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Tracy LF, Danis DO, Rodriggs T, Kariveda R, Grillone GA. Laryngotracheal Amyloidosis: Amyloid Airway Center 23-Year Experience. Laryngoscope 2024; 134:1606-1613. [PMID: 37732696 DOI: 10.1002/lary.31049] [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: 03/13/2023] [Revised: 08/04/2023] [Accepted: 09/01/2023] [Indexed: 09/22/2023]
Abstract
OBJECTIVES Localized laryngotracheal amyloidosis (LA) is a rare disease that can impact phonation and respiration. Treatment options include observation, surgery, and radiation therapy (RT). Given the rare incidence of LA, evidence regarding optimal management and long-term outcomes is limited. STUDY DESIGN Retrospective cross-sectional analysis. METHODS All patients with LA presenting to an international amyloid center from 1999 to 2022 were analyzed. Patients were categorized by treatment modality: surgery, RT, or observation. Patient and disease factors including demographics, clinical presentation, and progression with need for additional treatment were evaluated. RESULTS Seventy-one patients (27M:44F) with LA were treated with surgery (n = 40), RT (n = 11), and observation (n = 20). Gender distribution, age at diagnosis, and systemic workup did not differ significantly between treatment cohorts. A correlation was identified between LA location and treatment modality, with higher rate of subglottic/tracheal amyloid in RT patients vs. surgery and observation patients [(90% and 52% respectively), p < 0.005]. Surgery patients had a median of two surgeries for disease management (range: 1-32) and RT patients had median five surgeries prior to RT (range: 0-17). Six patients required tracheotomy: 3/40 surgery, 3/11 RT and 0/20 in observation cohort. Surgery and RT patients had a longer duration of follow-up (mean 6.7 and 11.7 years) compared with the observation cohort (5.7 years). CONCLUSION Laryngotracheal amyloidosis is a rare disease with variable presentation. Selective surgery of involved subsites is the primary treatment, though multiple surgeries may be needed to optimize function. Observation is appropriate for those with minimal symptoms. For recalcitrant disease, and particularly subglottic/tracheal amyloid, radiotherapy can be beneficial. LEVEL OF EVIDENCE 4 Laryngoscope, 134:1606-1613, 2024.
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Affiliation(s)
- Lauren F Tracy
- Department of Otolaryngology-Head and Neck Surgery, Boston University Aram V. Chobanian & Edward Avedisian School of Medicine, Boston, Massachusetts, U.S.A
- Boston University Aram V. Chobanian & Edward Avedisian School of Medicine, Boston, Massachusetts, U.S.A
| | - D O'Neil Danis
- Boston University Aram V. Chobanian & Edward Avedisian School of Medicine, Boston, Massachusetts, U.S.A
| | - Timothy Rodriggs
- Department of Otolaryngology-Head and Neck Surgery, Boston University Aram V. Chobanian & Edward Avedisian School of Medicine, Boston, Massachusetts, U.S.A
| | - Rohith Kariveda
- Boston University Aram V. Chobanian & Edward Avedisian School of Medicine, Boston, Massachusetts, U.S.A
| | - Gregory A Grillone
- Department of Otolaryngology-Head and Neck Surgery, Boston University Aram V. Chobanian & Edward Avedisian School of Medicine, Boston, Massachusetts, U.S.A
- Boston University Aram V. Chobanian & Edward Avedisian School of Medicine, Boston, Massachusetts, U.S.A
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2
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Riehani A, Soubani AO. The spectrum of pulmonary amyloidosis. Respir Med 2023; 218:107407. [PMID: 37696313 DOI: 10.1016/j.rmed.2023.107407] [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: 05/07/2023] [Revised: 08/21/2023] [Accepted: 09/08/2023] [Indexed: 09/13/2023]
Abstract
Amyloidosis is a disease caused by misfolded proteins that deposit in the extracellular matrix as fibrils, resulting in the dysfunction of the involved organ. The lung is a common target of Amyloidosis, but pulmonary amyloidosis is uncommonly diagnosed since it is rarely symptomatic. Diagnosis of pulmonary amyloidosis is usually made in the setting of systemic amyloidosis, however in cases of localized pulmonary disease, surgical or transbronchial tissue biopsy might be indicated. Pulmonary amyloidosis can be present in a variety of discrete entities. Diffuse Alveolar septal amyloidosis is the most common type and is usually associated with systemic AL amyloidosis. Depending on the degree of the interstitial involvement, it may affect alveolar gas exchange and cause respiratory symptoms. Localized pulmonary Amyloidosis can present as Nodular, Cystic or Tracheobronchial Amyloidosis which may cause symptoms of airway obstruction and large airway stenosis. Pleural effusions, mediastinal lymphadenopathy and pulmonary hypertension has also been reported. Treatment of all types of pulmonary amyloidosis depends on the type of precursor protein, organ involvement and distribution of the disease. Most of the cases are asymptomatic and require only close monitoring. Diffuse alveolar septal amyloidosis treatment follows the treatment of underlying systemic amyloidosis. Tracheobronchial amyloidosis is usually treated with bronchoscopic interventions including debulking and stenting or with external beam radiation. Long-term prognosis of pulmonary amyloidosis usually depends on the type of lung involvement and other organ function.
