Clin Endosc.  2013 Nov;46(6):651-655.

Gastric Outlet Obstruction Due to Gastric Amyloidosis Mimicking Malignancy in a Patient with Ankylosing Spondylitis

• Seon CS
• Park YS
• Jung YM
• Choi JH
• Son BK
• Ahn SB
• Kim SH
• Jo YJ

Abstract

Amyloidosis is a group of disorders characterized by the extracellular accumulation of insoluble, fibrillar proteins in various organs and tissues. It is classified, on the basis of the identity of the precursor protein, as primary, secondary, or familial amyloidosis. Gastrointestinal amyloidosis usually presents as bleeding, ulceration, malabsorption, protein loss, and diarrhea. However, gastric amyloidosis with gastric outlet obstruction mimicking linitis plastica is rare. We report a case of gastrointestinal amyloidosis with gastric outlet obstruction in a patient with ankylosing spondylitis. The patient was indicated for subtotal gastrectomy because of the aggravation of obstructive symptoms, but refused the operation and was transferred to another hospital. Three months later, the patient died of aspiration pneumonia during medical treatment.

Keyword

Gastrointestinal amyloidosis; Spondylitis, ankylosing; Linitis plastica

MeSH Terms

Amyloidosis*
Amyloidosis, Familial
Diarrhea
Gastrectomy
Gastric Outlet Obstruction*
Hemorrhage
Humans
Linitis Plastica
Pneumonia, Aspiration
Spondylitis, Ankylosing*
Ulcer

Figure

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  Fig. 1 (A) Computed tomography of the stomach showing a large amount of food stasis with focal submucosal thickening in the gastric antrum. (B) Endoscopic finding of the gastric antrum showing marked edema of the mucosa, multiple ulcerations, and luminal narrowing of the gastric antrum. (C) Endoscopic finding of the pylorus showing pyloric stenosis with ulceration. (D) Endoscopic finding of the duodenal bulb showing a normal appearance.

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  Fig. 2 (A) Photomicrograph of the gastric biopsy specimen showing deposition of eosinophilic amorphous materials in the lamina propria and the submucosa of the gastric antrum, consistent with amyloidosis (H&E stain, ×200). (B) Photomicrograph of the duodenal biopsy specimen showing deposition of amyloid fibrils in the lamina propria and the submucosa of the duodenum (H&E stain, ×200).

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  Fig. 3 (A, B) Polarization microscopic findings of the stomach showing apple-green birefringence (A, Congo red stain, ×200; B, ×400). (C, D) Electron microscopic findings of the stomach showing amyloid fibrils attached to the subepithelial layers (C, ×2,500; D, ×4,000).

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