Threlkeld C, Nguyen T H
J Am Osteopath Assoc. 1996 Mar;96(3):188-90. doi: 10.7556/jaoa.1996.96.3.188.
A 46-year-old man was seen with a 2-month history of crampy abdominal pain and recent onset of hematochezia. Colonoscopic examination revealed a semiannular mass lesion in the descending colon which was thought to represent a near-obstructing neoplasm. A partial colon resection was performed. Gross inspection revealed a segment of bowel with focally necrotic mucosa but no mass lesion. Microscopic examination revealed deposits of amyloid infiltrating the muscularis propria, submucosal vessel walls, and lamina propria, with focal ischemic necrosis of mucosa. Special stains were positive for light chains, indicating primary amyloidosis. Follow-up studies for multiple myeloma and inflammatory disorders gave negative results. A diagnosis of isolated amyloidosis of the colon was rendered. Two months after surgery, the patient had a recurrence of symptoms and colon biopsy specimens revealed amyloidosis. The patient was given colchicine, with subjective and objective improvement. The various types of amyloidosis are discussed.
一名46岁男性，有2个月的腹部绞痛病史，近期出现便血。结肠镜检查发现降结肠有一个半环形肿块病变，考虑为接近梗阻性肿瘤。行部分结肠切除术。大体检查显示一段肠管，黏膜有局灶性坏死，但无肿块病变。显微镜检查显示淀粉样物质沉积浸润固有肌层、黏膜下血管壁和固有层，伴有黏膜局灶性缺血坏死。特殊染色轻链呈阳性，提示原发性淀粉样变性。对多发性骨髓瘤和炎症性疾病的后续检查结果为阴性。诊断为结肠孤立性淀粉样变性。术后两个月，患者症状复发，结肠活检标本显示淀粉样变性。给予患者秋水仙碱治疗后，主观和客观症状均有改善。文中讨论了各种类型的淀粉样变性。
