1
|
Gonzalez TV, Roden AC, Bartholmai BJ, Lindell RM. Pulmonary light chain deposition disease: Case series and review of the literature. Radiol Case Rep 2024; 19:3763-3769. [PMID: 38983277 PMCID: PMC11231504 DOI: 10.1016/j.radcr.2024.05.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 05/14/2024] [Accepted: 05/17/2024] [Indexed: 07/11/2024] Open
Abstract
Pulmonary light chain deposition disease is a rare entity characterized by immunoglobulin deposition within the lung parenchyma with pathologic features distinct from pulmonary amyloidosis. Here, the authors present the clinical presentation, associations, and radiologic features of pulmonary light chain deposition disease in a series of 4 patients as well as discuss the distinctions from amyloidosis. The present case series highlights the frequent presence of both cysts and nodules at CT. Clinically, lymphoma and/or autoimmune disease are often associated.
Collapse
Affiliation(s)
- Tomas V Gonzalez
- Department of Radiology, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA
| | - Anja C Roden
- Department of Pathology, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA
| | - Brian J Bartholmai
- Department of Radiology, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA
| | - Rebecca M Lindell
- Department of Radiology, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA
| |
Collapse
|
2
|
Lestelle F, Beigelman C, Rotzinger D, Si-Mohamed S, Nasser M, Wemeau L, Hirschi S, Prevot G, Roux A, Bunel V, Gomez E, Sohier L, Pradier HM, Gaubert MR, Gondouin A, Lazor R, Glerant JC, Bejui FT, Colombat M, Cottin V. Phenotypes and outcome of diffuse pulmonary non-amyloid light chain deposition disease. Respir Res 2024; 25:159. [PMID: 38600600 PMCID: PMC11005206 DOI: 10.1186/s12931-024-02798-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 04/01/2024] [Indexed: 04/12/2024] Open
Abstract
BACKGROUND Light chain deposition disease (LCDD) is a very rare entity. Clinical manifestations of LCDD vary according to the organs involved. Data on pulmonary LCDD are scarce and limited to small series or case reports. This study aimed to describe the characteristics and outcome of diffuse pulmonary non-amyloid LCDD localized to the lungs. STUDY DESIGN AND METHODS A multicenter retrospective cohort study was conducted. Clinical characteristics were collected, and chest CTs were centrally reviewed. The diagnosis of pulmonary non-amyloid LCDD was confirmed by immunohistochemistry. RESULTS Thirty-one cases were identified (68% female), with a median age at diagnosis of 50 years (IQR 20). Baseline FEV1/FVC was < 0.70 in 45% of patients. Mean (± SD) FEV1 and DLCO were 86% ± 26.2 and 52% ± 23.9, respectively. CT revealed peculiar patterns of thin-walled cysts (58%) and thin-walled cystic bronchiectases (27%). Increased serum kappa light chain was found in 87% of patients. Histological analysis showed kappa light chain deposits in all patients, except one with lambda chain deposits. Median annual FEV1 decline was 127 ml (IQR 178) and median DLCO decline was 4.3% (IQR 4.3). Sixteen patients received immunomodulatory treatment or chemotherapy; serum light chain levels decreased in 9 cases (75%), without significant improvement in FEV1 (p = 0.173). Overall, 48% of patients underwent bilateral lung transplantation. Transplant-free survival at 5 and 10 years were 70% and 30%, respectively. An annual FEV1 decline greater than 127 ml/year was associated with increased risk of death or transplantation (p = 0.005). CONCLUSIONS Diffuse pulmonary LCDD is characterised by female predominance, a peculiar imaging pattern with bronchiectasis and/or cysts, progressive airway obstruction and severe DLCO impairment, and poor outcome. Lung transplantation is a treatment of choice.
Collapse
Affiliation(s)
- François Lestelle
- Hospices Civils de Lyon, Centre de Référence Coordinateur Des Maladies Pulmonaires Rares (OrphaLung), Hôpital Louis Pradel, Service de Pneumologie, 69677, Lyon, France
| | - Catherine Beigelman
- Service de Radiologie Et de Radiologie Interventionnelle, Hôpital Universitaire de Lausanne, Université de Lausanne, Lausanne, Suisse
| | - David Rotzinger
- Service de Radiologie Et de Radiologie Interventionnelle, Hôpital Universitaire de Lausanne, Université de Lausanne, Lausanne, Suisse
| | - Salim Si-Mohamed
- Hospices Civils de Lyon, Hôpital Louis Pradel, Service de Radiologie, Lyon 69677U1206, Université de Lyon, INSA-Lyon, Université Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS, UMR 5220, F-69621, 7 Avenue Jean Capelle O, 69100, Villeurbanne, France
| | - Mouhamad Nasser
- Hospices Civils de Lyon, Centre de Référence Coordinateur Des Maladies Pulmonaires Rares (OrphaLung), Hôpital Louis Pradel, Service de Pneumologie, 69677, Lyon, France
| | - Lidwine Wemeau
- Centre de Référence Constitutif Des Maladies Pulmonaires Rares (OrphaLung), CHU Lille, Service de Pneumologie, Lille, France
| | - Sandrine Hirschi
- Centre de Compétence Des Maladies Pulmonaires Rares (OrphaLung), CHU Strasbourg, Service de Pneumologie, Strasbourg, France
| | - Grégoire Prevot
- Centre de Compétence Des Maladies Pulmonaires Rares (OrphaLung), CHU Toulouse, Hôpital LarreyUniversité Paul Sabatier, Toulouse, France
| | - Antoine Roux
- Service de Pneumologie Et de Transplantation Pulmonaire, Hopital Foch, Suresnes, France
| | - Vincent Bunel
- Service de Pneumologie B Et de Transplantation Pulmonaire, AP-HP, HĂ´pital Bichat Claude-Bernard, Inserm U1152, Paris, France
