出血性十二指腸潰瘍を契機に発見された老人性TTRアミロイドーシスの1例

Senile Systemic Amyloidosis in an Elderly Patient with Hemorrhagic Duodenal Ulcer Report of a Case

要旨　十二指腸潰瘍に対する手術標本にて，老人性全身性アミロイドーシス（senile systemic amyloidosis ; SSA）を診断しえた症例を報告する．85歳，男性が十二指腸潰瘍に対する開腹止血術時に胃部分切除を施行された．組織学的に切除標本にアミロイド沈着を認め，免疫組織学的検査にてトランスサイレチン（transthyretin ; TTR）アミロイドと判明し，SSAと診断された．SSAは高齢者において最も頻度の高い全身性アミロイドーシスで，主に心臓，肺に沈着するが，全身の血管壁や間質にも沈着を伴い，手術検体にて偶然発見されることがある．高齢者の組織標本を検索する病理医はTTRアミロイド沈着にも留意する必要があり，沈着を認めた場合は，ほかの全身性アミロイドーシスとの鑑別診断に加え，心アミロイドーシスの評価を臨床医に助言すべきである．

　We report here a case of SSA（senile systemic amyloidosis）which was diagnosed using a surgical specimen. An 85-year-old man underwent partial gastrectomy for hemorrhagic duodenal ulcer. Histologically, amyloid deposits were scattered within the gastric wall and immunohistochemical examination revealed TTR（transthyretin）-derived amyloid. SSA is the most common systemic amyloidosis in the elderly and it mainly affects the heart and lungs as well as the vascular wall and stoma of various organs. TTR-derived amyloid was incidentally found in the surgical specimen. Pathologists should pay attention to amyloid in the resected specimen from elderly patients in daily practice. When TTR amyloid deposits have been recognized in the gastrointestinal tract, clinical estimation of cardiac amyloidosis is required as well as differential diagnosis for systemic amyloidosis.