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Raddell T, Ashraf F, Zhao X, Abramian O, Budak-Alpdogan T. A Case of Recurrent Localized Pulmonary Nodular Light Chain Amyloidosis Treated with Daratumumab plus CyBorD. Acta Haematol 2024:1-6. [PMID: 39074451 DOI: 10.1159/000540272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Accepted: 07/07/2024] [Indexed: 07/31/2024]
Abstract
INTRODUCTION Nodular pulmonary amyloidosis (NPA) is a localized form of light chain (AL) amyloidosis often found incidentally and typically has an indolent and benign disease course treated with resection or local excision. We present a patient with recurrent localized AL amyloidosis who required further treatment. CASE PRESENTATION A 63-year-old female with monoclonal gammopathy of undetermined significance (MGUS) was found to have pulmonary AL amyloid on wedge resection and later had recurrence. The patient did not have signs of clonal plasma cell proliferation or systemic AL amyloid. She was treated with daratumumab, cyclophosphamide, bortezomib, and dexamethasone. After initiation of treatment, the patient has had significant hematologic and radiographic response. CONCLUSION The patient had NPA recurrence with organ dysfunction without systemic disease. Because the presentation of recurrent pulmonary AL amyloidosis is rare, there is no published evidence on treatment. However, the patient has had hematologic and radiographic improvement after initiating treatment with a systemic protocol.
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Affiliation(s)
- Ted Raddell
- Department of Internal Medicine, Cooper University Health Care, Camden, New Jersey, USA
| | - Farah Ashraf
- Department of Hematology and Oncology, Cooper University Health Care, Camden, New Jersey, USA
| | - Xiaofeng Zhao
- Department of Pathology, Cooper University Health Care, Camden, New Jersey, USA
| | - Osheen Abramian
- Department of Pulmonology and Interventional Pulmonology, Cooper University Health Care, Camden, New Jersey, USA
| | - Tulin Budak-Alpdogan
- Department of Hematology and Oncology, Cooper University Health Care, Camden, New Jersey, USA
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Trikannad AK, Shrestha A, Vellanki S, Cheema HI, Patel TH, Bachu R, Sharma S, Jeffus SK, Thanendrarajan S. Amyloid Light-Chain (AL) Amyloidosis of the Trachea Associated With an Indolent B-cell Neoplasm. Cureus 2024; 16:e53074. [PMID: 38414681 PMCID: PMC10896678 DOI: 10.7759/cureus.53074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2024] [Indexed: 02/29/2024] Open
Abstract
We report the case of a 66-year-old woman who was diagnosed with localized tracheal amyloid light-chain (AL) amyloidosis caused by an underlying B-cell neoplasm. The diagnosis was confirmed through subsequent bronchoscopy and biopsies; however, she experienced a challenging episode of hypoxic respiratory failure that required intervention. Repeat bronchoscopies showed persistent subglottic stenosis and tracheobronchomalacia, which led to tracheal debulking surgery and additional interventions. The patient's treatment began with rituximab, zanubrutinib, and dexamethasone with outpatient follow-up. The rarity of tracheobronchial amyloidosis and its connection to B-cell malignancies are highlighted, emphasizing the challenges in diagnosis and the importance of tailored treatment strategies. The patient's clinical course, characterized by atypical respiratory symptoms, delayed diagnosis, and an evolving treatment approach, underscores the complexities of managing such a rare and intricate case.