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Affiliation(s)
- Anas Riehani
- Division of Pulmonary, Critical Care and Sleep Medicine, Wayne State University School of Medicine, Detroit, MI, USA
| | - Ayman O Soubani
- Division of Pulmonary, Critical Care and Sleep Medicine, Wayne State University School of Medicine, Detroit, MI, USA.
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3
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Abstract
Small biopsies in the larynx can make a definitive diagnosis challenging due to the sampling or tangential sectioning. The differential diagnosis can be divided into mucosal lesions (squamous papillomas, intraepithelial dysplasia, and invasive squamous cell carcinoma) or submucosal lesions (vocal cord polyps/nodules, amyloidosis, granular cell tumor, rhabdomyoma, neuroendocrine neoplasms, salivary gland tumors, and cartilaginous tumors). Diagnostic criteria (both morphologic and immunohistochemical) are reviewed to arrive at a diagnosis even on small biopsy.
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Affiliation(s)
- Abberly Lott Limbach
- Department of Pathology, E422 Doan Hall, 410W 10th Ave, Columbus, OH 43210, United States.
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4
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Silver JA, Lahijanian Z, Kay-Rivest E, Marquez JC, Young J, Chagnon F, Torres C, Kost KM. Laryngeal Amyloidosis: What is the Role of Imaging? J Voice 2023:S0892-1997(23)00202-3. [PMID: 37596098 DOI: 10.1016/j.jvoice.2023.06.020] [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: 05/15/2023] [Revised: 06/18/2023] [Accepted: 06/19/2023] [Indexed: 08/20/2023]
Abstract
OBJECTIVE/HYPOTHESIS To review the imaging findings of laryngeal amyloidosis and to identify radiological findings suggestive of this disease. STUDY DESIGN Retrospective case series. METHODS A retrospective chart review of patients with pathologically confirmed laryngeal amyloidosis was performed from 2009 to 2022. Clinical and demographic factors were collected. A fellowship-trained head and neck radiologist reviewed all computed tomography (CT) scans and magnetic resonance imaging (MRI) findings within this cohort. RESULTS 12 patients were identified and a total of 36 imaging studies analyzed. Localized amyloidosis was found in the supraglottic region (n = 6), glottic region (n = 7), and subglottic region (n = 5); six patients had disease spanning two subsites. The most common finding on the CT scan was a homogeneous and well-defined submucosal soft tissue mass. Punctate calcifications were present in three cases. The presence of contrast enhancement was identified in the majority of patients who underwent MRI (4/5). MRI showed consistent signal intensity, hypointense, or isointense on both T1-weighted and T2-weighted images. Diffusion-weighted sequences were obtained in every patient and did not demonstrate diffusion restriction. CONCLUSION This is the largest series searching for unifying imaging characteristics of laryngeal amyloidosis. This research suggests that characteristics from CT and MR provide both similar and unique features of laryngeal amyloidosis on imaging. Both modalities identify a submucosal mass. CT is the preferred modality to demonstrate punctate calcifications, while MRI identifies enhancement and altered signal characteristics. The main benefit of serial imaging is the correlation with patient symptoms, identification of the extent of disease, and assisting in delineating appropriate timing for surgery.
