J Med Cases

Journal of Medical Cases, ISSN 1923-4155 print, 1923-4163 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Med Cases and Elmer Press Inc

Journal website http://www.journalmc.org

Case Report

Volume 4, Number 3, March 2013, pages 166-169

Isolated Russell Body Duodenitis with Concurrent Helicobacter Pylori Gastritis

Figure 1. The EGD revealed normal gastric cardia (A) and antrum (B) but mild nodularity in the duodenal bulb (C) and nonspecific duodenitis in the second portion of duodenum (D).

Figure 2. Mild chronic gastritis with patchy activity (A, HE stain, 200×) and the presence of H. pylori organisms (B, immunoperoxidase stain, 400×). There were no Russell body-containing plasma cells.

Figure 3. Duodenal mucosa had dense Russell body-containing plasma cells (A, HE stain, 100×; B, HE stain, 400×) in some fragments and Brunner’s gland hyperplasia, gastric foveolar metaplasia, and active inflammation in other fragments (C, HE stain, 400×).

Figure 4. These plasma cells were polytypic for kappa light chain (A, immunoperoxidase stain, 400×) and lambda light chain (B, immunoperoxidase stain, 400×) but stained negative for CD138 (C, immunoperoxidase stain, 400×), CD68 and pan-cytokeratin (AE1/AE3) (D and E, immunoperoxidase stain, 200×).

**Table 1.** Demographic, Clinical, Endoscopic, and Pathologic Features of Russell Body Duodenitis
Author	Age at Diagnosis	Sex	Clinical Features	Endoscopic Features	Pathologic Features
Savage et al, 2011	55 yrs	M	2-week history abdominal pain; HIV positive with undetectable viral load and CD4 of 514 /mm³; history of lymphoma (5- year remission)	Non-specific gastritis and duodenitis without identifiable mass	Mild chronic gastritis, no Russell bodies, negative for H. pylori	Duodenal mucosa with dense infiltrate of plasma cells in lamina propria that contained numerous Russell bodies, mild peptic duodenitis	CD138+, cytokeratin-, polytypic kappa and lambda
Paniz Mondolfi et al, 2012	69 yrs	F	Multiple complaints of dysphagia with prior endoscopy showing Schatzki ring, and repeat showing esophagitis and gastroduodenitis; history of Crohn’s disease, cirrhosis, rheumatoid arthritis, morbid obesity with sleeve gastrectomy	Nodule within duodenal bulb	Negative for H. pylori	Enteric-type mucosa with gastric metaplasia and numerous lamina propria plasma cells containing Russell bodies	CD138+, CD68-, polytypic kappa and lambda
Current study	59 yrs	F	Epigastric pain, bloating, and diarrhea of several years duration; history of type II diabetes mellitus, gastroesophageal reflux disease and irritable bowel syndrome, and chronic obstruction pulmonary disease	Nodular mucosa in the duodenum, normal appearing esophagus and stomach	Mild chronic gastritis with patchy activity, no Russell bodies, positive for H. pylori	Duodenal mucosa with dense infiltrate of Russell body containing plasma cells in lamina propria, mild peptic duodenitis	CD138-, CD68-, AE1/AE3-, polytypic kappa and lambda

Table 1. Demographic, Clinical, Endoscopic, and Pathologic Features of Russell Body Duodenitis

Author

Age at Diagnosis

Sex

Clinical Features

Endoscopic Features

Pathologic Features

Stomach

Duodenum

Immunophenotype of Russel body containing plasma cells

Savage et al, 2011

55 yrs

2-week history abdominal pain; HIV positive with undetectable viral load and CD4 of 514 /mm³; history of lymphoma (5- year remission)

Non-specific gastritis and duodenitis without identifiable mass

Mild chronic gastritis, no Russell bodies, negative for H. pylori

Duodenal mucosa with dense infiltrate of plasma cells in lamina propria that contained numerous Russell bodies, mild peptic duodenitis

CD138+, cytokeratin-, polytypic kappa and lambda

Paniz Mondolfi et al, 2012

69 yrs

Multiple complaints of dysphagia with prior endoscopy showing Schatzki ring, and repeat showing esophagitis and gastroduodenitis; history of Crohn’s disease, cirrhosis, rheumatoid arthritis, morbid obesity with sleeve gastrectomy

Nodule within duodenal bulb

Negative for H. pylori

Enteric-type mucosa with gastric metaplasia and numerous lamina propria plasma cells containing Russell bodies

CD138+, CD68-, polytypic kappa and lambda

Current study

59 yrs

Epigastric pain, bloating, and diarrhea of several years duration; history of type II diabetes mellitus, gastroesophageal reflux disease and irritable bowel syndrome, and chronic obstruction pulmonary disease

Nodular mucosa in the duodenum, normal appearing esophagus and stomach

Mild chronic gastritis with patchy activity, no Russell bodies, positive for H. pylori

Duodenal mucosa with dense infiltrate of Russell body containing plasma cells in lamina propria, mild peptic duodenitis

CD138-, CD68-, AE1/AE3-, polytypic kappa and lambda