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Presented by Ralph Hruban, M.D. and prepared by Jeffrey Seibel, M.D. Ph.D.
Case 2: This 80-year-old male presented with hematochezia.
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Question 1 of 1
1. Question
Week 49: Case 2
This 80-year-old male presented with hematochezia./images/JS0716case2a.jpg
/images/JS0716case2b.jpg
/images/JS0716case2c.jpgCorrect
Answer: Amyloidosis
Histology: This biopsy is characterized by the accumulation of homogenous pink hyaline material in the interstitium and in vessels. A Congo Red stain (not shown) was positive with the characteristic apple-green birefringence.
Discussion: The intestinal tract is involved in ~75% of the cases of systemic amyloidosis. When the intestinal tract is involved, amyloidosis can lead to hemorrhage (because the vessels are fragile), focal ulcers in the stomach and colon, and reduced motility. Reduced motility is believed to be the result of amyloid deposited in the enteric nerves and muscles. The underlying disorders that lead to the deposition of amyloid in the intestinal tract include hereditary disorders, inflammatory diseases (chronic infections, rheumatoid arthritis, Crohn disease) and monoclonal gamopathies (AL-type). The Congo Red stain helps establish the diagnosis and immunohistochemical stains for immunoglobulin kappa and lambda light chains can help define the etiology of the process.
Incorrect
Answer: Amyloidosis
Histology: This biopsy is characterized by the accumulation of homogenous pink hyaline material in the interstitium and in vessels. A Congo Red stain (not shown) was positive with the characteristic apple-green birefringence.
Discussion: The intestinal tract is involved in ~75% of the cases of systemic amyloidosis. When the intestinal tract is involved, amyloidosis can lead to hemorrhage (because the vessels are fragile), focal ulcers in the stomach and colon, and reduced motility. Reduced motility is believed to be the result of amyloid deposited in the enteric nerves and muscles. The underlying disorders that lead to the deposition of amyloid in the intestinal tract include hereditary disorders, inflammatory diseases (chronic infections, rheumatoid arthritis, Crohn disease) and monoclonal gamopathies (AL-type). The Congo Red stain helps establish the diagnosis and immunohistochemical stains for immunoglobulin kappa and lambda light chains can help define the etiology of the process.