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Affiliation(s)
- Jennifer A Silver
- Department of Otolaryngology-Head and Neck surgery, Royal Victoria Hospital, Montreal, Quebec, Canada
| | - Zubin Lahijanian
- Department of Radiology, Royal Victoria Hospital, Montreal, Quebec, Canada
| | - Emily Kay-Rivest
- Department of Otolaryngology-Head and Neck surgery, Royal Victoria Hospital, Montreal, Quebec, Canada
| | - Juan C Marquez
- Department of Radiology, Royal Victoria Hospital, Montreal, Quebec, Canada
| | - Jonathan Young
- Department of Otolaryngology-Head and Neck surgery, Royal Victoria Hospital, Montreal, Quebec, Canada
| | - Francoise Chagnon
- Department of Otolaryngology-Head and Neck surgery, Royal Victoria Hospital, Montreal, Quebec, Canada
| | - Carlos Torres
- Department of Radiology, Royal Victoria Hospital, Montreal, Quebec, Canada
| | - Karen M Kost
- Department of Otolaryngology-Head and Neck surgery, Royal Victoria Hospital, Montreal, Quebec, Canada.
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5
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Hou T, Abu-Salah A, Cummings OW, Halum S, Mesa H, Zhang D. Amyloid Deposition in the Upper Aerodigestive Tract, A Single Institute Experience. EAR, NOSE & THROAT JOURNAL 2023:1455613231189144. [PMID: 37515371 DOI: 10.1177/01455613231189144] [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: 07/30/2023] Open
Abstract
Objectives: The purpose of this study is to evaluate clinical information, laboratory results, and pathologic findings of patients with amyloidosis involving larynx, oral cavity, and pharynx from our institute. Methods: A total of 39 specimens from 28 patients were retrieved from 2000 to 2020. Data collection included clinical presentation, radiographic, laboratory results, and pathologic findings. Results: A total of 12 patients had laryngeal amyloidosis and true vocal cord was the most common location. Protein electrophoresis detected monoclonal protein in 10% (1/10) of patients tested. Two patients had hematopoietic disorder (2/12, 17%) and another patient had a peptide profile consistent with amyloid transthyretin (ATTR) detected by mass spectrometry. Twelve patients showed amyloidosis in the oral cavity with 75% involving the tongue. Monoclonal protein was found in 89% of cases tested. Nine patients (9/12, 75%) had systematic involvement including 6 with hematopoietic malignancy and 3 with biopsy-confirmed systemic light chain amyloidosis. Compared to the laryngeal amyloidosis, amyloid deposition in oral cavity had a significant higher association with systematic disease (P < .01). Pharyngeal amyloidosis was seen in 7 patients. Three of 6 patients tested (3/6, 50%) were found to have biopsy-confirmed hematopoietic malignancy. Conclusions: Laryngeal amyloidosis is mostly a localized disease. Amyloidosis involving oral cavity is associated with significantly higher risk of systematic involvement which warrants a comprehensive laboratory, radiographic, and pathologic workup. There is limited data about pharynx amyloidosis. Oropharynx and hypopharynx amyloidosis appear to be more likely associated with underlying hematologic malignancy compared to nasopharynx involvement.
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Affiliation(s)
- Tieying Hou
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Asma Abu-Salah
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Oscar W Cummings
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Stacey Halum
- Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Hector Mesa
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Dongwei Zhang
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
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Surgical treatment of laryngeal amyloidosis: a systematic review. Eur Arch Otorhinolaryngol 2023; 280:3065-3074. [PMID: 36790723 DOI: 10.1007/s00405-023-07881-6] [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: 12/04/2022] [Accepted: 02/08/2023] [Indexed: 02/16/2023]
Abstract
PURPOSE The aim of this review was to study the surgical management of laryngeal amyloidosis and estimate the rate of recurrence after surgery. METHODS A systematic review searching PubMed and EMBASE was performed. A qualitative synthesis of data regarding the surgical management of LA and a quantitative analysis of the recurrence rate after surgery was conducted. RESULTS This systematic review included 14 retrospective studies, one of whom is retrospective controlled. A total of 515 subjects were included, the mean age ranged from 43.3 to 58 years with a male-to-female ratio of 1:1.3. All cases had a localized laryngeal amyloidosis. The supraglottic region was the most affected laryngeal site and multiple sites were commonly involved. Surgical treatment consists of endoscopic excision using laser, cold or powered instruments. Open surgery is required for severe primary case or revision surgery. Surgical complications such as granulomatosis scar tissue formation, tracheostomy, laryngotracheal stenosis, pneumothorax and concomitant malignancy were developed in 17.5% of patients. The time onset to diagnosis varied from 1 months to 15 years and the duration of follow-up from 3 months to 25 years. The rate of recurrence was 28.4% (95% CI 24.5-32.6) and the timing of recurrences ranged from 3 months to 10 years. CONCLUSION The recurrence rate after primary surgery for laryngeal amyloidosis is high. A tailored surgical treatment based on the disease extension and a long-term follow up are recommended.
