Gastric amyloidoma in patient after remission of Non-Hodgkin’s Lymphoma

Abstract

Amyloidosis is commonly systemic, occasionally organlimited, and rarely a solitary localized mass. The latter, commonly referred to as tumoral amyloidosis, is described as occurring in nearly every organ/tissue. Only a few reports of gastric amyloidosis exist today. We describe a 72 year-old black male from Barbados presenting with 3 d of diffuse abdominal pain. His medical history included Non-Hodgkin's Lymphoma diagnosed five years ago, status-post six rounds of cyclophosphamide, adriamycin, vincristine, prednisone chemotherapy, and currently was in remission. On computed tomography scan of the abdomen, thickening and calcification of the gastric wall was noted along with pneumatosis. On esophagogastroduodenoscopy, a large circumferential friable mass was seen from the gastroesophageal junction to the body. A large nonbleeding 3 cm polyp was also seen in post bulbar area of duodenum. Biopsies were stained with Congo red and gave green birefringence under polarized light, consistent with tumoral amyloidosis. Positron emission tomography scan revealed diffuse gastric mucosa uptake compatible with gastric malignancy without metastatic foci. Treatment for gastric amyloidomas has presently been one of observation or, at most, resection of the amyloid mass. It is not known if our patient required the same approach or if this warranted the re-institution of chemotherapy for Non-Hodgkin's Lymphoma. Until more reports of tumoral amyloidosis are made known, treatment as well as prognosis remain uncertain.

Mesenteric Amyloidosis: Radiologic Imaging with Pathologic Correlation

“…[8] Typically, amyloidomas can be found in the central nervous system, respiratory system, cardiac system, gastrointestinal tract, and soft tissue extremities. [3,[9][10][11] Amyloid deposition along the mesentery is very rare. [12] Similarly to pulmonary amyloidosis, variable forms of the gastrointestinal amyloidosis can be recognized.…”

Efficacy of anakinra in a patient with systemic amyloidosis presenting as amyloidoma

“…It is therefore also called secondary amyloidosis . Depending upon the body region affected, amyloidosis can be systemic, occasionally organ limited, and very rarely as a solitary localized mass . The least common presentation of amyloid deposition is a solitary localized tumor‐like deposit termed amyloidoma or tumoral amyloidosis.…”

“…The least common presentation of amyloid deposition is a solitary localized tumor‐like deposit termed amyloidoma or tumoral amyloidosis. Amyloidoma of soft tissues are exceedingly rare and occur most often in the mediastinum or abdomen . Although most amyloidomas are light chain amyloidosis (AL)‐type, there have been recent reports of amyloidomas with AA fibrils secondary to chronic infection or inflammation …”

A Case of Abdominal Aortic Retroperitoneal and Mesenteric Amyloid Light Chain Amyloidoma

“…Amyloidoma (tumoral amyloidosis) is a solitary localized tumor-like amyloid deposition defined as the absence of any evidence of systemic amyloidosis. In many cases, the development sites of amyloidoma are in the systemic organs such as the respiratory system [ 7 ], genitals [ 8 ], gastrointestinal tract [ 9 ], and central nervous system [ 10 ]. However, development in the soft tissues, the retroperitoneum and mesentery in particular, is quite rare [ 11 – 13 ].…”