Clin Endosc.  2018 May;51(3):285-288. 10.5946/ce.2017.118.

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

• Ahn YH
• Rhee YY
• Choi SC
• Seo GS

• KMID: 2414871
• DOI: http://doi.org/10.5946/ce.2017.118

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.

Keyword

Localized gastric amyloidosis; Light chain amyloidosis; Co-expression

MeSH Terms

Abdomen
Amyloidogenic Proteins
Amyloidosis*
Biopsy
Birefringence
Congo Red
Early Detection of Cancer
Echocardiography
Endoscopy, Digestive System
Eosinophils
Female
Gastritis
Gastrointestinal Tract
Humans
Mass Screening
Microscopy, Polarization
Middle Aged
Paraproteinemias
Pelvis
Plaque, Amyloid
Plasma Cells
Stomach Neoplasms
Thorax
Ulcer
Amyloidogenic Proteins
Congo Red

Figure

• 

  Fig. 1. Endoscopic findings. A round lesion approximately 20 mm in diameter, with central depression and a pale-colored base on the lesser curvature of the mid-gastric body.

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  Fig. 2. Histopathologic findings. (A) Congo red staining shows amorphous amyloid proteins (Congo red, ×200). (B) Apple-green birefringence is shown using polarized light microscopy after Congo red staining (Congo red, ×200).

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  Fig. 3. Immunohistochemical staining shows the presence of plasma cells with co-expression of kappa (A) and lambda (B) light chains in the mucosal layer.

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