polarized light. Congo red staining with prior potassium permanganate incubation confirmed the light chain (AL) amyloid protein type. Based on these results, gastric malignancy, systemic amyloidosis and amyloid deposits induced by inflammatory disease were excluded and this lesion was consequently diagnosed as localized gastric amyloidosis. Our patient was an older woman and there were no findings relative to an increase in gastrointestinal symptoms or anemia, so no further treatment was performed. She continued to be in good condition without any finding of disease progression six years after verification of our diagnosis.ConclusionsWe report an unusual case of primary amyloidosis of the stomach resembling scirrhous gastric carcinoma. This case of localized gastric amyloidosis was differentiated from scirrhous gastric cancer after performing endoscopic mucosal resection without an invasive surgical resection, as endoscopic mucosal resection provided sufficient tissue specimens from the lesion to make an accurate histological evaluation.

Amylose gastrique pseudotumorale

Introduction Localized gastric amyloidosis is rare. It should be considered in differentiation of gastric tumors, in which biopsy is the only means to confirm the diagnosis. Case report A 56-year old male patient presented dysphagia and vomiting. A plastic linitis was suggested by endoscopic ultrasonography. Total gastrectomy and clearance of perigastric lymph nodes were performed. The postoperative pathological diagnosis determined the lesion to be localized gastric amyloidosis and no malignant tumor was found. No sign of recurrence has been found one year after surgical resection. Discussion Currently, surgical resection of pathological tissue and circumambient lymph nodes may be a preferable therapeutic strategy for the localized amyloidosis to prevent possible complications.

A case report of localized gastric amyloidosis

A case report of localized gastric amyloidosis