Kamata Tsugumasa, Suzuki Haruhisa, Yoshinaga Shigetaka, Nonaka Satoru, Fukagawa Takeo, Katai Hitoshi, Taniguchi Hirokazu, Kushima Ryoji, Oda Ichiro
Endoscopy Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan.
J Med Case Rep. 2012 Aug 3;6:231. doi: 10.1186/1752-1947-6-231.
Amyloidosis 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.
A 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.
We 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.
淀粉样变性最常表现为多个组织和器官的系统性受累，而局限于胃的淀粉样沉积物极为罕见。有时通过活检标本难以对局限性胃淀粉样变性做出明确诊断，且在某些情况下，仅在胃手术切除后才能最终确诊淀粉样变性。
一名76岁有上腹部不适的日本女性接受了食管胃十二指肠镜检查。食管胃十二指肠镜检查显示胃壁增厚，提示胃体部上至下部大弯处为硬癌性胃癌。活检标本显示黏膜下层有淀粉样沉积物，无恶性表现。我们采用条带活检法通过内镜黏膜切除术切除病变的代表性部分以获取足够的组织标本，然后对样本进行详细的组织学评估。切除的标本显示胃黏膜和黏膜下层有淀粉样物质沉积，无任何恶性表现。刚果红染色结果显示淀粉样蛋白呈阳性，在偏振光下呈现绿色双折射。高锰酸钾预处理后的刚果红染色证实为轻链（AL）型淀粉样蛋白。基于这些结果，排除了胃恶性肿瘤、系统性淀粉样变性和炎症性疾病引起的淀粉样沉积物，因此该病变被诊断为局限性胃淀粉样变性。我们的患者是一位老年女性，没有胃肠道症状或贫血增加的相关表现，所以未进行进一步治疗。在确诊六年之后，她的病情持续良好，未发现疾病进展。
我们报告了一例罕见的原发性胃淀粉样变性病例，类似硬癌性胃癌。该局限性胃淀粉样变性病例在未进行侵入性手术切除的情况下，通过内镜黏膜切除术与硬癌性胃癌得以区分，因为内镜黏膜切除术从病变处提供了足够的组织标本以进行准确的组织学评估。
