Clin Endosc.  2013 Sep;46(5):579-581.

Systemic Amyloidosis Manifested by Gastric Outlet Obstruction

• Park SW
• Lee HW
• Cho EJ

Abstract

Amyloidosis is characterized by extracellular deposition of insoluble protein fibrils that stain with Congo red application and appear apple green under polarized light. The presenting symptoms result from the involvement of many affected, nonspecific and generalized organ systems. Our patient was an 80-year-old woman with no medical history. She presented with a 2-week history of nausea and vomiting. An esophagogastroduodenoscopy showed erythematous and edematous mucosa on the antrum with pyloric stenosis. Histopathologic examination of the biopsy specimen showed the deposition of amorphous, homogeneous, and acidophilic material in the gastric mucosa. Amyloidal protein was proven by positive Congo red stain. A serum and urine immunfixation electrophoresis showed lambda light chain band. She developed symptoms of repeated greenish color vomiting. A follow-up esophagogastroduodenoscopy showed progressed antral obstruction. However, she refused further evaluation and treatment and was managed conservatively. She later died of disease progression after 34 hospital days.

Keyword

Amyloidosis; Gastric outlet obstruction

MeSH Terms

Aged, 80 and over
Amyloid
Amyloidosis
Biopsy
Carbamates
Congo Red
Disease Progression
Electrophoresis
Endoscopy, Digestive System
Female
Follow-Up Studies
Gastric Mucosa
Gastric Outlet Obstruction
Humans
Light
Mucous Membrane
Nausea
Organometallic Compounds
Pyloric Stenosis
Vomiting
Amyloid
Carbamates
Congo Red
Organometallic Compounds

Figure

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  Fig. 1 Gastric outlet obstruction on the esophagogastroduodenoscopy. (A) Erythematous, edematous mucosa was shown at the antrum at the hospital day 1. (B) Antral obstruction was noted at the hospital day 14, due to amyloidosis. A single hole was noted on the antrum of nasogastric tube insertions site. Gastric outlet obstruction had progressed.

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  Fig. 2 Antral thickening and gastric outlet obstruction by the computed tomography scan with contrast. Very diffuse wall thickening in the antrum of the stomach with partial gastric outlet obstruction, without perigastric fat infiltration or regional lymphadenopathy.

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  Fig. 3 Histopathology by stomach biopsy. (A) Deposition of amorphous, homogeneous, and acidophilic material in the gastric mucosal (H&E stain, ×200). (B) Apple-green birefringence, which is typical of amyloid (Congo red stain, ×100).

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