RESUMEN
A 66-year-old man with recurrent stroke within a short period of time was referred to our department from the neurology department to rule out any malignancy. An endoscopic examination revealed a white depressed lesion in the body of the stomach, and computed tomography revealed a high-density area in the mesentery around the stomach. A mucosa-associated lymphoid tissue (MALT) lymphoma was detected from both the stomach biopsy and resected mesenteric specimen. Systemic chemotherapy was administered for the MALT lymphoma (Lugano classification stage IV). Cerebral infarction did not occur after the treatment. We concluded that Trousseau syndrome associated with the MALT lymphoma disseminated to the mesenteric adipose tissue. A MALT lymphoma has a small probability of occurring in Trousseau syndrome.
Asunto(s)
Linfoma de Células B de la Zona Marginal/complicaciones , Linfoma de Células B de la Zona Marginal/patología , Mesenterio , Neoplasias de Tejido Adiposo/complicaciones , Neoplasias de Tejido Adiposo/patología , Neoplasias Peritoneales/complicaciones , Neoplasias Peritoneales/patología , Accidente Cerebrovascular/etiología , Anciano , Protocolos de Quimioterapia Combinada Antineoplásica/administración & dosificación , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Ciclofosfamida/administración & dosificación , Humanos , Linfoma de Células B de la Zona Marginal/diagnóstico por imagen , Linfoma de Células B de la Zona Marginal/tratamiento farmacológico , Masculino , Mesenterio/diagnóstico por imagen , Invasividad Neoplásica , Neoplasias de Tejido Adiposo/diagnóstico por imagen , Neoplasias de Tejido Adiposo/tratamiento farmacológico , Neoplasias Peritoneales/diagnóstico por imagen , Neoplasias Peritoneales/tratamiento farmacológico , Prednisona/administración & dosificación , Recurrencia , Rituximab/administración & dosificación , Síndrome , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Vincristina/administración & dosificaciónRESUMEN
An 82-year-old woman with a history of bronchiectasis for 20 years was admitted to our hospital with anorexia and diarrhea. Sigmoidoscopy showed multiple mucosal erythematous areas and erosions. Histologic examination with Congo red stain revealed massive amyloid deposition around the submucosal vessels as well as in the parenchyma of the mucosa and submucosa. With immunohistochemistry, the diagnosis of secondary/reactive AA amyloidosis was confirmed. Esophagogastroduodenoscopy demonstrated diffuse dark brown mucosa, establishing the diagnosis of acute necrotizing esophagitis. Ischemia associated with amyloid deposition of the vessels in the esophagus was considered to be a possible etiology of acute necrotizing esophagitis. Additionally, gastric outlet obstruction and gastroesophageal reflux associated with gastroduodenal erosions caused by amyloid deposition were supposed to be another factor. Amyloid deposition in the esophageal mucosa may cause a reduction in mucosal defense that is responsible for the pathogenesis. We report the first case of acute necrotizing esophagitis associated with amyloidosis.