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7
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Ioannou A. Once localised amyloid deposits are detected systemic disease should be excluded. QJM 2022; 115:699. [PMID: 34865164 DOI: 10.1093/qjmed/hcab301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Indexed: 11/14/2022] Open
Affiliation(s)
- Adam Ioannou
- From the Department of Cardiology, Royal Free Hospital, Royal Free NHS Foundation Trust, Pond Street, London NW3 2QG, UK
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8
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Baqir M, Schwegman AR, Maldonado F, Johnson TF, Ryu JH. Airway Amyloidosis: A Retrospective Analysis of 43 Patients. J Bronchology Interv Pulmonol 2022; 29:275-282. [PMID: 34984992 DOI: 10.1097/lbr.0000000000000836] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 11/09/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Amyloidosis can involve any compartment in the thorax. We aimed to explore the clinical and radiologic presentation, treatment, and clinical course of airway amyloidosis. METHODS A computer-assisted search was performed to identify patients who had biopsy-proven airway amyloidosis and were evaluated at Mayo Clinic in Rochester, MN, from January 1, 1997 through December 31, 2019. Demographic, clinical, and radiologic features along with clinical outcomes were analyzed. RESULTS We identified 43 patients who had airway amyloidosis. Median age was 60 years (range: 33 to 91 y), and 58% were female. Shortness of breath (63% of patients) and cough (44%) were the most common presenting symptoms. Most patients (82%) had localized amyloidosis with light chain being the most common amyloid type; 63% had tracheobronchial amyloidosis, and 23% had tracheal and upper airway involvement. On computed tomography of the chest, the most common findings were airway wall thickening with nodularity (60% of patients), airway calcification (53%), and airway occlusion without collapse (47%). On bronchoscopy (33 patients), the extent of amyloid involvement was most commonly submucosal (n=15) or nodular (n=8). External beam radiotherapy was the most common treatment modality. Among the 30 patients who had follow-up at our institution, the prognosis appeared to depend on the extent of the disease and whether patients had localized or systemic amyloidosis. CONCLUSION Computed tomography of the chest, bronchoscopy, and biopsy are needed to establish the diagnosis of airway amyloidosis, and systemic amyloidosis should be ruled out. Treatment of amyloidosis requires a multidisciplinary approach.
