Solitary Amyloidosis of the Sigmoid Colon Featuring Submucosal Tumor Caused Hematochezia

Naotaka Ogasawara; Wataru Kitagawa; Konen Obayashi; Yoshitsugi Itoh; Hisatsugu Noda; Yasushi Funaki; Toyoharu Yokoi; Makoto Sasaki; Hirokazu Imai; Kunio Kasugai

doi:10.2169/internalmedicine.52.0944

CASE REPORTS

Solitary Amyloidosis of the Sigmoid Colon Featuring Submucosal Tumor Caused Hematochezia

Naotaka Ogasawara, Wataru Kitagawa, Konen Obayashi, Yoshitsugi Itoh, Hisatsugu Noda, Yasushi Funaki, Toyoharu Yokoi, Makoto Sasaki, Hirokazu Imai, Kunio Kasugai

Author information

Naotaka Ogasawara
Department of Gastroenterology, Aichi Medical University School of Medicine, Japan
Wataru Kitagawa
Department of Nephrology and Rheumatology, Aichi Medical University School of Medicine, Japan
Konen Obayashi
Diagnostic Unit for Amyloidosis, Department of Laboratory Medicine, Kumamoto University Hospital, Japan
Yoshitsugi Itoh
Department of Gastroenterology, Aichi Medical University School of Medicine, Japan
Hisatsugu Noda
Department of Gastroenterology, Aichi Medical University School of Medicine, Japan
Yasushi Funaki
Department of Gastroenterology, Aichi Medical University School of Medicine, Japan
Toyoharu Yokoi
Department of Pathology, Aichi Medical University School of Medicine, Japan
Makoto Sasaki
Department of Gastroenterology, Aichi Medical University School of Medicine, Japan
Hirokazu Imai
Department of Nephrology and Rheumatology, Aichi Medical University School of Medicine, Japan
Kunio Kasugai
Department of Gastroenterology, Aichi Medical University School of Medicine, Japan

Keywords: amyloidosis, colon, endoscopic submucosal resection (EMR), submucosal tumor, ultrasonography (US)

JOURNAL OPEN ACCESS

2013 Volume 52 Issue 22 Pages 2523-2527

DOI https://doi.org/10.2169/internalmedicine.52.0944

Details

Abstract

A previously a healthy 64-year-old woman complained of a two-week history of hemorrhaging upon defecation. The laboratory and urinalysis findings were normal, and no serum or urine M components were detectable on protein electrophoresis. An air contrast barium enema revealed an elevated lesion measuring -20 mm in diameter with a smooth surface and a depression in the sigmoid colon. Colonoscopy revealed a red colored and congested tumor. The exposed surface of the submucosal tumor (SMT) center was somewhat yellow in color and covered with fuzz. All other portions of the colon were normal. The endoscopy and double-contrast barium revealed a normal upper gastrointestinal tract and a normal small intestine, respectively. A histopathological evaluation of a biopsy specimen obtained from the SMT suggested amyloid deposition. However, the other biopsy specimens of the esophagus, stomach, duodenal bulb, second portion of the duodenum, terminal ileum and other portions of the colon demonstrated no amyloid deposition. Colonoscopic ultrasonography (US) revealed the hypoechoic, homogeneous SMT to be mainly localized within the submucosa. An endoscopic submucosal resection (EMR) of the solitary amyloidosis was performed and the immunohistopathology revealed the entire SMT to consist of amyloid light chain kappa amyloid deposition. We considered that the US followed by EMR contributed to the precise diagnosis of solitary amyloidosis and the treatment of hematochezia caused by a solitary area of amyloidosis within the sigmoid colon.

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