Spheroid‐type of AL amyloid deposition associated with colonic adenocarcinoma: A case report with literature review
Spheroid‐type of AL amyloid deposition associated with colonic adenocarcinoma: A case report with literature review
复制标题
与结肠腺癌相关的球状型 AL 淀粉样蛋白沉积：一例报告并文献复习
DOI：
--
复制
发表时间：
2018
期刊：
影响因子：
--
通讯作者：
J. Ro
中科院分区：
文献类型：
--
作者：
M. Kim;Z. McCroskey;Yingchao Piao;A. Belcheva;L. Truong;Paul J. Kurtin;J. Ro
我们报告了一个结肠腺癌，在结肠、回肠末端和阑尾中发现了一种特殊的球状淀粉样蛋白的弥漫性粘膜下沉积。一名65岁女性，既往有高血压和慢性阻塞性肺疾病病史，因痉挛性腹痛和恶心到急诊室就诊。腹部计算机断层扫描（CT）显示右结肠扭转。行紧急右半结肠切除术。该标本显示结肠腺癌伴局部粘膜下浸润（pT 1），起源于绒毛管状腺瘤。在结肠、回肠和阑尾中发现弥漫性粘膜下球状淀粉样蛋白沉积（类似于淀粉样体样结构，伴Liesegang环形成）。对这种不寻常的球形材料进行的电子显微镜检查进一步证实了淀粉样纤维的存在。通过液相色谱-质谱分析检测到该标本中的AL（λ）型淀粉样变性。由于未获得患者同意，未进行单克隆丙种球蛋白病检测。然而，在组织切片评价中，未发现浆细胞肿瘤。胃肠道中孤立性AL淀粉样蛋白沉积的病例很少报告，在英文文献中没有结肠腺癌与原发性淀粉样蛋白沉积相关的病例报告。
We report a colonic adenocarcinoma associated with diffuse submucosal deposition of a peculiar spheroid‐type amyloid identified in the colon, terminal ileum, and appendix. A 65‐year‐old woman with past medical histories of hypertension, and chronic obstructive pulmonary disease, presented to the emergency room with cramping abdominal pain and nausea. A computed tomography (CT) scan of abdomen showed right colonic volvulus. Emergency right hemicolectomy was performed. The specimen showed colonic adenocarcinoma with focal submucosal invasion (pT1) arising from a villotubular adenoma. A diffuse submucosal spheroid‐type amyloid deposition (resembling corpora amylacea‐like structures with Liesegang ring formation) was identified in the colon, ileum, and appendix. Electron microscopy examination of this unusual spheroidal‐type material further confirmed the presence of amyloid fibrils. Analysis by liquid chromatography–mass spectrometry detected AL (lambda) type amyloidosis in this specimen. Tests for monoclonal gammopathy were not performed because patient consent was not obtained. In tissue section evaluation, however, no plasma cell neoplasm was identified. Cases with isolated AL amyloid deposition in the gastrointestinal tract have been reported rarely, and there is no case report of colonic adenocarcinoma associated with primary amyloid deposition in the English literature.