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Affiliation(s)
- Misbah Baqir
- Division of Pulmonary and Critical Care Medicine
| | - Alex R Schwegman
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, University of Minnesota, Minneapolis, MN
| | - Fabien Maldonado
- Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN
| | | | - Jay H Ryu
- Division of Pulmonary and Critical Care Medicine
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9
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Localized laryngeal amyloidosis: A systematic review. Am J Otolaryngol 2022; 43:103550. [DOI: 10.1016/j.amjoto.2022.103550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Accepted: 07/24/2022] [Indexed: 11/22/2022]
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10
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Dermody SM, Campagnaro EL, Kupfer RA, Hogikyan ND, Morrison RJ. Laryngotracheobronchial Amyloidosis: Patterns of Presentation and Management. Ann Otol Rhinol Laryngol 2021; 131:737-742. [PMID: 34459282 DOI: 10.1177/00034894211042772] [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: 11/16/2022]
Abstract
OBJECTIVE To evaluate the pattern of presentation and management of laryngotracheobronchial amyloidosis at a tertiary care academic center over a 27 year period. METHODS In a retrospective review, the electronic medical record at a tertiary care academic center was queried for encounters with 3 laryngologists between 1996 and 2019 which included the ICD-9 or ICD-10 diagnosis of amyloidosis. Demographics, clinical presentation, referral diagnoses, medical history, family history, laboratory values, radiology studies, and treatment modalities of subjects were collated. Results were analyzed using standard univariate descriptive statistics. RESULTS Seventeen subjects were identified with an average age at diagnosis of 58 years (range 26-76 years). The most common amyloid type on biopsy was immunoglobulin light chain (AL) subtype. The most common location of laryngeal amyloid at diagnosis was the glottis and disease was more likely to be bilateral at the time of diagnosis in this location. Supraglottic disease more often had a unilateral presentation and had a tendency to spread to additional laryngeal subsites. Nearly 25% of subjects had associated systemic disease, including multiple myeloma, auto-immune disease, and familial ATTR mutation. CONCLUSIONS The overall rate of associated systemic disease was low in our study cohort; however, it is higher than typically referenced in extant literature. Our cohort demonstrates that while laryngeal amyloidosis is a chronic condition, the behavior is generally indolent with a low treatment burden.
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Affiliation(s)
- Sarah M Dermody
- Department of Otolaryngology-Head & Neck Surgery, Vocal Health Center, University of Michigan, Ann Arbor, MI, USA
| | - Erica L Campagnaro
- Department of Medicine, Rogel Cancer Center, University of Michigan, Ann Arbor, MI, USA
| | - Robbi A Kupfer
- Department of Otolaryngology-Head & Neck Surgery, Vocal Health Center, University of Michigan, Ann Arbor, MI, USA
| | - Norman D Hogikyan
- Department of Otolaryngology-Head & Neck Surgery, Vocal Health Center, University of Michigan, Ann Arbor, MI, USA
| | - Robert J Morrison
- Department of Otolaryngology-Head & Neck Surgery, Vocal Health Center, University of Michigan, Ann Arbor, MI, USA
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11
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Mira C, Montalvão P, Fonseca I, Borges A. Localised laryngotracheal amyloidosis: a differential diagnosis not to forget. BMJ Case Rep 2021; 14:e237954. [PMID: 33526525 PMCID: PMC7853032 DOI: 10.1136/bcr-2020-237954] [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] [Accepted: 12/13/2020] [Indexed: 02/03/2023] Open
Abstract
We present a case of multifocal laryngotracheal amyloidosis (LTA) in a 43-year-old man with persistent and progressive dysphonia and dyspnoea, and a first inconclusive histology. Although laryngeal amyloidosis accounts for fewer than 1% of all benign laryngeal tumours, it is in fact the most common site of amyloid deposition in the head, neck and respiratory tract. The clinical scenario is non-specific and diagnosis depends on a high degree of suspicion and on histology. Imaging is useful in mapping lesions, which are often more extensive than they appear during laryngoscopy. Despite being a benign entity, the prognosis is variable with a high-rate and long-latency recurrences, requiring long-term follow-up.
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Affiliation(s)
- Catarina Mira
- Radiology Department, Hospital Beatriz Angelo, Loures, Portugal
| | - Pedro Montalvão
- Otorhinolaryngology Deparment, Portuguese Institute of Oncology of Lisbon, Francisco Gentil, Lisbon, Portugal
| | - Isabel Fonseca
- Pathology, Portuguese Institute of Oncology of Lisbon, Francisco Gentil, Lisboa, Portugal
| | - Alexandra Borges
- Radiology Department, Portuguese Institute of Oncology of Lisbon, Francisco Gentil, Lisboa, Portugal
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Ng C, Mentias Y, Abdelgalil A. Imaging features of non-epithelial tumours of the larynx. Clin Radiol 2020; 75:711.e5-711.e12. [DOI: 10.1016/j.crad.2020.01.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 01/23/2020] [Indexed: 12/27/2022]
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13
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Takumi K, Staziaki PV, Hito R, Nadgir RN, Berk JL, Andreu-Arasa VC, Chavez W, Sakai O. Amyloidosis in the head and neck: CT findings with clinicopathological correlation. Eur J Radiol 2020; 128:109034. [PMID: 32438260 DOI: 10.1016/j.ejrad.2020.109034] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 03/11/2020] [Accepted: 04/20/2020] [Indexed: 10/24/2022]
Abstract
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.
