Amyloidosis-induced Lower Gastrointestinal Bleeding in a Patient with Multiple Myeloma

We reported a case of gastrointestinal amyloidosis associated with multiple myeloma (MM), presenting with an unusual abdominal condition causing right upper abdominal pain and hematochezia. An abdominal examination revealed a huge tender mass below the right costal margin. A barium enema examination demonstrated a filling defect in the transverse colon and abdominal computed tomography disclosed an inhomogeneous mass. There was no evidence of thrombocytopenia or a coagulation factor deficiency. A surgical specimen showed deposit of amyloid substance in the colon. As this case illustrates, the absence of systemic symptoms of amyloidosis and nonspecific radiological findings in gastrointestinal amyloidosis may make the diagnosis difficult. Therefore, we recommend that a diagnosis of amyloidosis-induced bleeding of the colon should be considered in patients with multiple myeloma with obscure hemorrhaging

Morphometric studies in human pancreatic cancer argues against the etiological role of type 2 diabetes in pancreatic cancer

Background: To understand the role of islet amyloid polypeptide (IAPP) in type 2 diabetes and pancreatic cancer (PC), we investigated the patterns of its expression and its ratio to insulin, glucagon, somatostatin and pancreatic polypeptide cells by morphometry in tissues from these two diseases in comparison to the normal pancreas. Materials and Methods: Pancreatic tissues from 11 donors (five without pancreatic disease and six with type 2 diabetes) and 11 surgical specimens from PC patients obtained from the cancer area (zone A) and the adjacent tumor-free area (zone B) were examined immunohistochemically. The size of islets, the number on ß-, α-, δ- pp- and IAPP-expressing cells and their ratios in the islets of these tissues were determined. Results: In the normal pancreas, only 50% of the ß-cells while α- and δ-cells co-expressed IAPP only sporadically. In tissues from diabetics as well as in zone A, the number of the ß-cells and the IAPP-expressing cells was reduced significantly, while the number of α- and δ-cells was increased. In zone B, however, significantly more ß-cell and IAPP-expressing cells and a significantly lower number of α-cells were found compared to those in zone A. Significant differences were also found between the specimens from type 2 diabetics and pancreatic cancer relative to the ratios of IAPP/ß-cell, IAPP/α-cells and ß-cell/δ-cells. Conclusion: The morphometric data show a decrease rather than an increase in the number of IAPP-expressing cells in PC. Differences in abnormalities in type-2 diabetics and in zone B of PC tissue strongly argue against the role of type 2 diabetes in PC. Rather, the development of diabetes in subjects prone to pancreatic cancer could be a red flag for malignanc