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Affiliation(s)
- Anup Kumar Trikannad
- Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, USA
| | - Asis Shrestha
- Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, USA
| | - Sruthi Vellanki
- Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, USA
| | - Hira I Cheema
- Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, USA
| | - Tanvi H Patel
- Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, USA
| | - Ramya Bachu
- Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, USA
| | - Shobhit Sharma
- Radiology, University of Arkansas for Medical Sciences, Little Rock, USA
| | - Susanne K Jeffus
- Pathology, University of Arkansas for Medical Sciences, Little Rock, USA
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Yin M, Ouyang L, Tan J, Liu W, Zhang W. CT showed multiple pulmonary balloon lesions with intermediate balloon calcification in a case of nodular pulmonary amyloidosis: A case report. Medicine (Baltimore) 2023; 102:e34964. [PMID: 37682150 PMCID: PMC10489398 DOI: 10.1097/md.0000000000034964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 08/07/2023] [Indexed: 09/09/2023] Open
Abstract
RATIONALE Amyloidosis is a rare disease characterized by the misfolding of autologous proteins and extracellular deposition of fibrils, which can involve 1 or more vital organs in the body. Nodular pulmonary amyloidosis with extensive pulmonary cysts is even less common. This study discusses the diagnosis and treatment of a case of pulmonary nodular amyloidosis with extensive pulmonary cysts and calcification in the middle of the cysts on chest computed tomography, and reviews the related literature. We hope that this rare case will raise awareness of this disease among clinicians. PATIENT CONCERNS Multiple pulmonary nodules and cysts were found on computed tomography of the chest, and the patient was eager to further clarify the nature of the nodules and the next treatment plan. DIAGNOSES Amyloidosis of pulmonary nodules. INTERVENTIONS AND OUTCOMES Since the patient's primary lesion was outside the bronchial lumen near the hilum, we opted for endobronchial ultrasound-guided tunnel biopsy to obtain pathological specimens, and confirmed the diagnosis of nodular pulmonary amyloidosis. After a definite diagnosis, the patient was regularly followed without any specific treatment. LESSONS For patients with multiple pulmonary nodules combined with extensive pulmonary cysts, we also need to be alert to the possibility of pulmonary nodule amyloidosis. Secondly, when the main lesion is located outside the bronchial cavity near the hilum of the lung, the method of pathological tissue biopsy should also consider endobronchial ultrasound-guided tunnel biopsy.
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Affiliation(s)
- Mingquan Yin
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Hunan Normal University/Hunan Provincial People’s Hospital, Changsha, China
| | - Lecong Ouyang
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Hunan Normal University/Hunan Provincial People’s Hospital, Changsha, China
| | - Jianlong Tan
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Hunan Normal University/Hunan Provincial People’s Hospital, Changsha, China
| | - Wei Liu
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Hunan Normal University/Hunan Provincial People’s Hospital, Changsha, China
| | - Weidong Zhang
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Hunan Normal University/Hunan Provincial People’s Hospital, Changsha, China
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Tambuzzi S, Gentile G, Boracchi M, Marasciuolo L, Zoja R. Post-Mortem Diagnosis of a Rare Case of Massive Nodular Pulmonary Amyloidosis in a Forensic Setting. Acad Forensic Pathol 2023; 13:41-47. [PMID: 37091197 PMCID: PMC10119865 DOI: 10.1177/19253621231164023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 02/24/2023] [Indexed: 04/25/2023]
Affiliation(s)
| | - Guendalina Gentile
- Guendalina Gentile BSc, Sezione di Medicina
Legale—Dipartimento di Scienze Biomediche per la Salute—Università degli Studi, via Luigi
Mangiagalli, 37, 20133 Milano, Italy;
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Patel H, Sheikh A, Medarametla GD, Selvam SA, Mahmood SN, Johal G, Arunachalam J, Radhakrishnan H, Shah V, Vallath AL, Patel D, Palasamudram Shekar S, Patel U, Changawala N. Uncommon Presentation of Undiagnosed B-Cell Lymphoproliferative Disorder as Nodular Pulmonary Amyloidosis. J Med Cases 2023; 14:36-43. [PMID: 36755997 PMCID: PMC9881482 DOI: 10.14740/jmc4026] [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: 11/21/2022] [Accepted: 01/11/2023] [Indexed: 01/20/2023] Open
Abstract
B-cell lymphoproliferative disorders are characterized by the accumulation of mature B lymphocytes in the bone marrow, lymphoid tissues, and/or peripheral blood. They can cause amyloid deposits in the lungs. In rare cases, lung nodules can be the first sign of this disorder. We present the case of an 89-year-old woman with stable shortness of breath and lung nodules on imaging. A positron emission tomography-computed tomography (PET-CT) scan showed the most intense hypermetabolic nodule in the patient's lung, which was 1.5 × 1.4 cm. A biopsy of this nodule showed amyloid material with trapped plasma cell infiltrate on microscopy. Congo red stain under polarizing microscopy showed apple-green birefringence, which is diagnostic for amyloidosis. Immunohistochemistry showed a mixture of kappa-positive and lambda-positive cells. B-cell gene rearrangement-clonal gene rearrangements were detected in the immunoglobulin heavy chain (IgH) gene and the kappa light chain (IGK). These findings suggest a B-cell lymphoproliferative disorder, such as a plasmacytoma or a marginal cell lymphoma with plasma cell differentiation. The patient was diagnosed with a B-cell lymphoproliferative disorder and pulmonary amyloidosis. Isolated amyloidosis in the lungs usually has a good prognosis, but it can be a sign of autoimmune diseases or B-cell lymphoproliferative disorders, as in this case. Early diagnosis of B-cell lymphoproliferative disorder can lead to successful treatment and prevents complications.
