Japanese

Clinicopathologic Analysis of the Upper Digestive Tract Lesions in Patients with Amyloidosis Shuji Tada 1,3 , Mitsuo Iida 1,2 , Kazuoki Hizawa 1 1The Second Department of Internal Medicine, Faculty of Medicine, Kyushu University Keyword: アミロイドーシス , 上部消化管内視鏡検査 , X線診断 , アミロイド蛋白 pp.1357-1368
Published Date 1994/12/25
DOI https://doi.org/10.11477/mf.1403106014
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 Clinicopathologic findings of the upper digestive tract lesions were studied in 72 patients with amyloidosis according to the chemical type of amyloid protein. Radiographic and endoscopic examinations of the upper digestive tract revealed various findings such as a coarse mucosal pattern with innumerable fine granular elevations, erosions, shallow ulcers, mucosal friability, thickening of the folds, and multiple polypoid protrusions. Immunohistochemical study of the biopsy specimens identified the following chemical types: amyloid A protein (AA)in 52 cases, light chain protein (AL) in 14,β2-microglobulin (AH) in three, and atypical prealbumin (AF) in three, Considerable differences were found between chemical types of amyloid protein. The AA cases produced a coarse mucosal pattern with innumerable fine granular elevations, which reflected expansion of the lamina propria by amyloid deposits. Multiple polypoid protrusions and invariable thickening of the folds were evident only in the AL cases, correlating with massive amyloid deposits in the muscularis mucosae and submucosa. The AH and the AF cases produced gastric retention, relating to extensive amyloid deposits in the muscularis propria in the AH, and in the myenteric plexuses in the AF. Clinically, a more frequent occurrence of diarrhea, malnutrition, and occult blood in stools was present in the AA cases, whereas dysphagia with macroglossia and chronic intestinal pseudo-obstruction were evident only in the AL and the AH cases. These results suggest that clinicopathologic differences between the chemical types exist in patients with amyloidosis and that characteristic radiographic and endoscopic changes of chemical types can be detected well in the upper digestive tract.


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電子版ISSN 1882-1219 印刷版ISSN 0536-2180 医学書院

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