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Huang HP, Tsai SF. A Rare Case of Amyloidoma of the Chest Wall Presented with Fever of Unknown Origin. Diagnostics (Basel) 2022; 12:diagnostics12040906. [PMID: 35453954 PMCID: PMC9032845 DOI: 10.3390/diagnostics12040906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 03/29/2022] [Accepted: 04/05/2022] [Indexed: 02/01/2023] Open
Abstract
Amyloidoma of the chest wall is an uncommon entity, consisting of a solitary tumor-like deposit of amyloid. Until now, while rarely reported, it was mostly presented with back pain and swelling. Here, we report the first case of a chest wall amyloidoma initially presented with fever of unknown origin. Due to the rarity of the lesion as a primary entity, protein electrophoresis and long-term follow-up are required. In addition, patients undergoing long-term hemodialysis are particularly at risk for such acquired amyloidosis. However, soft-tissue tumors, considered as amyloidoma, is also rare in patients with long-term hemodialysis. For patients with a fever of unknown primary origin, clinicians should keep amyloidoma in mind, especially in high-risk populations.
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Affiliation(s)
- Hsien-Po Huang
- Department of Internal Medicine, Taichung Veterans General Hospital, Taichung 40705, Taiwan;
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung 40227, Taiwan
| | - Shang-Feng Tsai
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung 40227, Taiwan
- Department of Life Science, Tunghai University, Taichung 40705, Taiwan
- Department of Medicine, National Yang Ming University, Taipei 11221, Taiwan
- Division of Nephrology, Department of Internal Medicine, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sect. 4, Taichung 40705, Taiwan
- Correspondence:
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Crain MA, Vasilakis GM, Adkins JR, Adelanwa A, Hogg JP, Lakhani DA, Kim C. Primary nodular chest amyloidoma: A case report and review of literature. Radiol Case Rep 2022; 17:631-637. [PMID: 35027986 PMCID: PMC8715137 DOI: 10.1016/j.radcr.2021.11.048] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 11/21/2021] [Indexed: 11/28/2022] Open
Abstract
Primary nodular chest wall amyloidoma, in which a solitary mass of amyloid is deposited in and around the lungs with no evidence of systemic amyloidosis, is extremely rare, most often asymptomatic, and may resemble primary bronchogenic carcinoma. As a result, there are fewer than 100 cases published in the literature and no controlled clinical trials. Primary nodular chest wall amyloidoma is typically diagnosed either as an incidental radiological finding or after very serious and destructive mass growth at which point late-stage respiratory and pain symptoms finally develop, most often in elderly patients. We present imaging studies of a 61-year-old male patient with an unusually massive and destructive chest wall mass, originating in the chest wall, diagnosed as chest wall amyloidoma by histopathology analysis. Our CT, MRI, and PET scan findings are consistent with and contribute to the developing pattern of imaging characteristics seen in other case studies, which can be used to identify amyloidoma before it becomes destructive using non-invasive imaging analyses.
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Affiliation(s)
| | | | | | - Ayodele Adelanwa
- Department of Pathology, West Virginia University, Morgantown, WV
| | - Jeffery P Hogg
- Department of Pathology, West Virginia University, Morgantown, WV
| | | | - Cathy Kim
- Section of Cardiothoracic Imaging, Department of Radiology, West Virginia University, 1 Medical Center Drive Morgantown, WV 26506, USA
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Nasir J, Der Mesropian PJ, Foulke L, Salman L, Haqqie S, Shaikh G. Hemodialysis-associated soft tissue amyloidomas of the chest and abdominal wall. Hemodial Int 2019; 24:E1-E4. [PMID: 31680424 DOI: 10.1111/hdi.12791] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 09/09/2019] [Accepted: 09/10/2019] [Indexed: 11/30/2022]
Abstract
Amyloidoma is a highly unusual presentation of amyloidosis in tumoral or nodular form. Isolated soft tissue amyloidomas in individuals with end-stage renal disease on chronic hemodialysis is exceedingly rare, particularly in the era of advanced dialysis technologies. We report the case of a 55-year-old male with end-stage renal disease due to autosomal-dominant polycystic kidney disease, on HD for over 30 years, who was found to have soft-tissue, dialysis-related (β2 -microglobulin) amyloidomas (DRA). He presented with painful, palpable masses within the thoracic and abdominal walls. Serum β2 -microglobulin level was only mildly elevated at 24.9 mg/L. Biopsy confirmed amyloidosis with positivity for Congo Red staining and apple-green birefringence under polarized light. Amyloid subtyping with immunohistochemistry showed positive β2 -microglobulin staining within the deposits. Conservative therapy involving pain management and close monitoring resulted in eventual improvement in symptoms and thus proved to be a viable option for treatment.
