CT and MR imaging of localized amyloidosis

Oral localized amyloidosis

This report describes two cases of oral localized amyloidosis (LA). In case 1, a 52-year-old man appeared with painful slightly, yellowish multiple nodules located on the dorsum of the tongue, of unknown duration. Incisional biopsy was performed, and the histopathologic analysis revealed a homogeneous, eosinophilic, and extracellular material. Congo red stain showed salmon pink coloration at light microscopy and apple-green birefringence at polarized light. In case 2, a 74-year-old man presented asymptomatic nodular lesions on the labial commissures with duration of several months. An excisional biopsy was performed in both lesions, and microscopically the specimen demonstrated the same histopathologic features of the case 1. Furthermore, amyloidosis with systemic involvement was excluded after investigations for both patients. Thus, the final diagnosis for both cases was LA. The patient 1 refused the surgical excision of the residual lesion, and in both cases, no signs of clinical and systemic progression were observed after 24 and 84 months of follow up. Although it is rare, LA should be considered in the differential diagnosis of multiple or single yellowish nodules on the oral cavity.

CT and MRI Features of Localized Peritumoral Amyloidosis in a Patient with Head and Neck Mucosa-Associated Lymphoid Tissue Lymphoma: A Case Report

Amyloidosis has been reported to be associated with non-Hodgkin lymphoma. Amyloidosis and lymphoma can be related in two ways: lymphoma-associated systemic amyloidosis and peritumoral amyloidosis with lymphoma. We report a rare case of peritumoral amyloidosis in a patient with head and neck mucosa-associated lymphoid tissue lymphoma. On CT, the oropharyngeal mass showed an irregularly shaped soft-tissue density with multifocal amorphous calcifications and heterogeneous enhancement. On MRI, the mass showed heterogeneous low signal intensity on both T1- and T2-weighted images. On contrast-enhanced MR images, the mass showed good enhancement with several inner non-enhancing foci. Concurrent pathologies, such as peritumoral amyloidosis, should be considered when calcifications are noted in patients with pre-treatment lymphoma.

Amyloidosis in the head and neck: CT findings with clinicopathological correlation

PURPOSE

To characterize the CT imaging features of head and neck amyloidosis and correlate with extent of disease and clinical outcomes.

MATERIALS AND METHODS

This retrospective study included 80 patients with head and neck amyloidosis who underwent soft tissue neck CT imaging between November 2003 and April 2018. The CT imaging features including lesion distribution, morphology (focal, diffuse/circumferential, or combined), presence and pattern of calcification, (punctate or diffuse), and thickness of airway lesion were evaluated and compared with the extent of amyloidosis (localized or systemic), and clinical course (stable, no recurrence, or progression requiring repeated surgical treatment).

RESULTS

Localized disease (83.8%, 67/80) was most common with AL type (97.6%, 41/42) representing nearly all cases of head and neck amyloidosis. The larynx was the most frequently affected organ (60.0%, 48/80), specifically the glottis (43.8%, 35/80). Calcification was seen in 65.0% of cases (52/80). Non-airway or tongue lesions were significantly associated with systemic (92.3%, 12/13) as opposed to localized amyloidosis (4.5%, 3/67; P < 0.001). Repeated surgical treatment was significantly associated with laryngeal amyloidosis (35.3%, 12/34; P = 0.002) and multi-centric disease (33.3%, 10/30; P = 0.048). Airway wall thickness in patients who required repeated surgical treatment was significantly greater than in patients with stable or no recurrent disease (P = 0.016).

CONCLUSION

Knowledge of the imaging features of head and neck amyloidosis can aid the diagnosis, disease monitoring, and prediction of patients requiring repeated surgical intervention.

Spectrum of orocutaneous disease associations: Genodermatoses and inflammatory conditions

The oral cavity and cutaneous organ systems share a close embryologic origin. Therefore, there are numerous dermatologic conditions presenting with concomitant oral findings of which the dermatologist must be aware. The second article in this continuing medical education series reviews inflammatory orocutaneous conditions and a number of genodermatoses. It is essential for dermatologists to be familiar with oral cavity manifestations associated with dermatologic diseases for prompt diagnosis, management, and appropriate referral to stomatology and dentistry.

Prognostic impact of T2-weighted CMR imaging for cardiac amyloidosis

OBJECTIVES

Using cardiac magnetic resonance imaging (MRI) we tested the diagnostic value of various markers for amyloid infiltration.

METHODS

We performed MRI at 1.5 T in 36 consecutive patients with cardiac amyloidosis and 48 healthy volunteers. The protocol included cine imaging, T2-weighted spin echo, T1-weighted spin echo before and early after contrast and late gadolinium enhancement. We compared the frequency of abnormalities and their relation to mortality.

