Yoshii S, Mabe K, Nosho K, Yamamoto H, Yasui H, Okuda H, Suzuki A, Fujita M, Sato T. Submucosal hematoma is a highly suggestive finding for amyloid light-chain amyloidosis: Two case reports. World J Gastrointest Endosc 2012; 4(9): 434-437 [PMID: 23125904 DOI: 10.4253/wjge.v4.i9.434]
Corresponding Author of This Article
Shinji Yoshii, MD, Department of Gastroenterology, Keiyukai Sapporo Hospital, Kita1-1, Hondori14-chome, Shiroishi-ku, Sapporo 003-0027, Japan. shinjiyoshii@yahoo.co.jp
Article-Type of This Article
Case Report
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Shinji Yoshii, Department of Gastroenterology, Keiyukai Sapporo Hospital, Sapporo 003-0027, Japan
Katsuhiro Mabe, Third Department of Internal Medicine, Hokkaido University Graduate School of Medicine, Sapporo 060-8648, Japan
Katsuhiko Nosho, Hiroyuki Yamamoto, Hiroshi Yasui, First Department of Internal Medicine, Sapporo Medical University School of Medicine, Sapporo 060-8556, Japan
Hiroyuki Okuda, Department of Medical Oncology, Keiyukai Sapporo Hospital, Sapporo 003-0027, Japan
Akira Suzuki, Department of Pathology, KKR Sapporo Medical Center, Sapporo 062-0931, Japan
Masahiro Fujita, Toshihiro Sato, Keiyukai Institute of Clinical Pathology, Sapporo 003-0027, Japan
Author contributions: Yoshii S and Mabe K contributed equally to the conception and design of the study; Yoshii S wrote the manuscript; Yoshii S and Mabe K performed the endoscopic examinations; Nosho K and Yamamoto H made preparations for this manuscript; Yasui H treated the patients and provided much of the information; Mabe K, Okuda H and Nosho K contributed to the drafting and critical review of the article for important intellectual content; Suzuki A, Fujita M and Sato T performed the pathological analysis; all authors read and approved the final manuscript.
Correspondence to: Shinji Yoshii, MD, Department of Gastroenterology, Keiyukai Sapporo Hospital, Kita1-1, Hondori14-chome, Shiroishi-ku, Sapporo 003-0027, Japan. shinjiyoshii@yahoo.co.jp
Telephone: +81-11-8632101 Fax: +81-11-8641032
Received: November 12, 2011 Revised: May 27, 2012 Accepted: September 12, 2012 Published online: September 16, 2012
Abstract
The clinical and endoscopic features of amyloid light-chain (AL) amyloidosis are diverse and mimic various other diseases. Endoscopically, few reports on submucosal hematomas of the gastrointestinal (GI) tract are available in the literature. Here, we report two cases of AL amyloidosis presenting as submucosal hematomas in the absence of clinical disease elsewhere in the body. The 2 cases were referred to our hospital because of hematochezia. The endoscopic findings in both cases were similar in submucosal hematoma formation. However, the clinical courses differed. In the first case, there was no evidence of systemic amyloidosis and the disease was conservatively managed. In the second case, the disease progressed to systemic amyloidosis and the patient died within a short time. We conclude that the endoscopic detection of a submucosal hematoma in the setting of GI bleeding should raise suspicion of AL amyloidosis. Referral to a hematologist should be done immediately for treatment while the involvement is limited to the GI tract.
