Localized primary gastric amyloidosis: Three case reports

Figure 1 Endoscopic and histological data of patient 1. A: Esophagogastroduodenoscopy revealed a faint reddish flat elevated lesion, 15 × 16 mm in size, with multiple nodules on the surface in the great curvature of the antrum adjacent to the corpus. B: Narrow-band imaging (NBI) indicated a defined green area. C: Magnifying endoscopy with NBI showed expanded normal glands with changed polarity as well as dilated and tortuous vessels. D: Hematoxylin-eosin staining showed cystic dilated gastric glands. E: Massive and cord-like pink substances were deposited in the mesenchyme and inside the blood vessel wall at the bottom of the lamina propria mucosa, muscularis mucosae and superficial submucosal layer. F: Polarized light microscopy revealed apple-green birefringence in the lesions. Orange arrows indicate amyloid depositions.

Figure 2 Endoscopic and histological data of patient 2. A: Conventional endoscopy showed a red and white area in the atrophic gastric antrum with active gastritis. B: Narrow-band imaging (NBI) showed a defined light brownish area. C: Magnifying endoscopy with NBI revealed expanded normal glands with changed polarity and tree-like vessels. D: Hematoxylin-eosin staining showed abundant cord-like red substances in the mucosal layers. E: These tissues were positive for Congo red staining. Orange arrows indicate amyloid depositions.

Figure 3 Endoscopic and histological data of patient 3. A: Conventional endoscopy demonstrated that the whole gastric mucosa was congestive, edematous and mainly red. B: Endoscopic ultrasound showed that the mucosa and submucosa layer were thickened (white arrow) but that the muscle and serosal layers were intact. C: A gastric tube was placed into the antrum to provide nutritional support. D: Hematoxylin-eosin staining revealed an abundant brick-red substance in the mucosal and submucosal layers. E: These tissues were positive for Congo red staining. Orange arrows indicate amyloid depositions.