背景:阴燃多发性骨髓瘤(SMM)是一种无症状的浆细胞增殖性疾病,可发展为多发性骨髓瘤(MM)。淀粉样变性(轻链)(AL)是最常见的全身性淀粉样变性形式。关于SMM与AL并存并累及消化道的报道很少。
方法:一名63岁女性下肢水肿,腹胀,腹痛,和便血.胃镜检查显示胃潴留,胃垂钓者粘膜粗糙,充血,和轻微的血液渗出。结肠镜检查显示远端升结肠和乙状结肠粘膜充血和水肿伴多发圆形和不规则溃疡,粘膜下瘀斑,还有血肿.胃和结肠组织活检证实刚果红染色阳性诊断为AL。MM通过骨髓活检和免疫组织化学证实。病人没有高钙血症,肾功能不全,贫血,骨病变或恶性生物标志物定义为骨髓中浆细胞>60%。此外,无血清游离轻链比例升高,或通过磁共振成像(SLiM标准)检测到骨髓病变的存在。患者最终被诊断为与AL共存的SMM。她接受了化疗,症状缓解后出院。她在近五年的随访中表现良好。
结论:该病例强调了诊断胃肠道AL需要高度怀疑指数。应怀疑在内镜下发现颗粒状粘膜的老年患者,瘀斑,粘膜下血肿.及时诊断和适当的治疗有助于改善这些患者的预后。
BACKGROUND: Smoldering multiple myeloma (SMM) is an asymptomatic plasma cell proliferative disorder that can progress to multiple myeloma (MM). Amyloidosis (light chain) (AL) is the most common form of systemic amyloidosis. There are few
reports of SMM coexisting with AL involving the digestive tract.
METHODS: A 63-year-old woman presented with lower limb edema, abdominal distension, abdominal pain, and hematochezia. Gastroscopy showed gastric retention, gastric angler mucosal coarseness, hyperemia, and mild oozing of blood. Colonoscopy showed hyperemic and edematous mucosa of the distal ascending colon and sigmoid colon with the presence of multiple round and irregular ulcers, submucosal ecchymosis, and hematoma. Gastric and colonic tissue biopsy confirmed the diagnosis of AL by positive Congo red staining. MM was confirmed by bone marrow biopsy and immunohistochemistry. The patient had no hypercalcemia, renal dysfunction, anemia, bone lesions or biomarkers of malignancy defined as plasma cells > 60% in bone marrow. Additionally, no elevated serum free light chain ratio, or presence of bone marrow lesions by magnetic resonance imaging (SLiM criteria) were detected. The patient was finally diagnosed with SMM coexisting with AL. She received chemotherapy and was discharged when the symptoms were relieved. She is doing well at nearly five years of follow up.
CONCLUSIONS: This
case highlights that high index of suspicion is required to diagnose gastrointestinal AL. It should be suspected in elderly patients with endoscopic findings of granular-appearing mucosa, ecchymosis, and submucosal hematoma. Timely diagnosis and appropriate therapy can help to improve the prognosis of these patients.