PMC8177977_01
Scanning images of 99 mTc-labeled human serum albumin (HSA) scintigraphy. 99 mTc-labeled HSA scintigraphy revealed albumin leakage from the gastrointestinal tract (arrows). (a) At 7 hours of scanning, collection of the radiotracer was found in the left upper portion of the abdomen, indicating albumin loss into the small intestine. (b) At 24 hours of scanning, diffuse collection of the radiotracer was found in the right and upper portions of the abdomen, indicating albumin loss into the colon.
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Because persistent hypoproteinemia and chronic diarrhea were observed, PLE was considered as a possible underlying disorder. 99 mTc-labeled human serum albumin (HSA) scintigraphy revealed leakage of albumin from the gastrointestinal tract (Figure 1).
Findings of esophagogastroduodenoscopy (EGD). EGD revealed some elevated lesions in the gastric fornix (a) and moderate edema with redness in the gastric antrum and duodenum (b-d).
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EGD revealed some elevated lesions in the gastric fornix and moderate edema with redness in the gastric antrum and duodenum (Figure 2).
Findings of colonoscopy: (a) descending colon, (b and c) sigmoid colon, (d) rectum. Colonoscopy showed erythema and moderate edema in the entire colon and multiple submucosal tumor-like wall thickenings in the left-sided colon and the rectum.
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TCS showed erythema and moderate mucosal edema in the entire colon and multiple submucosal tumor-like wall thickenings in the left-sided colon and the rectum (Figure 3).
Histopathological findings of gastrointestinal biopsy. Histopathological examination showed Congo-red-positive amyloid deposits in the muscularis mucosae and submucosa of the stomach, duodenum, colon, and rectum. Immunohistostaining showed that the amyloid fibrils were composed of immunoglobulin lambda light chains.
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Immunohistostaining showed that the amyloid fibrils were composed of immunoglobulin lambda light chains (Figure 4).
Osteolytic lesions of the skull. Head skeletal X-rays (a and b) and computed tomography (CT) (c) showed multiple, lytic, and punched-out lesions in the skull (arrows).
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An additional head skeletal X-ray showed punched-out lesions, and head CT showed multiple osteolytic lesions in the skull (Figure 5).
Findings of bone marrow aspiration. Bone marrow aspiration demonstrated an increase of atypical plasma cells of up to 28.8% of the marrow elements.
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Bone marrow aspiration showed an increase of atypical plasma cells of up to 28.8% of the marrow elements (Figure 6).