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Affiliation(s)
- Koji Takumi
- Department of Radiology, Boston Medical Center, Boston University School of Medicine, Boston, MA, United States; Department of Radiology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Pedro V Staziaki
- Department of Radiology, Boston Medical Center, Boston University School of Medicine, Boston, MA, United States
| | - Rania Hito
- Department of Radiology, Veteran Affairs Boston Healthcare System, Boston University School of Medicine, Boston, MA, United States
| | - Rohini N Nadgir
- Department of Radiology, Boston Medical Center, Boston University School of Medicine, Boston, MA, United States; The Russell H. Morgan Department of Radiology and Radiological Science, Division of Neuroradiology, The Johns Hopkins Medical Institutions, Baltimore, MD, United States
| | - John L Berk
- Amyloidosis Center, Boston Medical Center, Boston University School of Medicine, Boston, MA, United States
| | - V Carlota Andreu-Arasa
- Department of Radiology, Boston Medical Center, Boston University School of Medicine, Boston, MA, United States
| | - Wilson Chavez
- Department of Radiology, Boston Medical Center, Boston University School of Medicine, Boston, MA, United States
| | - Osamu Sakai
- Department of Radiology, Boston Medical Center, Boston University School of Medicine, Boston, MA, United States; Department of Otolaryngology - Head and Neck Surgery, Boston Medical Center, Boston University School of Medicine, Boston, MA, United States; Department of Radiation Oncology, Boston Medical Center, Boston University School of Medicine, Boston, MA, United States.
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14
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Mesolella M, Petruzzi G, Buono S, Salerno G, Salzano FA, Di Lorenzo G, Motta G. Focus on localized laryngeal amyloidosis: management of five cases. Open Med (Wars) 2020; 15:327-332. [PMID: 33335993 PMCID: PMC7712266 DOI: 10.1515/med-2020-0400] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 02/17/2020] [Accepted: 02/23/2020] [Indexed: 11/15/2022] Open
Abstract
Amyloidosis is a group of idiopathic clinical syndromes caused by the deposition of insoluble fibrillar proteins (amyloid) in the extracellular matrix of organs and tissues. These deposits disrupt the function of the target organ. Amyloidosis can manifest as a systemic disease or a single-organ involvement (local form). Its etiology still remains unclear. Deposits of amyloid in the larynx are rare, accounting for between 0.2 and 1.2% of benign tumors of the larynx. In this retrospective study, we report the clinical aspects, diagnosis, treatment and follow-up of five female patients with localized laryngeal amyloidosis without systemic involvement. The patients were all treated successfully using microlaryngoscopy with CO2 laser or cold instruments. Prognosis is excellent; however, appropriate follow-up is an important part of the long-term management of this disease in order to prevent and control the possibility of local recurrence.
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Affiliation(s)
- Massimo Mesolella
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, 80121 Naples, Italy
| | - Gerardo Petruzzi
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, 80121 Naples, Italy
| | - Sarah Buono
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, 80121 Naples, Italy
| | - Grazia Salerno
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, 80121 Naples, Italy
| | - Francesco Antonio Salzano
- Department of Medicine, Surgery and Odontology, “Scuola Medica Salernitana” University of Salerno, Salerno, Italy
| | - Giuseppe Di Lorenzo
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, 80121 Naples, Italy
| | - Gaetano Motta
- Department of Mental and Physical Health and Preventive Medicine, Head and Neck Surgery Unit, University of Campania “Luigi Vanvitelli”, Naples, Italy
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15
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Singh A, Haq M, Gautam P, Gautam D, Handa AC, Handa KK. Clinical Profile of Patients with Head and Neck Amyloidosis: A Single-Institution Retrospective Chart Review. Int Arch Otorhinolaryngol 2020; 24:e450-e456. [PMID: 33101510 PMCID: PMC7575368 DOI: 10.1055/s-0039-3402494] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 11/11/2019] [Indexed: 11/24/2022] Open
Abstract
Introduction
Isolated amyloidosis involving the head and neck is a rare entity. The pathophysiology of the localized disease appears to be distinct from that of the systemic counterpart. Systemic progression of the localized disease is unusual, and the prognosis of the localized form is excellent.
