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Malone MAV, Castillo DAA, Santos HT, Kaur A, Elrafei T, Steinberg L, Kumar A. A systematic review of the literature on localized gastrointestinal tract amyloidosis: Presentation, management and outcomes. Eur J Haematol 2024. [PMID: 39030954 DOI: 10.1111/ejh.14269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 06/22/2024] [Accepted: 06/25/2024] [Indexed: 07/22/2024]
Abstract
PURPOSE Localized gastrointestinal tract amyloidosis is uncommon and little is known regarding this entity. There is no current standard of care for the management of localized amyloidosis. The objective of this study was to evaluate the characteristics, available treatments, outcomes and surveillance of these patients. METHODS We conducted a systematic review of cases reported in the literature from 1962 to 2021. Patients with gastrointestinal amyloidosis reported in English literature were included in the analysis. We described and summarized the patient's characteristics, treatments, clinical presentations, outcomes and surveillance. RESULTS The systematic review of reported clinical cases included 62 patients. In these patients, the most common site of amyloid deposition was the stomach (42%). The median age of diagnosis is 64.4 years old; there is a 2:1 prevalence among males (63%) to females (37%); abdominal pain is the most common type of presentation (41%), although patients could also be asymptomatic. There is a high curative rate (100%) with resection alone. Among patients treated with a type of systemic therapy, 80% achieved a complete response. The minority of cases reported a type of surveillance post treatment, and among those 62% pursued serial clinical evaluations alone. CONCLUSION To our knowledge, this is the first and largest systematic review of the literature in gastrointestinal tract amyloidosis. This is more common among males and seems to have an excellent curative rate (100%) with surgery alone. Systemic therapy is an option for those with non-resectable amyloidomas. Serial clinical evaluations should be part of the standard surveillance care in these patients.
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Affiliation(s)
| | | | - Heitor Tavares Santos
- Department of Medicine, Division of Internal Medicine, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Anahat Kaur
- Department of Medicine, Division of Oncology and Hematology, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Tarek Elrafei
- Department of Medicine, Division of Oncology and Hematology, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Lewis Steinberg
- Department of Medicine, Division of Oncology and Hematology, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Abhishek Kumar
- Department of Medicine, Division of Oncology and Hematology, Albert Einstein College of Medicine, Bronx, New York, USA
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Khalil G, Fiani D, Antaki F, Diab E. Primary gastric amyloidosis associated with linitis plastica and delayed progression to systemic amyloidosis and multiple myeloma. BMJ Case Rep 2023; 16:e252786. [PMID: 37247951 PMCID: PMC10230937 DOI: 10.1136/bcr-2022-252786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
Abstract
We report the case of a woman in her 50s who underwent, 5 years prior, a total gastrectomy after neoadjuvant chemotherapy for diffuse-type gastric cancer diagnosed during a workup for isolated gastric primary light chain (AL) amyloidosis. At the time of diagnosis, immunoglobulins light chain measurements and bone marrow biopsy were performed to rule out multiple myeloma and came back normal. Three years later, the patient developed systemic amyloidosis involving the heart and the lungs, after which she developed multiple myeloma. Isolated amyloid deposits in the stomach are a rare finding. While AL amyloidosis is frequently found in concomitance with multiple myeloma, late progression of primary AL amyloidosis to systemic amyloidosis and multiple myeloma is uncommon.
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Affiliation(s)
- Georges Khalil
- Department of Internal Medicine, Saint John Hospital, Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Beirut, Lebanon
| | - Dimitri Fiani
- Department of Internal Medicine, Universite Saint-Joseph Faculte de medecine, Beirut, Lebanon
| | - Fares Antaki
- Ophthalmology, Centre Hospitalier Universitaire de l'Universite de Montreal, Montreal, Quebec, Canada
| | - Ernest Diab
- Department of Hematology-Oncology, Universite Saint-Joseph Faculte de medecine, Beirut, Lebanon
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Endoscopic Submucosal Dissection of Localized Gastric Amyloidosis. ACG Case Rep J 2021; 8:e00627. [PMID: 34345635 PMCID: PMC8323794 DOI: 10.14309/crj.0000000000000627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 03/30/2021] [Indexed: 11/17/2022] Open
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Lin XY, Pan D, Sang LX, Chang B. Primary localized gastric amyloidosis: A scoping review of the literature from clinical presentations to prognosis. World J Gastroenterol 2021; 27:1132-1148. [PMID: 33828390 PMCID: PMC8006099 DOI: 10.3748/wjg.v27.i12.1132] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 01/10/2021] [Accepted: 02/25/2021] [Indexed: 02/06/2023] Open
Abstract
Localized gastric amyloidosis (LGA) is a rare disease characterized by abnormal extracellular deposition of amyloid protein restricted to the stomach and it is confirmed by positive results of Congo red staining. Over decades, only a few cases have been reported and studies or research focusing on it are few. Although LGA has a low incidence, patients may suffer a lot from it and require proper diagnosis and management. However, the pathology of LGA remains unknown and no overall review of LGA from its presentations to its prognosis has been published. Patients with LGA are often asymptomatic or manifest atypical symptoms, making it difficult to differentiate from other gastrointestinal diseases. Here, we report the case of a 70-year-old woman with LGA and provide an overview of case reports of LGA available to us. Based on that, we conclude current concepts of clinical manifestations, diagnosis, treatment, and prognosis of LGA, aiming at providing a detailed diagnostic procedure for clinicians and promoting the guidelines of LGA. In addition, a few advanced technologies applied in amyloidosis are also discussed in this review, aiming at providing clinicians with a reference of diagnostic process. With this review, we hope to raise awareness of LGA among the public and clinicians.
