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Takakura H, Tachino H, Takii K, Imura J, Shojaku H. Localized Amyloidosis of the Nasal Mucosa: A Case Report and Review of the Literature. Front Surg 2021; 8:774469. [PMID: 34805263 PMCID: PMC8602088 DOI: 10.3389/fsurg.2021.774469] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 10/15/2021] [Indexed: 12/11/2022] Open
Abstract
Amyloidosis is a disorder of protein folding in which various proteins automatically aggregate into a highly abnormal fibrillar conformation. Amyloidosis is classified into systemic and localized forms depending on whether the abnormal proteins deposited in several different organs or only a single organ. In localized amyloidosis of the head and neck regions, laryngeal amyloidosis is common; however, localized amyloidosis of the nose is extremely rare. We herein report a case of localized amyloidosis of the nose and review the relevant literature on localized sinonasal amyloidosis. A 41-year-old man presented with a history of severe nasal obstruction, which had persisted for two decades. Nasal endoscopy and imaging studies showed extensive thickening of the bilateral nasal mucosa and diffuse submucosal deposition of calcification. After histopathological and systemic examinations, he was diagnosed with localized amyloidosis of the nasal mucosa. Septoplasty and bilateral inferior turbinoplasty, which consisted of mucosal resection using an ultrasonic bone curette, was performed and his symptoms markedly improved. Localized sinonasal amyloidosis has a good prognosis and surgical resection should be selected as a first-line treatment; however, clinicians should recognize the high probability of recurrence.
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Affiliation(s)
- Hiromasa Takakura
- Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine, Academic Assembly, University of Toyama, Toyama, Japan
| | - Hirohiko Tachino
- Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine, Academic Assembly, University of Toyama, Toyama, Japan
| | - Kouji Takii
- Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine, Academic Assembly, University of Toyama, Toyama, Japan
| | - Johji Imura
- Department of Diagnostic Pathology, Faculty of Medicine, Academic Assembly, University of Toyama, Toyama, Japan
| | - Hideo Shojaku
- Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine, Academic Assembly, University of Toyama, Toyama, Japan
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Onishi T, Yasuda M, Koida A, Inui TA, Okamoto S, Hirano S. A Case of Primary Systemic Amyloidosis Involving the Sinonasal Tract. EAR, NOSE & THROAT JOURNAL 2020; 100:NP397-NP401. [PMID: 32364447 DOI: 10.1177/0145561320922719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
We present a case of primary systemic amyloidosis diagnosed by endoscopic sinus surgery. A 75-year-old woman had blurred vision in her left eye; computed tomography and magnetic resonance imaging showed shadows of the bilateral paranasal sinuses. Endoscopic sinus surgery was performed, and amyloidosis was diagnosed by histopathology. She had previously been diagnosed with amyloidosis of the stomach, and therefore, she was diagnosed with primary systemic amyloidosis. A systemic workup for additional amyloid deposits revealed no evidence of other diseases. The patient remained under follow-up without further treatment, as no further amyloid deposition or progression of the lesions was seen. Amyloidosis is a rare condition characterized by the deposition of abnormal protein filaments in the extracellular tissue. Generally, systemic amyloidosis does not involve the head and neck region, and the presence of amyloid in the nasal and paranasal sinus mucosa is more likely to be indicative of a localized process. However, in our patient, the lesions were located in both the sinonasal tract and the stomach, indicating systemic amyloidosis. To our knowledge, there have been no previous reports of systemic amyloidosis involving the sinonasal tract, and therefore, we consider this case to be extremely rare.
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Affiliation(s)
- Toshinori Onishi
- Department of Otolaryngology-Head and Neck Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Makoto Yasuda
- Department of Otolaryngology-Head and Neck Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Atsuhide Koida
- Department of Otolaryngology-Head and Neck Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Taka-Aki Inui
- Department of Otolaryngology-Head and Neck Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Shota Okamoto
- Department of Otolaryngology-Head and Neck Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Shigeru Hirano
- Department of Otolaryngology-Head and Neck Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
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3
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Agrawal A, Makhecha M, Rambhia K. Primary Systemic Amyloidosis Mimicking Rhinophyma. Indian Dermatol Online J 2019; 10:204-205. [PMID: 30984606 PMCID: PMC6434763 DOI: 10.4103/idoj.idoj_163_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Affiliation(s)
- Ankita Agrawal
- Department of Dermatology, HBT Medical College and Cooper Hospital, Mumbai, Maharashtra, India
| | - Meena Makhecha
- Department of Dermatology, HBT Medical College and Cooper Hospital, Mumbai, Maharashtra, India
| | - Kinjal Rambhia
- Department of Dermatology, HBT Medical College and Cooper Hospital, Mumbai, Maharashtra, India
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4
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Wahid NW, Abed T, Meghji S, Gilbertson J, Barnes M. Localized Sinonasal Amyloidosis. ALLERGY & RHINOLOGY 2019; 10:2152656719860821. [PMID: 31321117 PMCID: PMC6611016 DOI: 10.1177/2152656719860821] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Localized amyloidosis involving the nasal mucosa is rare, with only 38 published cases reported to date. We report a case of amyloidosis localized to the sinonasal tract. A 61-year-old man presented with a 1-year history of left-sided nasal obstruction. Endoscopic examination and computed tomography revealed the presence of a nasal mass originating from the left inferior turbinate. The patient subsequently underwent an examination under anesthesia and an excision biopsy of the nasal mass. Histology confirmed amyloidosis with no immunospecific stains. Systemic amyloidosis testing was negative, leading to a diagnosis of localized sinonasal amyloidosis of nonamyloid A (AA) subtype. To our knowledge, this is the second reported case of non-AA subtype of the sinonasal tract. The patient was managed conservatively and is currently under close follow-up.