RESULTS

Median follow-up was 31 months. Twenty-three patients died. Mean left ventricular (LV) mass was 205 ± 70 g. LV ejection fraction (EF) was 55 ± 12%. T2 ratio was 1.5 ± 0.4. 33/36 patients had pericardial and 22/36 had pleural effusions. All but two had heterogeneous late enhancement. Surviving patients did not differ from those who had died with regard to gender, LV mass or volume. Surviving patients had a significantly higher LVEF (60.4 ± 9.9% vs. 51.6 ± 11.5%; p = 0.03). The deceased patients had a lower T2 ratio than those who survived (1.38 ± 0.42 vs. 1.76 ± 0.17; p = 0.005). Low T2 was associated with shorter survival (Chi-squared 11.3; p < 0.001). Cox regression analysis confirmed T2 ratio < 1.5 as the only independent predictors for survival.

CONCLUSION

Cardiac amyloidosis is associated with hypointense signal on T2-weighted images. A lower T2 ratio was independently associated with shortened survival.

Gastrointestinal amyloidosis presenting as enterocolitis on abdominal CT scan

The imaging findings of amyloidosis are nonspecific and diverse due to its association with various chronic diseases such as multiple myeloma. We report a case of gastrointestinal amyloidosis presenting as enterocolitis on a contrast enhanced CT scan of the abdomen.

Amyloidosis of the small intestine

Amyloidosis is a rare disease characterized by forming pathological protein deposits - amyloid - in many organs and tissues. This decreases their functionality. The aim of this small study was to determine, whether the radiological picture of the small intestine involvement in amyloidosis is in some sense specific as sometimes described in literature giving rise to high suspicion for the disease in symptomatic patients.

MATERIAL AND METHODS

The prospective study comprising seven patients hospitalized in surgical department is presented together with a survey on the disease, its appearance in radiological imaging. All patients underwent abdominal ultrasound (ATL 5000 HDI, 7-12MHz linear probe, no contrast enhancement, supine position), abdominal CT (Somatom Plus, Siemens, single detector, conventional abdominal CT protocol) and enteroclysis (Micropaque suspension 300ml, application rate of 75ml/min, dilution with HP-7000 being 1:1 and HP-7000 solution 2000ml, application rate of 120ml/min.).

RESULTS

The amyloid deposits in the small intestine could be visualized in five of seven patients with the disease. Enteroclysis revealed a diffuse slowed down intestinal motility with an obstruction-like picture in all of our seven patients. The intestinal secretion was normal, plicae were getting polyp-like shape in five of them forming so called "thumb printing" picture. CT showed thickening of the intestinal wall due to deposits with poor blood supply and contrast retention in five of seven patients. Ultrasound visualized thickened, hypoechoic nodular plicae and slowed down motility in these five patients. The most striking finding was the pathological deposits in the intestinal wall were highly hypo-vascular. However, this picture is very similar to that of ischemic enteritis. All seven patients had proven amyloid deposits from bioptic specimens.

CONCLUSION

The diagnosis of amyloidosis must be supported by bioptic examination as it has no pathognomic radiological picture. Nevertheless, it allows usually to rise a high suspicion for this and sometimes even guess the type of the pathological protein involved. This can start a search for the primary reason of possible amyloidosis and thus perhaps spear the patients quality of life.

Localized oral amyloidosis of the palate

BACKGROUND

Amyloidosis is a rare disease with multifactorial pathogenesis. Localized amyloidosis affecting the head and neck region is an uncommon and benign process, which has almost no clinical consequences. The most reported characteristic features of localized oral amyloidosis appear as multiple soft nodules of the tongue, lip and cheek.

METHODS

We report the case of a 68-year-old woman suffering from a primary localized amyloidosis presenting as a purple patch on the palate.

CONCLUSIONS

The presence of systemic amyloidosis or underlying plasma cell dyscrasia have to be ruled out in patients presenting with a diagnosis of amyloidosis of the oral mucosa. If a primary localized amyloidosis is proven, the surgical therapy may be useful to eliminate a functional impairment.

Primary localized amyloidosis of urethra: Magnetic resonance imaging findings

Amyloidosis of the urogenital tract is relatively rare. We experienced a case of primary localized amyloidosis of the urethra and report its characteristics on magnetic resonance imaging. In our case, the lesion exhibited low signal intensity on T1-weighted and T2-weighted images and was well-enhanced on gadolinium-enhanced T1-weighted images. The gross appearance on cystoscopic examination suggested urethral malignancy but the low signal intensity is atypical for malignant tissue. Because magnetic resonance imaging clearly demonstrated the local extent and depth of the lesion, it was useful in making our decision to perform conservative resection.

Plasma cell dyscrasias and amyloidosis

The plasma cell dyscrasias and amyloidosis are distinct clinical entities that may co-exist. Both disease processes may present with manifestations in the head and neck, making familiarity with these conditions by otolaryngologists essential. Prompt diagnosis and evaluation for systemic disease are crucial in proper treatment planning.

Primary localized amyloidosis of the urinary bladder

We report a rare case of localized form of primary amyloidosis (amyloidoma) of the urinary bladder with CT and MR findings. Clinically, it is difficult to distinguish from invasive transitional cell carcinoma and inflammatory lesion. We think that the MR intensity on T2-weighted images is helpful in making the diagnosis.