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Affiliation(s)
- Junaid Nasir
- Department of Medicine, Division of Nephrology, Albany Medical Center, Albany, New York, USA
| | - Paul J Der Mesropian
- Department of Medicine, Division of Nephrology, Albany Medical Center, Albany, New York, USA
| | - Llewellyn Foulke
- Department of Pathology, Albany Medical Center, Albany, New York, USA
| | - Loay Salman
- Department of Medicine, Division of Nephrology, Albany Medical Center, Albany, New York, USA
| | - Syed Haqqie
- Department of Medicine, Division of Nephrology, Albany Medical Center, Albany, New York, USA
| | - Gulvahid Shaikh
- Department of Medicine, Division of Nephrology, Albany Medical Center, Albany, New York, USA
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Safi S, Op den Winkel J, Schnabel PA, Hegenbart U, Neben K, Schneider T, Dienemann H. Extended resection of a plasmocytoma of bone and an amyloidoma of the chest wall. Ann Thorac Surg 2013; 96:2223-5. [PMID: 24296191 DOI: 10.1016/j.athoracsur.2013.04.109] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2013] [Revised: 03/25/2013] [Accepted: 04/02/2013] [Indexed: 12/01/2022]
Abstract
Solitary plasmocytoma of bone is a rare condition of plasma cell neoplasia that presents as a single lesion. Amyloidoma of the chest wall is an uncommon presentation of solitary tissue amyloid deposition in the absence of systemic light-chain amyloidosis. This report describes a patient with both uncommon conditions. The tumor originated from the spine and invaded the right lung. In this exceedingly rare case, radiotherapy and a two-step resection of the right lower lobe, full-thickness chest wall, diaphragm, and vertebral body of T9 provided local control of the tumor. Spondylodesis of T7 to T11 provided spine stability.
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Affiliation(s)
- Seyer Safi
- Department of Thoracic Surgery, Thoraxklinik, University of Heidelberg, Heidelberg, Germany.
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Kumar S, Kumar S, Ahmad A, Kumar A. Primary amyloidoma of chest wall--a rare condition. BMJ Case Rep 2012; 2012:bcr.01.2012.5552. [PMID: 22605798 DOI: 10.1136/bcr.01.2012.5552] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Organ specific amyloidosis has been shown to be confined to various organs like liver, lung, spleen, urinary bladder and gastro-intestinal tract, but amyloidoma or tumoural amyloidosis of chest wall with no evidence of systemic amyloidosis is an extremely rare presentation and only two cases have been reported till now. The authors report a case of chest wall amyloidoma with review of literature.
