title: Submucosal hematoma is a highly suggestive finding for amyloid light-chain amyloidosis: Two case reports.
abstract: The clinical and endoscopic features of amyloid light-chain (AL) amyloidosis are diverse and mimic various other diseases. Endoscopically, few reports on submucosal hematomas of the gastrointestinal (GI) tract are available in the literature. Here, we report two cases of AL amyloidosis presenting as submucosal hematomas in the absence of clinical disease elsewhere in the body. The 2 cases were referred to our hospital because of hematochezia. The endoscopic findings in both cases were similar in submucosal hematoma formation. However, the clinical courses differed. In the first case, there was no evidence of systemic amyloidosis and the disease was conservatively managed. In the second case, the disease progressed to systemic amyloidosis and the patient died within a short time. We conclude that the endoscopic detection of a submucosal hematoma in the setting of GI bleeding should raise suspicion of AL amyloidosis. Referral to a hematologist should be done immediately for treatment while the involvement is limited to the GI tract.
authors.affiliation: Shinji Yoshii, Department of Gastroenterology, Keiyukai Sapporo Hospital, Sapporo 003-0027, Japan.
authors.forename: Shinji
authors.initials: S
authors.lastname: Yoshii
authors.forename: Katsuhiro
authors.initials: K
authors.lastname: Mabe
authors.forename: Katsuhiko
authors.initials: K
authors.lastname: Nosho
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Yamamoto
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Yasui
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Okuda
authors.forename: Akira
authors.initials: A
authors.lastname: Suzuki
authors.forename: Masahiro
authors.initials: M
authors.lastname: Fujita
authors.forename: Toshihiro
authors.initials: T
authors.lastname: Sato
keywords: Amyloid light-chain amyloidosis; Colonoscopy; Gastrointestinal bleeding; Submucosal hematoma