Sachdeva S, Sirohi N, Mandal K, Bansal D, Vaithiyam V, Dalal A, Goyal S, Sakhuja P. Esophageal stricture due to amyloidosis in plasma cell dyscrasia: A case report and review of literature. World J Clin Cases 2026; 14(28): 127546 [DOI: 10.12998/wjcc.127546]
Corresponding Author of This Article
Venkatesh Vaithiyam, DM, MD, Consultant, Department of Gastroenterology, Apollo Speciality Hospital, 80 Feet Road, Lake View Road, Deputy Collector Colony, Madurai 625020, Tamil Nādu, India. venkateshvaithiyam172@gmail.com
Research Domain of This Article
Gastroenterology & Hepatology
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case-report
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Sachdeva S, Sirohi N, Mandal K, Bansal D, Vaithiyam V, Dalal A, Goyal S, Sakhuja P. Esophageal stricture due to amyloidosis in plasma cell dyscrasia: A case report and review of literature. World J Clin Cases 2026; 14(28): 127546 [DOI: 10.12998/wjcc.127546]
Sanjeev Sachdeva, Nikhil Sirohi, Koushik Mandal, Dhruv Bansal, Venkatesh Vaithiyam, Ashok Dalal, Department of Gastroenterology, Govind Ballabh Pant Institute of Post Graduate Medical Education and Research, New Delhi 110002, Delhi, India
Venkatesh Vaithiyam, Department of Gastroenterology, Apollo Speciality Hospital, Madurai 625020, Tamil Nādu, India
Surbhi Goyal, Puja Sakhuja, Department of Pathology, Govind Ballabh Pant Institute of Post Graduate Medical Education and Research, New Delhi 110002, Delhi, India
Author contributions: Sirohi N and Vaithiyam V wrote the original draft; Mandal K, Bansal D, and Sachdeva S contributed to patient care, conceptualization, writing, reviewing, and editing; Sirohi N, Dalal A, and Vaithiyam V participated in drafting the manuscript; Sakhuja P and Goyal S performed the pathological review of the patient; Sachdeva S performed the final review of the manuscript; and all authors have read and approved the final version of the manuscript.
AI contribution statement: ChatGPT, Grammarly, and Paperpal were also used for language editing, grammar correction, and sentence refinement. All AI-assisted content was reviewed and verified by the authors, who take full responsibility for the final manuscript and figures.
Informed consent statement: Written informed consent was obtained from the patient for publication of this report and accompanying images.
Conflict-of-interest statement: All authors declare that they have no conflict of interest to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Corresponding author: Venkatesh Vaithiyam, DM, MD, Consultant, Department of Gastroenterology, Apollo Speciality Hospital, 80 Feet Road, Lake View Road, Deputy Collector Colony, Madurai 625020, Tamil Nādu, India. venkateshvaithiyam172@gmail.com
Received: September 1, 2026 Revised: October 4, 2026 Accepted: October 20, 2026 Published online: October 26, 2026 Processing time: 52 Days and 17.2 Hours
Abstract
BACKGROUND
Esophageal involvement in amyloidosis is rare and may present with progressive dysphagia from stricture formation. This report describes a rare case of esophageal amyloidosis associated with an underlying plasma cell dyscrasia.
CASE SUMMARY
A 65-year-old woman presented with a 3-month history of progressive dysphagia, weight loss, and anorexia. Her hemoglobin was 11.1 g/dL, with serum albumin 3.1 g/dL and globulin 5.1 g/dL. Barium swallow demonstrated a short, concentric stricture in the upper esophagus. Upper gastrointestinal endoscopy revealed luminal narrowing with mucosal erythema, fine nodularity, and small ulcerations. Histopathological examination of the esophageal biopsy showed abundant amorphous, eosinophilic extracellular material in the subepithelial stroma. The deposits were Congo red-positive and periodic acid-Schiff-negative. Immunohistochemistry indicated lambda light chain positivity. Serum protein electrophoresis suggested an M spike, with markedly elevated serum free lambda light chains and normal free kappa light chains. Diffuse, circumferential esophageal wall thickening was noted on whole-body positron emission tomography-computed tomography. Approximately 50% of plasma cells and immature plasmablasts, with CD38 and CD138 positivity and lambda light-chain restriction, were identified on bone marrow examination, confirming an underlying plasma cell dyscrasia. The esophageal stricture was successfully treated with endoscopic balloon dilation, resulting in significant symptomatic improvement. The patient was subsequently referred to hematology-oncology for definitive treatment of the underlying plasma cell dyscrasia.
CONCLUSION
Esophageal amyloidosis is a rare cause of esophageal stricture and progressive dysphagia and must be confirmed histopathologically via Congo red staining and amyloid typing. An underlying plasma cell dyscrasia must be identified, as definitive treatment should target the hematologic disorder.
Core Tip: Esophageal involvement in systemic amyloidosis is rare and presents in variable ways. We report a 65-year-old woman with progressive dysphagia, weight loss, and an upper esophageal stricture. Biopsy demonstrated Congo red-positive amyloid with lambda light-chain restriction, and bone marrow examination revealed approximately 50% lambda-restricted plasma cells, establishing an underlying plasma-cell dyscrasia. Although fat-pad and rectal biopsies were negative, a direct esophageal biopsy confirmed amyloid deposition at the site of disease. Endoscopic balloon dilation resulted in complete resolution of dysphagia, and daratumumab, bortezomib, cyclophosphamide, and dexamethasone therapy was initiated for disease modification.
