Dell Medical School at the University of Texas at Austin Austin, TX
Introduction: Isolated gastric amyloid is a rare condition with a variable presentation. The following is a case of gastric amyloid presenting as a single large lesion in a patient with few nonspecific symptoms.
Case Description/Methods: A 55-year-old woman with a history of Lennox-Gastaut Syndrome underwent endoscopy for emesis workup. The procedure showed a large, friable, ulcerated lesion in the gastric antrum on the lesser curvature (Fig. A). The lesion measured approximately 3 x 8 cm and was concerning for malignancy. However, biopsies of the lesion were consistent with active chronic gastritis with submucosal light chain (AL) amyloid deposition, lambda type (Fig. B).
Discussion: Gastric amyloidosis is a rare condition, occurring in approximately only 3% of patients with amyloidosis. In light chain amyloidosis, it most often manifests in patients with the lambda subtype, as in the case presented here. The symptoms are vague and protean, making a clinical diagnosis difficult. Patients may complain of epigastric discomfort and may demonstrate signs of dysmotility. Ultimately, the definitive diagnosis and classification of amyloid must be made with histologic confirmation. In this case, the patient was unable to communicate her symptoms because of her intellectual disability, but did have constipation and increased emesis in the absence of other reported symptoms or findings consistent with systemic amyloidosis. Extensive workup to exclude systemic amyloidosis was unrevealing. This particular case is notable for the presentation of the disease with a single, large, friable ulcer, adding to the literature concerning the variable presentation of gastric amyloidosis on endoscopy. Considering the difficulty in clinical diagnosis and the morbidity of this disease, the authors propose a low threshold to consider pathologic examination for gastric amyloidosis in patients with nonspecific symptoms and abnormal findings on endoscopy.
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