Comparative Histopathological Characteristics of Duodenal Involvement in Different Types of Amyloidosis

Background/Objectives: The duodenum is commonly involved in systemic amyloidosis. This retrospective observational study describes histoanatomical distributions of different types of duodenal amyloidosis to improve the diagnostic value of duodenal biopsies. Methods: We examined 21 biopsy and 16 autopsy specimens from duodenal amyloidosis patients. Immunohistochemical typing was performed using a broad panel of antibodies against different amyloid types. Results: AL lambda amyloidosis was determined in 5 (13%) biopsies and 7 (18%) autopsies, exhibiting interstitial and intravascular amyloid deposition patterns in 11 (92%) cases; AL kappa amyloidosis-in 7 (18%) biopsies and 1 (3%) autopsy, presenting with a combined interstitial and intravascular deposition pattern in 6 (75%) cases; transthyretin amyloidosis-in 2 (5%) biopsies and 2 (5%) autopsies, showing focal interstitial and intravascular deposits; and AA amyloidosis-in 7 (19%) biopsies and 6 (16%) autopsies, demonstrating a combined pattern of amyloid deposition. Regardless of the specific amyloid type, in 33 (89%) of 37 cases, amyloid deposits were determined in the muscularis mucosae and submucosa of the small intestine, while in the lamina propria, amyloid depositions were found only in 29 (78%) cases. Conclusions: When diagnosing duodenal amyloidosis, superficial biopsies can lead to false negative results. This is particularly true for ATTR amyloidosis, where mucosal involvement is rare. The most extensive amyloid deposits were observed in AL kappa amyloidosis. Gastrointestinal bleeding was a more frequent complication of AA amyloidosis stemming from the extensive amyloid deposits within the lamina propria which cause vascular fragility and friability.