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Affiliation(s)
- Suresh Kumar
- General Surgery Department, CSM (Erstwhile King George's) Medical University, Lucknow, Uttar Pradesh, India
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D'Alessandro P, Carey-Smith R, Wood D. Large resection and reconstruction of primary parietal thoracic sarcoma: a multidisciplinary approach on 11 patients at minimum 2-years follow-up. Orthop Traumatol Surg Res 2011; 97:73-8. [PMID: 21159567 DOI: 10.1016/j.otsr.2010.09.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2010] [Revised: 07/13/2010] [Accepted: 09/06/2010] [Indexed: 02/02/2023]
Abstract
BACKGROUND Thoracic sarcomas are rare, and resection can leave behind defects that require significant reconstruction by the multidisciplinary surgical team. The aim of this study is to review the experience of our regional referral centre with primary thoracic tumor resection and thoracic reconstruction. METHODS We have reviewed the treatment of all chest wall tumors resected at Sir Charles Gairdner Hospital in Western Australia over a 5-year period. There were 11 cases in total that involved removal of deep muscle, ribs and/or sternum. RESULTS In the six cases that required bony resection, the surgical team utilized a Gore-Tex (e-PTFE) mesh prosthesis to allow immediate closure of the defect, whilst five other closures were achievable using primary layered closure alone. Four patients had postoperative complications, including one who required prosthesis removal. Mean length of hospital stay was 5 days. No 30-day or 6-month mortality was recorded. All patients were followed-up for a minimum of 24 months, and all patients were alive and free of disease at their most recent follow-up. CONCLUSIONS This study concurs with previous literature indicating that thoracic tumor resection and immediate reconstruction often involving use of prosthetic mesh is a safe and effective one stage surgical procedure for a variety of chest wall defects with low postoperative morbidity.
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Affiliation(s)
- P D'Alessandro
- Orthopaedic Department, Sir Charles Gairdner Hospital, Perth, Western Australia.
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Fierens J, Mees U, Vanbockrijck M, Hendrikx M. Amyloidoma of the chest wall: a rare entity. Interact Cardiovasc Thorac Surg 2008; 7:1194-5. [PMID: 18710843 DOI: 10.1510/icvts.2008.178921] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Amyloidoma (tumoral amyloidosis) is defined as a solitary localized tumor-like deposit of amyloid, in the absence of systemic amyloidosis. Amyloidoma is the least common presentation of tissue amyloid deposition, reported in many anatomic sites including the respiratory, genitourinary and gastrointestinal tracts, as well as the central nervous system, skin, breast and soft tissue. Amyloidoma of the chest wall is extremely rare, and to date only one case has been reported in literature. The authors present a case of a chest wall tumor that causes local destruction, being an amyloidoma on histopathologic examination. It was treated with wide local excision, with no recurrence during almost two years of follow-up. A search for occult systemic disease is recommended and was also performed.
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Affiliation(s)
- Johan Fierens
- Department of Cardio-thoracic surgery, Virga Jesse Hospital, Hasselt, Belgium
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Dee CH, Missirian RJ, Chernoff IJ. Primary amyloidoma of the spine. A case report and review of the literature. Spine (Phila Pa 1976) 1998; 23:497-500. [PMID: 9516708 DOI: 10.1097/00007632-199802150-00019] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
STUDY DESIGN A rare case is reported of primary or idiopathic amyloidoma of the spine derived from production of light chain immunoglobulins. The tumor was successfully treated by anterior decompression and fusion with a fibula strut allograft. OBJECTIVE To describe a rare case of AL amyloidoma of the spine. SUMMARY OF BACKGROUND DATA Radiographic characteristics of this benign deposit are similar to harmful aggressive conditions afflicting the spine. RESULTS The patient returned to full function after the surgery with no evidence of systemic amyloidosis or development of multiple myeloma. METHODS An isolated AL amyloidoma of the spine was resected and successfully reconstructed with a fibula strut allograft and internal fixation. CONCLUSIONS Isolated deposits of amyloid in the spine occur very rarely. When no evidence of myeloproliferative disease or systemic amyloidosis is found, prognosis is excellent. The deposit, when it occurs in the spine has a predilection for the thoracic region and can cause neurologic compromise, pain, and deformity that is responsive to decompression and fusion. The diagnosis of primary amyloidoma requires histologic studies for confirmation.
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Affiliation(s)
- C H Dee
- Division of Orthopaedic Surgery, Southern Illinois University, Springfield, USA
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