Localized Gastric Amyloidosis with Kappa and Lambda Light Chain Co-Expression

Abstract

Esophagogastroduodenoscopy for cancer screening was performed in a 55-year-old woman as part of a health screening program, and revealed a depressed lesion approximately 20 mm in diameter in the lesser curvature of the mid-gastric body. Several biopsy specimens were collected as the lesion resembled early gastric cancer; however, histopathologic evaluation revealed chronic active gastritis with an ulcer and amorphous eosinophilic material deposition. Congo red staining identified amyloid proteins, and apple-green birefringence was shown using polarized light microscopy. Immunohistochemical staining revealed the presence of kappa and lambda chain-positive plasma cells. There was no evidence of underlying plasma cell dyscrasia or amyloid deposition in other segments of the gastrointestinal tract. Echocardiography and computed tomography of the chest, abdomen, and pelvis did not show any significant findings. Thus, the patient was diagnosed with localized gastric amyloidosis with kappa and lambda light chain coexpression.

Lower respiratory tract amyloidosis: Presentation, survival and prognostic factors. A multicenter consecutive case series

“…This issue is also reported in other series on respiratory amyloidosis 3,[24][25][26]. Recently, various non-AL amyloidosis were reported with respiratory localization,27,28 and co-deposition of kappa and lambda chain or light and heavy chain, in favor of an oligoclonal or polyclonal deposits, have been described in respiratory and extra-respiratory organ-limited amyloidosis [29][30][31]. This raises the question of a different physiopathology of organ-limited amyloidosis from that of typical monoclonal AL amyloidosis.…”

Asymptomatic Localized Gastric Amyloidosis with Two Separate Lesions

“…Until 1990s surgical resection was considered as proper treatment for localized gastric amyloidosis, 2,8 while after 2,000 most cases with localized gastric amyloidosis, especially symptom-free ones, maintained good condition without any treatment. 3,6,[9][10][11][12][13][14] So far, there have been no diagnostic criteria for localized gastric amyloidosis. It is only diagnosed by excluding other organ involvement.…”

Localized Gastric Amyloidosis

“…It is classified into systemic and localized amyloidosis based on the distribution of amyloid, and is categorized by the identity of the corresponding precursor proteins. Involvement of the gastrointestinal tract is often observed in patients with systemic amyloidosis; however, the amyloid deposition confined to the stomach is extremely rare [1][2][3]. The gross appearance of localized gastric amyloidosis takes various forms such as depressed lesion, submucosal tumorlike or nodular appearance, and thickened folds [1,2,4,5], and it is often difficult to differentiate from gastric cancer or malignant lymphoma with only conventional white light endoscopy.…”

“…Involvement of the gastrointestinal tract is often observed in patients with systemic amyloidosis; however, the amyloid deposition confined to the stomach is extremely rare [1][2][3]. The gross appearance of localized gastric amyloidosis takes various forms such as depressed lesion, submucosal tumorlike or nodular appearance, and thickened folds [1,2,4,5], and it is often difficult to differentiate from gastric cancer or malignant lymphoma with only conventional white light endoscopy. Magnifying endoscopy with narrow-band imaging is useful for the diagnosis of gastric amyloidosis, and a groovetype surface pattern with irregularity, round small vascular changes, and dilatated vessels without variable caliber have been reported for gastric amyloidosis [1,4].…”

“…Magnifying endoscopy with narrow-band imaging is useful for the diagnosis of gastric amyloidosis, and a groovetype surface pattern with irregularity, round small vascular changes, and dilatated vessels without variable caliber have been reported for gastric amyloidosis [1,4]. The majority of patients with localized gastric amyloidosis have a favorable prognosis without morphological changes, even after longterm observations [2,3].…”