Intest Res.  2014 Jul;12(3):245-250. 10.5217/ir.2014.12.3.245.

A Case of Localized Amyloid Light-Chain Amyloidosis in the Small Intestine

• Choi JH
• Ko BM
• Kim C
• Kim HK
• Han JP
• Hong SJ
• Moon JH
• Lee MS

• KMID: 2174384
• DOI: http://doi.org/10.5217/ir.2014.12.3.245

Abstract

Amyloidosis is characterized by the abnormal deposition of extracellular amyloid fibrils. Cases involving amyloid light-chain amyloidosis in the small intestine have been reported infrequently in Korea. Here, we report a case of localized light chain protein amyloidosis in the small intestine. Esophagogastroduodenoscopy, push enteroscopy, and capsule endoscopy revealed submucosal tumor-like lesions, multiple shallow ulcers, and several erosions in the distal duodenum and jejunum. An endoscopic biopsy established the diagnosis of amyloidosis. In through an immunohistochemical analysis, the presence of lambda light chain protein was detected. The patient had no evidence of an underlying clonal plasma cell disorder or additional organ involvement. Therefore, we concluded that the patient had localized amyloidosis of the small intestine.

Keyword

Amyloidosis; Intestine, small; Endosonography; Enteroscopy; Capsule endoscopy

MeSH Terms

Amyloid*
Amyloidosis*
Biopsy
Capsule Endoscopy
Diagnosis
Duodenum
Endoscopy, Digestive System
Endosonography
Humans
Intestine, Small*
Jejunum
Korea
Plasma Cells
Ulcer
Amyloid

Figure

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  Fig. 1 Upper endoscopic findings. Endoscopy revealed an elevated lesion with central erosion on the third portion of the duodenum.

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  Fig. 2 Abdominal CT findings. Abdominal CT scan revealed haziness in the mesentery (arrows) without abnormal enhancement of wall thickening and dilatation of the small bowel.

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  Fig. 3 Push enteroscopic findings. Endoscopy revealed (A) multiple shallow ulcers (white arrows) with broad bases and (B) discoloration of the jejunum (black arrow).

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  Fig. 4 Endoscopic ultrasonography (EUS) findings. EUS revealed hypoechoic thickening of the muscularis mucosa on (A) a flat lesion with a shallow ulcer and (B) an elevated lesion. Submucosal thickening was present on the elevated lesion (C).

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  Fig. 5 Capsule endoscopy (CE) findings. CE revealed (A) multiple shallow ulcers and (B) whitish plaque-like infiltration in the jejunum.

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  Fig. 6 Histopathologic analysis. Microscopic findings revealed (A) the presence of amorphous eosinophilic material deposits in the lamina propria (×100), (B) salmon-colored deposits of amyloid using Congo red staining (×100), and (C) the apple-green color birefringence of the deposits using polarizing microscopy (×100).

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