Necrotizing angiitis of the small intestine related to AA-amyloidosis: a novel association.
A 71-year-old man with intestinal pseudo-obstruction was found to have a diffusely thickened adynamic small bowel with AA-amyloid in submucosal vessels and muscularis propria, foreign body giant cell reaction to amyloid, and necrotizing angiitis. The mucosa was unremarkable. Immunostains demonstrated numerous CD68+ monocyte/macrophages and CD8+ T cells associated with the amyloid deposits. The patient had no evidence of systemic vasculitis and no underlying cause for AA-amyloidosis was identified. Necrotizing angiitis coexistent with amyloid angiopathy has been reported in brain and temporal arteries, but not in the gastrointestinal tract and not with AA-amyloid. The inflammatory cell infiltrates in this case are consistent with a foreign-body and/or cell-mediated immunologic reaction to AA-amyloid, although a role for these cells in amyloid formation cannot be excluded.
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Department of Pathology, Pusat Pakar Perubatan Normah Medical Specialist Centre, Sarawak, Malaysia.
West
A B
AB
Stokes
M B
MB
D000368:Aged; D000686:Amyloidosis / Q000473:pathology*; D005767:Gastrointestinal Diseases / Q000473:pathology*; D005773:Gastroscopy; D006801:Humans; D007421:Intestine, Small / Q000473:pathology*; D008297:Male; D000685:Serum Amyloid A Protein / Q000032:analysis*; D014657:Vasculitis / Q000473:pathology*
D000685:Serum Amyloid A Protein