A Case of Intestinal Amiloidosis with Hemorrhagic Mesenteric Cyst of the Jejunum

Nobuhiro Kurita, Mitsuo Shimada, Kouzou Yoshikawa, Tomohiko Miyatani, Jun Higashijima, Masanori Nishioka and Takashi Iwata

Department of Surgery, The University of Tokushima

We report a rare case of intestinal amyloidosis. A 70-year-old Japanese man with no his story of chronic inflammatory disease such as rheumatoid arthritis or Crohn's disease seen for upper abdominal pain was found in abdominal CT, MRI, and PET-CT to have a cystic tumor 5 cm in diameter in the jejunal mesentery. On laparotomy, the cystic tumor 5 cm in diameter containing clots from old bleeding was confirmed in the jejunal mesentery, together with enlarged lymph nodes and cystic tumors 2 cm in diameter. Histopathological examination showed marked deposits of AA type amyloid around the wall of microscopic blood vessels with extensive hemorrhaging, especially in the submucosal layer of the jejunum. Amyloid was also deposited in mesenteric lymph nodes surrounded by fat necrosis in the mesentery. Fat necrosis was thought to be due to ischemic change. The cyst wall consisted of old granular tissue. We surmised that blood vessel vulnerability was the main cause of cystic change in the jejunal mesentery. We have found no reports of intestinal amyloidosis with hemorrhagic cysts in the mesentery. Intestinal amyloidosis should thus be considered even in patients with no history of chronic inflammatory disease.

Key words
amyloidosis, mesenteric cyst, hemorrhage

Reprint requests
Mitsuo Shimada Department of Surgery, The University of Tokushima
3-18-15 Kuramoto-cho, Tokushima, 770-8503 JAPAN

Accepted
September 24, 2008

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