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A case of localized colorectal wild-type ATTR amyloidosis complicated by early stage colorectal cancer and a CMV-associated ulcer during the long-term follow-up

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Abstract

Gastrointestinal involvement is a rare manifestation of systemic amyloidosis, and few reports have been published on localized amyloidosis of the colon. Only one case report has been published on the long-term prognosis of localized colorectal amyloidosis, and there are no previous reports on localized colorectal ATTR amyloidosis. Here, we report an 80-year-old male with localized colorectal wild-type ATTR amyloidosis who presented with edematous mucosa with vascular changes throughout the colon. He did not exhibit any symptoms or endoscopic exacerbation for 8 years after diagnosis. However, after 8 years, he developed early stage colorectal cancer and cytomegalovirus-associated ulcer. He was treated with endoscopic submucosal dissection, which was relatively challenging due to his hemorrhagic condition and poor elevation of the submucosa caused by amyloid deposits. Since the tumor was completely resected, he will undergo regular follow-up. Our review of 20 previous cases of localized colorectal amyloidosis revealed its clinical features and long-term prognosis. Specifically, ours is the second case of a diffuse pan-colon type of colorectal localized amyloidosis, which may lead to various complications, such as colorectal cancer, over a long period of time, and thus, regular follow-up is necessary.

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Abbreviations

Ra:

Rectum above the peritoneal reflection

tub1:

Well differentiated tubular adenocarcinoma

pTis (M):

Pathologically intramucosal tumor

Ly:

Lymphatic invasion

V:

Venous invasion

HM:

Horizontal margin

VM:

Vertical margin

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Acknowledgements

The authors would like to thank Enago (www.enago.jp) for the English language review.

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Authors and Affiliations

  1. Department of Gastroenterology, Soka Municipal Hospital, 2-21-1 Soka, Soka-shi, Saitama, 340-8560, Japan

    Sho Watanabe, Hitoshi Uchida, Ittoku Nanke, Kozue Uchidate, Tomoyo Machida, Akira Igarashi, Kenichiro Kobashi & Tsunehito Yauchi

  2. Pathology, Soka Municipal Hospital, Saitama, Japan

    Mariko Negi

  3. Department of Gastroenterology, Tokyo Metropolitan Hiroo Hospital, Tokyo, Japan

    Takashi Fujii

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  1. Sho Watanabe
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  2. Hitoshi Uchida
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  3. Ittoku Nanke
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  4. Kozue Uchidate
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  5. Tomoyo Machida
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  9. Takashi Fujii
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  10. Tsunehito Yauchi
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Correspondence to Sho Watanabe.

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Written informed consent was given by the patient for the publication of this manuscript. Identifying information, aside from age and sex, was removed and the images provided were anonymized to protect patient confidentiality.

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Supplementary Information

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12328_2022_1628_MOESM1_ESM.jpg

Supplementary Fig. 1. Histological analysis of the punched-out ulcer revealed an active cytomegalovirus (CMV) infection. (A) Low and (B) high magnification. (A, B) Scale bar: 500 μm

12328_2022_1628_MOESM2_ESM.jpg

Supplementary Fig. 2. Endoscopic changes over time at the site where early stage colorectal cancer was detected. Endoscopic images of the site where early stage colorectal cancer was detected. Endoscopic images (A) 4 years ago and (B) 2 years ago

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Watanabe, S., Uchida, H., Nanke, I. et al. A case of localized colorectal wild-type ATTR amyloidosis complicated by early stage colorectal cancer and a CMV-associated ulcer during the long-term follow-up. Clin J Gastroenterol 15, 603–610 (2022). https://doi.org/10.1007/s12328-022-01628-2

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  • DOI: https://doi.org/10.1007/s12328-022-01628-2

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