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A 62-year-old asymptomatic and healthy man without any medical history and not taking medications was referred to colonoscopy as part of the national colon cancer screening programme due to a positive faecal occult blood test. Colonoscopy revealed three granular, polypoid protrusions located orally in ascending colon (figure 1A) with the proximal lesion raising suspicion of malignancy (figure 1B). Biopsy specimens from the proximal and distal lesions and from coecum showed, surprisingly, amyloid deposits on H&E (figure 2A) and confirmed by positive Congo red staining (figure 2B) and apple-green birefringence under polarised light. Immunohistochemistry was without detection of amyloid A but had numerous plasma cells in lamina propria raising suspicion of amyloid light-chain (AL) amyloidosis. Coherently, immune-electron microscopy revealed amyloid fibrils consisting of …
Contributors Study concept and design: CS. Acquisition of data: CS and LBR. Analysis and interpretation of data: all authors. Drafting of the manuscript: CS. Critical revision of the manuscript for important intellectual content: all authors. Final approval: all authors.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests CS speaker and advisory board member for MSD and Janssen-Cilag. LBR speaker for Takeda.
Provenance and peer review Not commissioned; internally peer reviewed.