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Affiliation(s)
| | - Tarik Abed
- ENT Department, Southend University Hospital, Westcliff-on-Sea, UK
| | - Sheneen Meghji
- ENT Department, Southend University Hospital, Westcliff-on-Sea, UK
| | - Janet Gilbertson
- National Amyloidosis Centre, University College London, Royal Free Hospital, London, UK
| | - Martyn Barnes
- ENT Department, Southend University Hospital, Westcliff-on-Sea, UK
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Singh A, Handa KK, Kumar A. Idiopathic Isolated Nasal Amyloidosis: Report of a Rare Case with Review of Literature. Indian J Otolaryngol Head Neck Surg 2018; 71:2106-2109. [PMID: 31763302 DOI: 10.1007/s12070-018-1528-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 11/08/2018] [Indexed: 11/26/2022] Open
Abstract
Deposition of amyloid in localized form is rare and most often involves head and neck region. Localized amyloidosis carries good prognosis with surgical debridement offering symptomatic benefit. We present an adolescent male presenting with localized sinonasal amyloidosis managed previously with conservative surgical debridement. The patient was symptomatic from early childhood and the previous histopathological reports were non-specific inflammation. A repeat biopsy revealed features of amyloidosis and retrospective review of past slides revealed the same. On explaining the course of the disease and prognosis, the patient opted for regular follow up. A pertinent comprehensive literature review of the condition is discussed.
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Affiliation(s)
- Anup Singh
- 1Department of Otolaryngology and Head and Neck Surgery, Medanta- The Medicity, Gurugram, Haryana India
- 38th Floor, Department of ENT and Head and Neck Surgery, Medanta- The Medicity, Gurugram, Haryana 122001 India
| | - Kumud Kumar Handa
- 1Department of Otolaryngology and Head and Neck Surgery, Medanta- The Medicity, Gurugram, Haryana India
| | - Avinash Kumar
- 2Department of Pathology, Medanta- The Medicity, Gurugram, India
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Chowsilpa S, Chaiyasate S, Wannasai K, Daroontum T. Localised nasopharyngeal amyloidosis: the importance of postoperative follow-up. BMJ Case Rep 2018; 2018:bcr-2017-222067. [PMID: 29444790 DOI: 10.1136/bcr-2017-222067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Localised nasopharyngeal amyloidosis is rare. Findings on physical examination and invasive pattern on CT scan can be misleading as it can resemble nasopharyngeal carcinoma. A 64-year-old man presented with left aural fullness for 6 months. The physical examination showed straw-coloured fluid in the left middle ear and irregular reddish mass at the left side of the nasopharynx. The CT scan showed a lobulated heterogeneous mass at the left side of the nasopharynx involving the left Eustachian tube opening. Pathology report was amyloidosis, thus, surgery was done. After a year, there were new foci of amyloidosis at the right side of the nasopharynx, and a repeat surgery was performed. Two years later, the systemic amyloidosis with underlying IgG4-related disease was suspected due to multiple organ involvement. Surgery is the treatment for localised amyloidosis with compressive symptoms. Close follow-up is important after surgical excision due to its recurrence and progression to systemic amyloidosis.
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Affiliation(s)
- Sanathorn Chowsilpa
- Department of Otolaryngology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Saisawat Chaiyasate
- Department of Otolaryngology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Komson Wannasai
- Department of Pathology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Teerada Daroontum
- Department of Pathology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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Lang SM, Täuscher D, Füller J, Müller AH, Schiffl H. Multifocal primary amyloidosis of the airways: Case report and review of the literature. Respir Med Case Rep 2015; 15:115-7. [PMID: 26236619 PMCID: PMC4501523 DOI: 10.1016/j.rmcr.2015.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2015] [Accepted: 05/03/2015] [Indexed: 12/20/2022] Open
Abstract
Primary localized amyloidosis of the airways is an uncommon disorder characterized by amyloid deposits in the airway mucosa. In contrast to systemic amyloidosis other organs are not involved. Among the entities of airway amyloidosis, tracheobronchial amyloidosis is comparatively the most common subtype in the lower respiratory tract and laryngeal amyloidosis in the upper respiratory tract. The pathophysiology of localized airway amyloidosis is poorly understood. The clinical presentation is variable and often non-specific. No general consensus exists with regard to optimal treatment resulting in a variety of modalities used in clinical practice to manage this disorder. We report the case of a 50 year old woman with multifocal localized amyloidosis of the tracheobronchial tree and the upper airways. Tracheobronchial amyloidosis was treated with endoscopic debulking and external beam radiation, sinunasal amyloid deposits were surgically excised and are currently under surveillance. The importance of this extremely rare case lies in the multifocal presentation of an uncommon disorder requiring a multidisciplinary approach to offer optimal treatment including external beam radiation.