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Affiliation(s)
- Xin-Yu Lin
- Department of Neurology, The First Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
| | - Dan Pan
- Department of Geriatrics, The First Affiliated Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
| | - Li-Xuan Sang
- Department of Geriatrics, The First Affiliated Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
| | - Bing Chang
- Department of Gastroenterology, The First Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
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Rech J, Arnulf B, Margerie‐Mellon C, Talbot A, Malphettes M, Vignon M, Royer B, Lavergne D, Kambouchner M, Meignin V, Bergeron A, Prevot G, Brillet P, Martinod E, Bridoux F, Nunes H, Jaccard A, Valeyre D, Uzunhan Y. Lower respiratory tract amyloidosis: Presentation, survival and prognostic factors. A multicenter consecutive case series. Am J Hematol 2019; 94:1214-1226. [PMID: 31396978 DOI: 10.1002/ajh.25608] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 07/18/2019] [Accepted: 08/05/2019] [Indexed: 12/15/2022]
Abstract
Lower-respiratory-tract (LRT) amyloidosis has rarely been investigated. Our study presents characteristics, outcomes and survival of LRT amyloidosis. This multicenter retrospective study, from 1995 to 2017, included 73 patients with amyloidosis and LRT involvement. Respiratory patterns were: tracheobronchial (n = 17), nodular (n = 10), interstitial (n = 14) or composite (several respiratory involvements, n = 32). Interstitial and composite patterns were associated with multi-organ amyloidosis (n = 37, 80%) while tracheobronchial and nodular patterns were associated with organ-limited amyloidosis (n = 21, 78%). Amyloid light chain (AL) amyloidosis was diagnosed in 43 patients (59%), mainly of lambda type (n = 33, 77%). Smokers' proportion was higher in tracheobronchial (71%) and nodular (90%) patterns than in interstitial (14%) and composite (34%) patterns. The B-cell neoplasms involved 15 patients (21%), solid neoplasms 8 (11%), connective tissue diseases 8 (11%) and multiple myeloma 6 (8%). The B-cell and solid neoplasms were most prevalent in nodular pattern. Median follow-up was 4.4 years (2.2-8.9). Twenty-four patients died, mostly from respiratory infection. Survival at 1, 5, 10 years was respectively 88%, 70% and 54% for multi-organ amyloidosis, 96%, 89% and 69% for organ-limited amyloidosis (P = .125). Tracheobronchial and nodular patterns survival was better than in other respiratory patterns (P = .039). Death risk factors (multivariate analysis) were: cardiac localization (hazard-ratio [HR] 4.3 [95% confidence interval 1.6-11.5]; P = .004), age (HR 2.1 [1.2-3.7]; P = .008) and dyspnea at diagnosis (HR 4.0 [1.3-12.3]; P = .014). Various LRT amyloidosis patterns depend on smoking habits, organ-limited or multi-organ extension and comorbidities. They are associated with a different survival, which is also predicted by age, cardiac localization and dyspnea at presentation.
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Affiliation(s)
- Jean‐Simon Rech
- INSERM UMR‐1272, Paris 13 University and AP‐HP, Pneumology DepartmentAvicenne Hospital Bobigny France
| | - Bertrand Arnulf
- Paris 7 University and APHP, Immuno‐Hematology DepartmentSaint‐Louis Hospital Paris France
| | | | - Alexis Talbot
- Paris 7 University and APHP, Immuno‐Hematology DepartmentSaint‐Louis Hospital Paris France
| | - Marion Malphettes
- Paris 7 University and APHP, Immuno‐Hematology DepartmentSaint‐Louis Hospital Paris France
| | | | - Bruno Royer
- Paris 7 University and APHP, Immuno‐Hematology DepartmentSaint‐Louis Hospital Paris France
| | - David Lavergne
- Hematology DepartmentFrench Reference Center for AL Amyloidosis (Limoges‐Poitiers) CHU Limoges, Limoges France
| | | | | | - Anne Bergeron
- Paris 7 University and APHP, Pneumology DepartmentSaint‐Louis Hospital Paris France
| | | | - Pierre‐Yves Brillet
- INSERM UMR‐1272, Paris 13 University and AP‐HP, Radiology DepartmentAvicenne Hospital Bobigny France
| | - Emmanuel Martinod
- INSERM UMR‐1272, Paris 13 University and AP‐HP, Thoracic Surgery DepartmentAvicenne Hospital Bobigny France
| | - Franck Bridoux
- Nephrology Department, French Reference Center for AL Amyloidosis (Limoges‐Poitiers)CHU Poitiers Poitiers France
| | - Hilario Nunes
- INSERM UMR‐1272, Paris 13 University and AP‐HP, Pneumology DepartmentAvicenne Hospital Bobigny France
| | - Arnaud Jaccard
- Hematology DepartmentFrench Reference Center for AL Amyloidosis (Limoges‐Poitiers) CHU Limoges, Limoges France
| | - Dominique Valeyre
- INSERM UMR‐1272, Paris 13 University and AP‐HP, Pneumology DepartmentAvicenne Hospital Bobigny France
| | - Yurdagül Uzunhan
- INSERM UMR‐1272, Paris 13 University and AP‐HP, Pneumology DepartmentAvicenne Hospital Bobigny France
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