Objective
To describe the demographic and clinicopathological characteristics of patients presenting with localized head and neck subsite amyloidosis.
Methods
A retrospective chart review of the patients with head and neck amyloidosis identified by the electronic search of the electronic database of the Departments of Pathology and Otorhinolaryngology was performed. The various demographic and clinical data were tabulated.
Results
In total, seven patients (four females, three males) with localized head and neck amyloidosis (three supraglottic, three lingual and one sinonasal) were identified. Six patients had AL-amyloid deposits, and one patient had AA-amyloid deposits. Supraglottic involvement and that of the base of the tongue were treated surgically using CO2 laser, and these patients were disease-free at the last follow-up. The patient with sinonasal amyloidosis experienced symptom recurrence after six months of the functional endoscopic sinus surgery. All of the patients were screened for systemic amyloidosis with abdominal fat pad biopsy, and were found to be free of systemic spread.
Conclusion
Isolated head and neck amyloidosis, as opposed to systemic amyloidosis, has an excellent prognosis in terms of survival. Therefore, systemic amyloidosis should be excluded in all cases. The treatment of choice remains surgical excision; however, watchful waiting may be a suitable strategy for mild symptoms or for cases in which the disease was discovered incidentally.
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Affiliation(s)
- Anup Singh
- Department of Otorhinolaryngology and Head and Neck Surgery, Medanta - The Medicity, Gurugram, Haryana, India
| | - Mubashshirul Haq
- Department of Otorhinolaryngology and Head and Neck Surgery, Medanta - The Medicity, Gurugram, Haryana, India
| | - Poonam Gautam
- Department of Otorhinolaryngology and Head and Neck Surgery, Medanta - The Medicity, Gurugram, Haryana, India
| | - Dheeraj Gautam
- Department of Pathology, Medanta - The Medicity, Gurugram, Haryana, India
| | - Aru C Handa
- Department of Otorhinolaryngology and Head and Neck Surgery, Medanta - The Medicity, Gurugram, Haryana, India
| | - Kumud K Handa
- Department of Otorhinolaryngology and Head and Neck Surgery, Medanta - The Medicity, Gurugram, Haryana, India
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Bartier S, Bodez D, Kharoubi M, Canouï-Poitrine F, Chatelin V, Henrion C, Coste A, Damy T, Béquignon E. Pharyngo-laryngeal involvement in systemic amyloidosis with cardiac involvement: a prospective observational study. Amyloid 2019; 26:216-224. [PMID: 31364411 DOI: 10.1080/13506129.2019.1646639] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Background: Systemic amyloidosis with cardiac involvement (CA) is a severe disease caused by the aggregation of misfolded proteins infiltrating organs and tissues and leading to their dysfunction. No study has yet focused on potential pharyngo-laryngeal impairments associated to CA. Our objective was to define its prevalence and describe pharyngo-laryngeal involvement patterns in a population with CA (light chain: AL, wild-type transthyretin: ATTRwt, variant transthyretin: ATTRv). Methods: Consecutive patients with a confirmed diagnosis of CA were prospectively investigated for pharyngo-laryngeal involvement. This included questionnaires on symptoms of dysphonia/dysphagia and quality of life Voice Handicap Index (VHI). In cases of dysphonia, a nasofibroscopy was performed to evaluate potential laryngeal organic lesions of amyloid infiltration and induced laryngeal dysfunction (mobility, glottic air leak). In cases of dysphagia, Video Endoscopy Swallowing Study (VESS) was performed to evaluate the presence of hypopharyngeal pooling at rest and during swallowing and the time of swallowing 80 ml of water. Results: Ninety-five CA patients were enrolled, of whom 19 were ATTRv, 36 AL and 40 ATTRwt. Their mean age was 73.8 ± 9.2 years and the sex ratio was 2.6 in favor of men. Dysphagia was reported in 17% of the patients and 40% had more specific oropharyngeal symptoms (food sticking, regurgitation, change in dietary habits), preceding the CA diagnosis by 7 (0-24) months. Recent weight loss was reported in 60% of the patients (mean loss of 10 ± 6.3 kg). VESS showed functional swallowing impairment in only 4 patients without any macroscopic organic lesion. Dysphonia was reported in 36% of the patients (44% and 47% in AL and ATTRv sub-groups, respectively) of whom 40% had functional or organic laryngeal abnormality (14% of vocal fold mobility dysfunction and 26% of abnormal mucosa) without any macroscopic-specific lesions of amyloid infiltration in these patients. Conclusions: This prospective study suggests, for the first time, that amyloid associated with CA could infiltrate the various anatomical structures of the pharyngo-larynx, responsible for functional impairment and potential nutritional depletion and poor quality of life.
