Endoscopic features of primary amyloidosis of the stomach.

A 72-year-old-woman, with a history of resection of tracheal (AL) amyloidosis at age 61 and biopsy-based diagnosis of gastric amyloidosis at age 68, was admitted to our hospital. No amyloid deposits had been detected in any other organ and multiple myeloma had been excluded. Gastroscopy showed several findings, including ulcerative lesions mimicking advanced cancer, submucosal tumor-like lesions, intramural hematomas, small ulcers, and flat elevated lesions (●" Fig.1). With narrow-band imaging (NBI) enhancement, the mucosa surrounding the ulcer appeared grayish-green in color (●" Fig.2). Endoscopic ultrasound (EUS) revealed hypoechoic thickening of the mucosa and submucosa, with the loss of the normal sonographic layers (●" Fig.3). Histological examination with Congo red staining revealed amorphous eosinophilic infiltrates, which also showed positive immunostaining for both kappa and lambda light chains, but not amyloid A, validating the diagnosis of gastric primary (AL) amyloidosis. Endoscopic examination and biopsy samples ruled out lesions in other gastrointestinal locations. However, there was massive bleeding on biopsy of the ulcerative lesion and blood transfusion was required. Endoscopic findings in gastric amyloidosis are nonspecific, including a variety of features such as erosions, fine granularFig.1 Gastroscopy (white-light examination) in a 72-year-old-woman with a history of amyloidosis. a An ulcerative lesion resembling advanced gastric cancer in the proximal stomach. b An elevated lesion with ulcer, similar to the submucosal tumor in the antrum. c Intramural hematomas and flat elevations in the middle stomach. d A small, shallow ulcer surrounded by erythema in the middle stomach. The presence of residual food suggested gastroparesis. Fig.2 Narrow-band imaging (NBI) view of the same lesion of●" Fig.1d, showing grayishgreen mucosa surrounding a small ulcer, without an obvious vascular pattern.