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Affiliation(s)
- Harsh Patel
- Department of Family Medicine, Central Jersey Urgent Care, Green Brook, NJ 08812, USA,Corresponding Author: Harsh Patel, Department of Family Medicine, Central Jersey Urgent Care, Green Brook, NJ 08812, USA.
| | - Aaiyat Sheikh
- Era’s Lucknow Medical College, Lucknow, Uttar Pradesh 226003, India
| | | | - Sri Abirami Selvam
- Department of Internal Medicine, St Mary Medical Center, Langhorne, PA 19047, USA
| | - Syed Nazeer Mahmood
- Department of Medicine, Section of Pulmonary/Critical Care, MedStar Washington Hospital Center, Washington, DC 20770, USA
| | - Gurleen Johal
- Department of Medicine, Hackensack Meridian Palisades Medical Center, North Bergen, NJ 07047, USA
| | - Janani Arunachalam
- Department of Biomedical Engineering, University of Houston, Houston, TX 77021, USA
| | | | - Viray Shah
- Department of Hospital Medicine, Medstar Good Samaritan Hospital, Baltimore, MD 21239, USA
| | - Aditya Lal Vallath
- Department of Emergency Medicine, Peerless Hospital and BK Roy Research Center, Kolkata, West Bengal 700094, India
| | | | - Saketh Palasamudram Shekar
- Interventional Pulmonology, Department of Pulmonary and Critical care Medicine, Pulmonary and Sleep Associates of Huntsville, Huntsville Hospital, Huntsville, AL 35801, USA
| | - Urvish Patel
- Department of Public Health and Neurology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
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Polo-Nieto JF, Quiroga-Dussan MDP, Castañeda-González JP, Fierro-Rodríguez DM, Durán-Acuña R, Carrillo-Bayona JA. Perilymphatic micronodular pattern as a manifestation of pulmonary amyloidosis on high-resolution computed tomography. Radiol Case Rep 2021; 16:850-854. [PMID: 33552338 PMCID: PMC7850939 DOI: 10.1016/j.radcr.2021.01.027] [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: 10/16/2020] [Revised: 01/05/2021] [Accepted: 01/11/2021] [Indexed: 12/26/2022] Open
Abstract
The term amyloidosis describes a group of diseases caused by the fibrillar deposit of poorly folded proteins in tissues with a secondary alteration of their function. Diffuse parenchymal lung disease associated with amyloidosis is rare and is most often diagnosed in autopsy. A 45-year-old male patient presented an acute episode of cough with mucoid expectoration. He had also dyspnea, dry cough, chest pain, and constitutional symptoms of 6 months of evolution. Initially the case was treated as acute pneumonia. After taking radiological images of the thorax, a diagnostic suspicion of lymphangitic spread of neoplasia was assumed. Histopathological findings of an open pulmonary biopsy demonstrated interstitial thickening with perivascular eosinophilic invasion. Congo Red staining and immunohistochemistry studies were done and turned out to be positive for amyloid. The perilymphatic micronodular pattern as a radiological manifestation of parenchymal pulmonary amyloidosis has been very rarely described in the literature, therefore it must be considered as a differential diagnosis in patients with this pattern in CT scan and should be an incentive for its histopathological study once a neoplasm is ruled out.
