華山論劍-專業案例挑戰/Case 2014-002

Date: 26 June posted by 陳啟仁/戴啟明/曾兆明/曾政豪/張吉仰/牟聯瑞醫師學術天地

Answer of Case 2014-002

Clinical Course:

Follow-up EGD showed that mucosa of bulb and second portion was fragile and easily bleeding. Several polypoid lesion with ulcers were noted at post bulbar area s/p biopsy. After EGD, we changed to side-view endoscope. The papilla was invisible. Elevated lesion with fragile mucosa was noted at the ampular portion s/p biopsy.

Pathology:

The section shows duodenal mucosa with deposits of hyalinized material in lamina propria and mucosa muscularis.

The section shows duodenal mucosa with deposits of hyalinized material in lamina propria and mucosa muscularis

Masson-Trichrome Stain

This case is consulted. Professor Shun in NTUH think this hyalinized material is amyloidosis as evidenced by positive Congo red stain. The case is unlike collagenous duodenitis, usually deposite in basement memberane area. So he suggestd to check the rectum or oral mucosa to rule out primary amyloidosis.

Small bowel enteroscopy and EUS

Follow-up evaluation :

Oral ulcer(-), arthritis(-),rash(-),photosensitivity(-),leg edema(-),Raynaud phenomenon(-),dry month or eye(-),back stiffness(-)

Final Diagnosis:

Intestine amyloidosis