Upper Gastrointestinal Bleeding from Gastric Amyloidosis in a Patient with Smoldering Multiple Myeloma

Figure 1

Initial EGD performed for an acute episode of melena in a 92-year-old woman with smoldering multiple myeloma (SMM) revealed a well-organized, hemispherical, 11 × 6 cm tightly adherent clot attached to the midgastric body that that could not be detached despite vigorous endoscopic irrigation and aspiration (a). About eight, 3–5 mm wide sessile polyps (nodules) were present in the gastric fundus and body, devoid of stigmata of recent hemorrhage, two of which were present at the 8 o’clock position. Repeat EGD performed one day later revealed that the clot had mostly dissolved exposing a 2.5 × 2 cm ulcerated mass, mostly covered by a clot in the midgastric body along the lesser curvature (b).

(a)

(b)