Clinical Endoscopy

The Korean Society of Gastrointestinal Endoscopy (대한소화기내시경학회)
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Localized Gastric Amyloidosis with Kappa and Lambda Light Chain Co-Expression

  • Ahn, Yong Hwan (Department of Internal Medicine, Plus Internal Medicine Clinic) ;
  • Rhee, Ye Young (Anatomic Pathology Reference Lab, Seegene Medical Foundation) ;
  • Choi, Suck Chei (Department of Internal medicine, Digestive Disease Research Institute, Wonkwang University College of Medicine) ;
  • Seo, Geom Seog (Department of Internal medicine, Digestive Disease Research Institute, Wonkwang University College of Medicine)
  • Received : 2017.07.19
  • Accepted : 2017.08.30
  • Published : 2018.05.30
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Abstract

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 co-expression.

Keywords

References

  1. Merlini G, Bellotti V. Molecular mechanisms of amyloidosis. N Engl J Med 2003;349:583-596. https://doi.org/10.1056/NEJMra023144
  2. Lim AY, Lee JH, Jung KS, et al. Clinical features and outcomes of systemic amyloidosis with gastrointestinal involvement: a single-center experience. Korean J Intern Med 2015;30:496-505. https://doi.org/10.3904/kjim.2015.30.4.496
  3. Biewend ML, Menke DM, Calamia KT. The spectrum of localized amyloidosis: a case series of 20 patients and review of the literature. Amyloid 2006;13:135-142. https://doi.org/10.1080/13506120600876773
  4. Katoh N, Matsuda M, Ikeda S. Clinical, endoscopic, and histopathological features of localized immunoglobulin light chain (AL) amyloidosis in the gastrointestinal tract. Amyloid 2015;22:254-256. https://doi.org/10.3109/13506129.2015.1075972
  5. Gertz MA. Immunoglobulin light chain amyloidosis: 2016 update on diagnosis, prognosis, and treatment. Am J Hematol 2016;91:947-956. https://doi.org/10.1002/ajh.24433
  6. Mahmood S, Bridoux F, Venner CP, et al. Natural history and outcomes in localised immunoglobulin light-chain amyloidosis: a long-term observational study. Lancet Haematol 2015;2:e241-e250. https://doi.org/10.1016/S2352-3026(15)00068-X
  7. Kourelis TV, Kyle RA, Dingli D, et al. Presentation and outcomes of localized immunoglobulin light chain amyloidosis: the Mayo Clinic experience. Mayo Clin Proc 2017;92:908-917. https://doi.org/10.1016/j.mayocp.2017.02.016
  8. Bjornsson S, Johannsson JH, Sigurjonsson F. Localized primary amyloidosis of the stomach presenting with gastric hemorrhage. Acta Med Scand 1987;221:115-119.
  9. Yanai H, Fuji T, Tada M, et al. Localized amyloidosis of the stomach. Gastrointest Endosc 1991;37:408-409. https://doi.org/10.1016/S0016-5107(91)70758-X
  10. Lee SH, Rhee PL, Kim JJ, et al. A case of primary gastric amyloidosis diagnosed by endoscopy. Korean J Gastrointest Endosc 1998;18:561-566.
  11. Lee YN, Hong SJ, Kim HK. [Localized gastric amyloidosis]. Korean J Gastroenterol 2011;58:117-120. https://doi.org/10.4166/kjg.2011.58.2.117
  12. Kamata T, Suzuki H, Yoshinaga S, et al. Localized gastric amyloidosis differentiated histologically from scirrhous gastric cancer using endoscopic mucosal resection: a case report. J Med Case Rep 2012;6:231. https://doi.org/10.1186/1752-1947-6-231
  13. Ebato T, Yamamoto T, Abe K, Ishii T, Kuyama Y. Endoscopic removal of localized gastric amyloidosis. Endoscopy 2012;44 Suppl 2 UCTN:E351. https://doi.org/10.1055/s-0032-1310026
  14. Yamaguchi T, Inoue T, Nishida T, et al. Localized gastric amyloidosis mimicking a submucosal tumor-like gastric cancer. Gastrointest Endosc 2015;82:175-177. https://doi.org/10.1016/j.gie.2015.01.043
  15. Kagawa M, Fujino Y, Muguruma N, et al. Localized amyloidosis of the stomach mimicking a superficial gastric cancer. Clin J Gastroenterol 2016;9:109-113. https://doi.org/10.1007/s12328-016-0651-x
  16. Gentry M, Pettenati M, Pang CS. Biclonal light chain gammopathy with aberrant CD33 expression in secondary plasma cell leukemia. Int J Clin Exp Pathol 2013;6:2224-2229.
  17. Jiwani S, Bornhost J, Alapat D. Biphenotypic plasma cell myeloma: two cases of plasma cell neoplasm with a coexpression of kappa and lambda light chains. Int J Clin Exp Pathol 2015;8:8536-8544.

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