| | - Emmanuel Gomez
- Centre de Compétence Des Maladies Pulmonaires Rares (OrphaLung), CHU Nancy, Service de Pneumologie, Nancy, France
| | - Laurent Sohier
- Centre Hospitalier Bretagne Sud, Service de Pneumologie, Lorient, France
| | - Helene Morisse Pradier
- Centre de Compétence Des Maladies Pulmonaires Rares (OrphaLung), CHU Rouen, Service de Pneumologie, Rouen, France
| | - Martine Reynaud Gaubert
- Service de Pneumologie Et Transplantation Pulmonaire, CHU Marseille Nord, Aix-Marseille Université Marseille, Assistance Publique-Hôpitaux de Marseille, Marseille, France
| | - Anne Gondouin
- Centre de Compétence Des Maladies Pulmonaires Rares (OrphaLung), CHU Besançon, Service de Pneumologie, Besançon, France
| | - Romain Lazor
- Service de Pneumologie, Centre Hospitalier Universitaire Vaudois, Lausanne, CH, Suisse
| | - Jean-Charles Glerant
- Hospices Civils de Lyon, HĂ´pital Louis Pradel, Service d'explorations Fonctionnelles Respiratoires, 69677, Lyon, France
| | | | - Magali Colombat
- CHU Toulouse, Institut Universitaire du Cancer de Toulouse, Service d'anatomie Et Cytologie Pathologiques, Toulouse, France
| | - Vincent Cottin
- Hospices Civils de Lyon, Centre de Référence Coordinateur Des Maladies Pulmonaires Rares (OrphaLung), Hôpital Louis Pradel, Service de Pneumologie, 69677, Lyon, France.
- UMR754, INRAE; Member of RespiFil and ERN-LUNG, Université, Claude Bernard Lyon 1, Lyon, France.
| |
Collapse
|
3
|
Green DB, Restrepo CS, Legasto AC, Bang TJ, Oh AS, Vargas D. Imaging of the rare cystic lung diseases. Curr Probl Diagn Radiol 2021; 51:648-658. [PMID: 33618900 DOI: 10.1067/j.cpradiol.2021.02.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 02/01/2021] [Indexed: 12/20/2022]
Abstract
When discussing cystic lung diseases, a certain group of diseases tends to receive the majority of attention. Other less frequently discussed cystic lung diseases are also important causes of morbidity in patients. Etiologies include genetic syndromes, lymphoproliferative diseases, infections, exogenous exposures, and a developmental abnormality. This review article focuses on the clinical and imaging features of these other cystic lung diseases.
Collapse
Affiliation(s)
- Daniel B Green
- Department of Radiology, Weill Cornell Medicine, New York, NY.
| | - Carlos S Restrepo
- Department of Radiology, University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - Alan C Legasto
- Department of Radiology, Weill Cornell Medicine, New York, NY
| | - Tami J Bang
- Department of Radiology, University of Colorado, Aurora, CO
| | - Andrea S Oh
- Department of Radiology, National Jewish Health, Denver, CO
| | - Daniel Vargas
- Department of Radiology, University of Colorado, Aurora, CO
| |
Collapse
|
4
|
Mezzanotte JN, Gibbons-Fideler IS, Shilo K, Lustberg M, Devarakonda S. Nodular pulmonary deposition disease in a patient with the acquired immunodeficiency syndrome: a case report. J Med Case Rep 2020; 14:64. [PMID: 32498712 PMCID: PMC7273682 DOI: 10.1186/s13256-020-02394-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 04/28/2020] [Indexed: 11/27/2022] Open
Abstract
Background Pulmonary nodules are a common cause for concern in patients with human immunodeficiency virus and acquired immunodeficiency syndrome. Most commonly, they are the result of an infection, given the patients’ immunocompromised state; however, in some cases, pulmonary nodules in patients with human immunodeficiency virus and patients with acquired immunodeficiency syndrome can result from cellular or protein deposits. We report a rare case of nodular pulmonary light chain deposition disease in a patient with acquired immunodeficiency syndrome and monoclonal gammopathy of undetermined significance. Case presentation A 53-year-old African American woman with acquired immunodeficiency syndrome had pulmonary nodules detected incidentally by imaging of her lungs. Pulmonary tuberculosis was high on the differential diagnosis, but she had a negative test result for pulmonary tuberculosis. Imaging also revealed multiple lucent bone lesions, and earlier in the year, serum protein electrophoresis had shown an immunoglobulin G-kappa monoclonal protein (M spike). She was mildly anemic, so there was concern for progression to myeloma; however, the result of her bone marrow biopsy was unremarkable. Lung biopsy revealed finely granular eosinophilic material with negative Congo red staining, consistent with light chain deposition disease. Conclusions The extent of this patient’s light chain deposition disease was thought to be caused by a combination of acquired immunodeficiency syndrome and monoclonal gammopathy of undetermined significance, and the interval decrease in lung nodule size after restarting antiretroviral therapy confirms this hypothesis and also highlights a potentially unique contribution of the hypergammaglobulinemia to this disease process in patients with human immunodeficiency virus and patients with acquired immunodeficiency syndrome .
Collapse
Affiliation(s)
- Jessica N Mezzanotte
- Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
| | | | - Konstantin Shilo
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Mark Lustberg
- Department of Infectious Disease, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Srinivas Devarakonda
- Department of Hematology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| |
Collapse
|