Kagawa Miwako, Fujino Yasuteru, Muguruma Naoki, Murayama Noriaki, Okamoto Koichi, Kitamura Shinji, Kimura Tetsuo, Kishi Kazuhiro, Miyamoto Hiroshi, Uehara Hisanori, Takayama Tetsuji
Department of Gastroenterology and Oncology, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15, Kuramoto-cho, Tokushima, 770-8503, Japan.
Department of Pathology and Laboratory Medicine, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan.
Clin J Gastroenterol. 2016 Jun;9(3):109-13. doi: 10.1007/s12328-016-0651-x. Epub 2016 May 12.
A 73-year-old man was referred to our hospital for further examination of a depressed lesion in the stomach found by cancer screening gastroscopy. A barium upper gastrointestinal series showed an area of irregular mucosa measuring 15 mm on the anterior wall of the gastric body. Esophagogastroduodenoscopy revealed a 15 mm depressed lesion on the anterior wall of the lower gastric body. We suspected an undifferentiated adenocarcinoma from the appearance and took some biopsies. However, histology of the specimens revealed amyloidal deposits in the submucosal layer without malignant findings. Congo red staining was positive for amyloidal protein and green birefringence was observed under polarized light microscopy. Congo red staining with prior potassium permanganate incubation confirmed the light chain (AL) amyloid type. There were no amyloid deposits in the colon or duodenum. Computed tomography of the chest, abdomen, and pelvis showed no remarkable findings. Thus, this case was diagnosed as a localized gastric amyloidosis characterized by AL type amyloid deposition in the mucosal or submucosal layer. As the clinical outcome of gastric AL amyloidosis seems favorable, this case is scheduled for periodic examination to recognize potential disease progression and has been stable for 2 years.
一名73岁男性因癌症筛查胃镜检查发现胃内有凹陷性病变而转诊至我院进一步检查。上消化道钡餐造影显示胃体前壁有一不规则黏膜区域，大小为15毫米。食管胃十二指肠镜检查发现胃体下部前壁有一个15毫米的凹陷性病变。从外观上我们怀疑是未分化腺癌，并取了一些活检组织。然而，标本的组织学检查显示黏膜下层有淀粉样沉积物，未发现恶性病变。刚果红染色显示淀粉样蛋白呈阳性，在偏振光显微镜下观察到绿色双折射。高锰酸钾孵育后刚果红染色证实为轻链（AL）型淀粉样变。结肠和十二指肠未发现淀粉样沉积物。胸部、腹部和骨盆的计算机断层扫描未发现明显异常。因此，该病例被诊断为以黏膜或黏膜下层AL型淀粉样沉积为特征的局限性胃淀粉样变。由于胃AL淀粉样变的临床预后似乎良好，该病例计划定期检查以识别潜在的疾病进展，目前已稳定2年。
