Abstract
Partial Gut Obstruction secondary to Localized Gastrointestinal Amyloidosis: A Case report
Gabriel Daniel Alcantara, MD; Ma. Felina Siray, MD; Joseph Bocobo, MD
St. Luke’s Medical Center – Global City
Significance: Gastrointestinal amyloidosis is a rare form of amyloidosis with the exact prevalence being unknown. The significance of this report is to present a case of a localized form of Gastrointestinal amyloidosis, the less commonly observed subset.
Clinical Presentation: This is a case of a 56 year old female, who was a known case of sigmoid amyloidosis back in 2018; incidentally diagnosed upon annual checkup, who now presented with beginning gastrointestinal obstruction.
Management: Patient was admitted and a CT scan done showed circumferential wall thickening of the sigmoid colon with non-obstructive bowel gas pattern. Flexible sigmoidoscopy was then done showing a rectal mass at the 10 cm level and a polypoid mass lesion about 13 cm in length. Rectal biopsy showed amyloid deposits and a laparoscopic sigmoidectomy was done succeedingly. Sigmoid biopsy and IHC stains showed amyloid deposits with Lambda-Light chain predominant atypical plasmacytosis. Serum protein electrophoresis (SPE) and Total Protein (TP) and serum immunofixation both showed no monocloncal gammopathy. Serum Free Light Chain panel showed findings suspicious for very low level monotypic serum free Lambda light chians based on the Free Light Ratio (FLC) of 0.40. Cardiac PYP-scan was done and noted to have negative results. Patient was then discharged and followed up after 1 week with repeat SPE+TP and Immunofixation wherein both still showed negative for monoclonal gammopathy.
Conclusion: The etiology of amyloidosis in this case is likely of the AL type as IHCs showed Lambda light chain predominant atypical plasmacytosis. Resection of the involved organ is the mainstay treatment of Localized AL-Amyloidosis, with gastrointestinal amyloidosis having an excellent 5-year disease free progression rate.
Important Dates to Remember
| JRRE Activities 2023-2024 |
Proposed Dates |
|---|---|
| Resumption of face-to-face Evidence-Based Medicine Workshop Venue to be announced once finalized. |
July 21, 2023 (Friday), 1-5pm |
| Monthly Critical Appraisal of Topics Conferences to be gaciliated by Research Coordinators per Institution | Monthly Critical Appraisal of Topics Conferences per Institution |
| CAT Plenary/Liver Con Dates: September 23, 2023 December 16, 2023 March 2024 (During the JAC) Resumption of face-to-face Quarterly Critical Appraisal of Topics facilitated by the JRRE |
2 Clinical scenarios and articles are to be sent to institutions each on August 2023, November 2023, and February 2024; |
| Hybrid Research Workshop 4 week asynchronous via Moodle, followed by a 1 day on-site Onsite Workshop Research Protocol Presentation for Level I GI Fellows-In-Training - Research Protocol Presentation: August 12, 2023 - Research Forums of the Tripartite Societies |
Week 1: July 15-21, 2023 Week 2: July 22-28, 2023 Week 3: July 29-August 4, 2023 Week 4: August 5-11, 2023 |
| Research Manuscript Workshop for level II GI Fellows-In-Training | January 6, 2024 |