Ahn Yong Hwan, Rhee Ye Young, Choi Suck Chei, Seo Geom Seog
Department of Internal Medicine, Plus Internal Medicine Clinic, Suncheon, Korea.
Anatomic Pathology Reference Lab, Seegene Medical Foundation, Seoul, Korea.
Clin Endosc. 2018 May;51(3):285-288. doi: 10.5946/ce.2017.118. Epub 2017 Oct 26.
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.
作为健康筛查项目的一部分,对一名55岁女性进行了食管胃十二指肠镜癌症筛查,结果显示胃体中部小弯处有一个直径约20毫米的凹陷性病变。由于该病变类似早期胃癌,因此采集了多份活检标本;然而,组织病理学评估显示为慢性活动性胃炎伴溃疡及无定形嗜酸性物质沉积。刚果红染色鉴定出淀粉样蛋白,偏振光显微镜显示苹果绿双折射。免疫组织化学染色显示存在κ和λ链阳性浆细胞。没有证据表明胃肠道其他部位存在潜在的浆细胞发育异常或淀粉样蛋白沉积。胸部、腹部和骨盆的超声心动图和计算机断层扫描未显示任何显著异常。因此,该患者被诊断为κ和λ轻链共表达的局限性胃淀粉样变性。