Duodenal Amyloidotic Tumor

Abstract

This duodenal polypoid lesion was found during Esophago Gastro Duodenoscopy
(EGDS) performed in a 77-year-old woman (Figure 1A). Our patient had already been diagnosed
with multiple myeloma a few years earlier; although treated with multiple lines of
treatment, the disease was still in progression with multiple vertebral localizations and renal
failure. She started complaining of asthenia and suffered from various episodes of melena over
two weeks; the Emergency Room assessment found Deep Venous Thrombosis (DVT) and severe
anemization (Hb 5.9 g/dl). After stabilization with 3 blood transfusions, she underwent an
EGDS to localize the source of bleeding. The polypoid lesion that was found underwent biopsy
because it raised suspicions of localization of myeloma, primary tumor of the duodenum or
infectious disease. Histology, instead, excluded the presence of a neoplastic tumor, but revealed
massive mucosal and submucosal deposits of an amorphous eosinophilic substance (Figure
1B), that showed apple-green birefringence on staining with Congo red (Figures 1C and 1D). A
diagnosis of tumoral intestinal AL amyloidosis was made.