Localized gastric amyloidosis in a patient diagnosed with Hodgkin lymphoma- A case report and review of literature

Abstract

Gastrointestinal amyloidosis (GIA), a protein deposition disorder, has numerous etiologies and manifestations and poses a significant diagnostic and treatment challenge. GIA is either acquired or genetic, and it is most commonly caused by chronic inflammatory disorders (AA amyloidosis), hematologic malignancy (AL amyloidosis), and end-stage renal disease (Beta-2 amyloidosis). In AL amyloidosis, the amyloid forming protein is derived from the light chain component of a protein in the blood called monoclonal immunoglobulin. These light chains are produced by abnormal cells (known as plasma or B cells) found in the bone marrow. AL amyloidosis can be caused by abnormal light chains produced by lymphomas or chronic lymphocytic leukaemia(CLL) in rare cases. Hodgkin lymphoma has been found to be associated with systemic amyloidosis and particularly with renal amyloidosis with an incidence of less than 1%.Here we report a rare case of a 61-year old female patient who was previously diagnosed with Hodgkin lymphoma and underwent chemotherapy, now presented with anemia, dypnoea and was found to have a non healing ulcer in the body of the stomach. Histopathological examination revealed gastric amyloidosis which was confirmed with Congo red stain and apple green birefringence under polarized light.