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Affiliation(s)
- S M Lang
- SRH Wald-Klinikum Gera, Department of Respiratory Medicine, Germany
| | - D Täuscher
- SRH Wald-Klinikum Gera, Department of Respiratory Medicine, Germany
| | - J Füller
- SRH Wald-Klinikum Gera, Department of Radiation Therapy, Germany
| | - A H Müller
- SRH Wald-Klinikum Gera, Department of Otolaryngology/Head and Neck Surgery, Germany
| | - H Schiffl
- Medizinische Klinik IV, University Hospital LMU Munich, Germany
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Østevik L, Gunnes G, de Souza GA, Wien TN, Sørby R. Nasal and ocular amyloidosis in a 15-year-old horse. Acta Vet Scand 2014; 56:50. [PMID: 25159190 PMCID: PMC4223893 DOI: 10.1186/s13028-014-0050-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Accepted: 08/08/2014] [Indexed: 11/16/2022] Open
Abstract
Localized nasal, conjunctival and corneal amyloidosis was diagnosed in a 15-year-old pony with nasal and conjunctival masses and severe dyspnoea. Multiple swellings had been evident in the nostrils for at least two years and had gradually increased in size before presentation due to dyspnoea and exercise intolerance. Surgical debulking of the masses was performed and histological examination revealed large amounts of extracellular, hyaline, eosinophilic, Congo red positive material in the lamina propria of the nasal mucosa. A tentative diagnosis of localized nasal amyloidosis was made. The treatment relieved the clinical signs, however, the nasal masses recurred and bilateral conjunctival, papillary masses developed. The horse was euthanized. Nodular nasal and papillary conjunctival masses consisting of rubbery, grey to yellow tissue were found at necropsy. At the limbus this tissue infiltrated and expanded the cornea. The masses consisted of amyloid and moderate infiltrates of T lymphocytes and B lymphocytes were present in the tissue. No predominance of either cell type was observed and no distinct neoplastic mass could be identified. Ultrastructural examination of the nasal mucosa and cornea confirmed the presence of abundant extracellular deposits of non-branching fibrils ranging from 9–11 nm in diameter consistent with amyloid. Immunohistochemistry of amyloid revealed no labelling for AA amyloid, and no peptides representing serum amyloid A (SAA) were detected by microscopic laser dissection and subsequent mass spectrometry. Peptides from immunoglobulin kappa-like light chains were detected and are suggestive of AL amyloidosis, however the results were inconclusive and a final identification of the amyloid protein could not be made. Nasal amyloidosis is a clinical entity of localized amyloid deposits in the horse. Localized amyloidosis involving the conjunctiva of the horse is previously described in only seven cases and the present case is the first case of combined, localized nasal and corneal amyloidosis in the horse. In several reported cases surgical excision has provided clinical improvement and return to normal levels of exercise, while medical treatment has had no effect. The present case however, shows that rapid recurrence and progression of nasal amyloidosis to involve ocular tissues can occur and lead to recurrent respiratory obstruction.
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Mirza AH, El-Shunnar S, Sama A. Nasopharyngeal amyloidosis: an unusual cause of unilateral hearing loss. J Surg Case Rep 2013; 2013:rjs048. [PMID: 24964411 PMCID: PMC3789629 DOI: 10.1093/jscr/rjs048] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Amyloidosis is typically a systemic depositional disease, diagnosed on clinical symptoms and signs in conjunction with histopathology. When occurring on a localized basis in the head and neck, the lesion is most commonly observed in the larynx. Primary localized nasal amyloidosis however is an uncommon finding, with 25 reported cases in the literature to date. We present the case of a young woman presenting with primary localized nasal amyloidosis secondary to the curious symptoms of unilateral hearing loss.
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Affiliation(s)
- A H Mirza
- Department of Otorhinolaryngology and Head and Neck Surgery, Nottingham University Hospitals Trust, Nottingham, UK
| | - Suliman El-Shunnar
- Department of Otorhinolaryngology and Head and Neck Surgery, Nottingham University Hospitals Trust, Nottingham, UK
| | - Anshul Sama
- Department of Otorhinolaryngology and Head and Neck Surgery, Nottingham University Hospitals Trust, Nottingham, UK
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