Shirota Yukihiro, Ueda Yoshimichi, Sato Katsuaki, Koura Takayoshi, Takeda Yasuhito, Hodo Yuji, Wakabayashi Tokio
Department of Gastroenterology, Saiseikai Kanazawa Hospital, Ni-13-6 Akatsuchimachi, Kanazawa, Ishikawa, 920-0353, Japan.
Department of Pathology, Keiju Medical Center, 94, Tomiokamachi, Nanao, Ishikawa, 926-8605, Japan.
Clin J Gastroenterol. 2025 Apr;18(2):269-277. doi: 10.1007/s12328-025-02097-z. Epub 2025 Jan 11.
Localized light chain amyloidosis is considered to be a plasmacytic B-cell lymphoproliferative disorder caused by antigenic induction. A hypothesis has been proposed that antigen-induced local plasmacytic B cells produce amyloidogenic proteins that are processed into amyloid fibrils in giant cells leading to amyloid fibril deposition. However, the inciting antigen exposure or immune response that signals plasmacytic B-cell infiltration, activation, and selection, is unknown. A case of localized light chain amyloidosis of the stomach that gradually regressed endoscopically after Helicobacter pylori eradication is presented. Histologically, plasmacytes decreased markedly and macrophages disappeared after eradication, and they are thought to play important roles in amyloid formation. There have been no reports of localized gastric amyloidosis in which the lesion regressed and few reports showing the relationship between localized gastric amyloidosis and Helicobacter pylori infection that evaluated the changes after eradication. Given the review of the latest findings about localized light chain amyloidosis, in addition to circumstantial evidence from the clinical course of this case, we would like to propose a bold new hypothesis that Helicobacter pylori could be one of the antigens inducing localized light chain amyloidosis of the stomach.
局限性轻链淀粉样变性被认为是一种由抗原诱导引起的浆细胞性B细胞淋巴增殖性疾病。有人提出一种假说，即抗原诱导的局部浆细胞性B细胞产生淀粉样蛋白原性蛋白，这些蛋白在巨细胞中被加工成淀粉样纤维，导致淀粉样纤维沉积。然而，引发浆细胞性B细胞浸润、激活和选择的刺激性抗原暴露或免疫反应尚不清楚。本文报告一例胃局限性轻链淀粉样变性病例，在根除幽门螺杆菌后内镜下病变逐渐消退。组织学上，根除后浆细胞明显减少，巨噬细胞消失，它们被认为在淀粉样蛋白形成中起重要作用。目前尚无病变消退的局限性胃淀粉样变性的报道，也很少有报道显示局限性胃淀粉样变性与幽门螺杆菌感染之间的关系并评估根除后的变化。鉴于对局限性轻链淀粉样变性最新研究结果的回顾，除了该病例临床过程中的间接证据外，我们大胆提出一个新假说，即幽门螺杆菌可能是诱导胃局限性轻链淀粉样变性的抗原之一。