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Affiliation(s)
- José Fernando Polo-Nieto
- Fundación Universitaria de Ciencias de la Salud, Bogotá, Colombia
- Department of Pathology. Hospital de San José, Bogotá, Colombia
| | - Maria Del Pilar Quiroga-Dussan
- Fundación Universitaria de Ciencias de la Salud, Bogotá, Colombia
- Department of Pathology. Hospital de San José, Bogotá, Colombia
| | - Juan Pablo Castañeda-González
- Fundación Universitaria de Ciencias de la Salud, Bogotá, Colombia
- Department of Pathology. Hospital de San José, Bogotá, Colombia
| | - Diana Marcela Fierro-Rodríguez
- Fundación Universitaria de Ciencias de la Salud, Bogotá, Colombia
- Department of Radiology. Hospital de San José, Bogotá, Colombia
| | - Ricardo Durán-Acuña
- Fundación Universitaria de Ciencias de la Salud, Bogotá, Colombia
- Department of Pulmonology. Hospital de San José, Bogotá, Colombia
| | - Jorge Alberto Carrillo-Bayona
- Fundación Universitaria de Ciencias de la Salud, Bogotá, Colombia
- Department of Radiology. Hospital de San José, Bogotá, Colombia
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Florent T, Nicolas C, Anaïs B, Benjamine D, Isabelle G, Romain A, Pierre-Mathieu B, Thanh Khoa H, Jean-Baptiste R. Pulmonary nodules associated with pulmonary embolism: A rare and misleading presentation of amyloidosis. Respir Med Case Rep 2020; 30:101095. [PMID: 32547915 PMCID: PMC7284055 DOI: 10.1016/j.rmcr.2020.101095] [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: 04/28/2020] [Accepted: 05/13/2020] [Indexed: 11/26/2022] Open
Abstract
Amyloidosis is a rare disease especially the localized form involving pulmonary parenchyma. We report the case of a 74 years old woman who presented with chest pain and dyspnoea. CT scan showed pulmonary embolism and bilateral nodules. Laboratory examinations highlighted circulating Kappa IgM. 18F-FDG PET/CT showed intense activity of the nodules. Histological investigation supported the diagnosis of nodular pulmonary amyloidosis. There were no sign of systemic amyloidosis or autoimmune disease. No treatment was initiated: the patient remains asymptomatic after one year. Localized pulmonary amyloidosis related to MGUS was the most likely diagnosis. Malignancy, a differential diagnosis of pulmonary amyloidosis, must be excluded: histological examinations are overriding. Difference between systemic and localized amyloidosis conditions treatment and prognosis. This observation emphasizes the difficulty to establish the diagnosis of pulmonary nodular amyloidosis and the complex relationship between amyloidosis and thromboembolism.
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Affiliation(s)
- Trescos Florent
- Department of Respiratory Medicine, Laveran Military Teaching Hospital, Marseille, France
| | - Cazes Nicolas
- Emergency Medical Service Battalion of Marseille Firefighters, Marseille, France
| | - Briquet Anaïs
- Department of Respiratory Medicine, Laveran Military Teaching Hospital, Marseille, France
| | - Delcasso Benjamine
- Department of Respiratory Medicine, Laveran Military Teaching Hospital, Marseille, France
| | - Graille Isabelle
- Department of Respiratory Medicine, Laveran Military Teaching Hospital, Marseille, France
| | - Appay Romain
- Department of Histopathology, Timone Teaching Hospital, Marseille, France
| | | | - Huynh Thanh Khoa
- Department of Oncology Medicine, Beauregard Private Hospital, Marseille, France
| | - Roseau Jean-Baptiste
- Department of Respiratory Medicine, Laveran Military Teaching Hospital, Marseille, France
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