[Fatal Dieulafoy's type ulcer in a case of gastric AL-amyloidosis].
Dieulafoy's ulcer is a particular form of gastric ulcer confined to a persistent caliber artery and may lead to severe hemorrhage. We report a case of fatal gastric bleeding in a woman with benign biclonal gammapathy. Autopsy found a typical Dieulafoy's ulcer centered by a persistent caliber artery which wall was thickened by AL-amyloid deposits. Amyloidosis involved the gastric wall, but also middle caliber arteries of the liver, the lung, the pancreas, the kidney and the myocardium. AL-amyloidosis is a rare and late complication of monoclonal gammapathy and may be asymptomatic. Pathogenesis of Dieulafoy's ulcer remains unclear. In our case, local ischemia may have facilitated gastric ulceration, and amyloid deposits may have contributed to arterial rupture.
Youssef
Nelly
N
Service d'Anatomie Pathologique, Hôpital Necker-Enfants Malades, 149 rue de Sèvres 75743 Paris Cedex 15. nelly.youssef@nck.ap-hop-paris.fr
Carbonell
Nicolas
N
Bonte
Hélène
H
Serfaty
Lawrence
L
Poupon
Raoul
R
Fléjou
Jean-François
JF
D000368:Aged; D000686:Amyloidosis / Q000209:etiology* / Q000473:pathology; D001158:Arteries / Q000002:abnormalities* / Q000473:pathology; D017809:Fatal Outcome; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology*; D006396:Hematemesis / Q000209:etiology; D006801:Humans; D007511:Ischemia / Q000150:complications; D010265:Paraproteinemias / Q000150:complications*; D013270:Stomach / Q000098:blood supply; D013272:Stomach Diseases / Q000209:etiology* / Q000473:pathology; D013276:Stomach Ulcer / Q000150:complications* / Q000473:pathology