PMC7345595_01
Upper endoscopy findings. Left to right: incisura of the stomach, gastric body, gastric body mass.
CRIS2020-1921805.001.jpg
PMC7345595_01_CRIS2020-1921805.001.jpg
fig1
No pathological findings were identified on colonoscopy; however, a large fungating, infiltrative, and polypoid, noncircumferential mass with bleeding and stigmata of recent bleeding was found at the lesser curvature incisura with mild antral gastritis, highly suspicious of gastric carcinoma (Figure 1).
CT scan skull base to midthigh findings. Axial view (a): the spleen and liver borderline enlarged. Coronal view (b): no focal abnormalmality in the distal esophagus and stomach with no masses, adenopathy, or further evidence of regional or distal metastatic disease.
CRIS2020-1921805.002.jpg
PMC7345595_01_CRIS2020-1921805.002.jpg
fig2
The scan was significant for small amount of fluid in the pelvis, anasarca, and mild hepatosplenomegaly (Figure 2).
Amyloid deposition in the stomach and liver. (a-d) Gastric mucosa with ulceration, fibrinopurulent exudate, regenerative changes, and hyalinization of lamina propria secondary to amyloid deposition (pink on hematoxylin and eosin (H&E), (a)), highlighted by a metachromatic reaction on crystal violet stain (magenta, (b)) and congophilia on Congo red stain (red, (c)) with apple-green birefringence on polarized light (d). (e-h). Core liver biopsy with diffuse hyalinized stroma (H&E, (e)) consistent with amyloid deposition demonstrated by crystal violet (f), Congo red stain (g), and apple-green birefringence on polarized light (h). Magnification: (a-d), 100x; (e-g), 200x; (h), 400x.
CRIS2020-1921805.003.jpg
PMC7345595_01_CRIS2020-1921805.003.jpg
fig3
Special stains for Congo red and crystal violet were positive, supporting the diagnosis (Figure 3).
Bone marrow biopsy showing a plasma cell neoplasm with lambda light chain restriction. Clusters of plasma cells in perivascular spaces highlighted by CD-138 immunostaining (a) with strong expression of lambda light chain (lambda (b)) and negativity for kappa light chain (kappa (c)). All microphotographs shown at high magnification, 600x.
CRIS2020-1921805.004.jpg
PMC7345595_01_CRIS2020-1921805.004.jpg
fig4
Excess free lambda light chains were consistent with diagnosis of primary systemic light chain amyloidosis (Figure 4).