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Affiliation(s)
- Sophie Bartier
- Department of Oto-rhino-laryngo Surgery, Centre Hospitalier Intercommunal de Créteil , Créteil , France.,Referral Center for Cardiac Amyloidosis, Filière Cardiogen and GRC Amyloid Research Institute , Créteil , France.,Henri Mondor Teaching Hospital, Mondor Amyloidosis Network , Créteil , France.,Department of Oto-rhino-laryngology, AP-HP, Henri Mondor Teaching Hospital , Créteil , France
| | - Diane Bodez
- Referral Center for Cardiac Amyloidosis, Filière Cardiogen and GRC Amyloid Research Institute , Créteil , France.,Henri Mondor Teaching Hospital, Mondor Amyloidosis Network , Créteil , France.,School of Medicine, University Paris-Est Creteil (UPEC) , Créteil , France.,INSERM U955 - Institut Mondor de Recherche Biomedicale , Créteil , France.,Department of Cardiology, AP-HPHenri Mondor Teaching Hospital , Créteil , France
| | - Mounira Kharoubi
- Referral Center for Cardiac Amyloidosis, Filière Cardiogen and GRC Amyloid Research Institute , Créteil , France.,Henri Mondor Teaching Hospital, Mondor Amyloidosis Network , Créteil , France.,School of Medicine, University Paris-Est Creteil (UPEC) , Créteil , France.,Department of Cardiology, AP-HPHenri Mondor Teaching Hospital , Créteil , France
| | - Florence Canouï-Poitrine
- School of Medicine, University Paris-Est Creteil (UPEC) , Créteil , France.,Department of Epidemiology and Biostatistics, AP-HPHenri Mondor Teaching Hospital , Créteil , France
| | - Véronique Chatelin
- Department of Oto-rhino-laryngology, AP-HP, Henri Mondor Teaching Hospital , Créteil , France
| | - Carole Henrion
- Referral Center for Cardiac Amyloidosis, Filière Cardiogen and GRC Amyloid Research Institute , Créteil , France.,Henri Mondor Teaching Hospital, Mondor Amyloidosis Network , Créteil , France.,School of Medicine, University Paris-Est Creteil (UPEC) , Créteil , France.,Department of Cardiology, AP-HPHenri Mondor Teaching Hospital , Créteil , France
| | - André Coste
- Department of Oto-rhino-laryngo Surgery, Centre Hospitalier Intercommunal de Créteil , Créteil , France.,Department of Oto-rhino-laryngology, AP-HP, Henri Mondor Teaching Hospital , Créteil , France.,School of Medicine, University Paris-Est Creteil (UPEC) , Créteil , France.,INSERM U955 - Institut Mondor de Recherche Biomedicale , Créteil , France.,CNRS ERL 7240 , Créteil , France
| | - Thibaud Damy
- Referral Center for Cardiac Amyloidosis, Filière Cardiogen and GRC Amyloid Research Institute , Créteil , France.,Henri Mondor Teaching Hospital, Mondor Amyloidosis Network , Créteil , France.,School of Medicine, University Paris-Est Creteil (UPEC) , Créteil , France.,Department of Cardiology, AP-HPHenri Mondor Teaching Hospital , Créteil , France
| | - Emilie Béquignon
- Department of Oto-rhino-laryngo Surgery, Centre Hospitalier Intercommunal de Créteil , Créteil , France.,Department of Oto-rhino-laryngology, AP-HP, Henri Mondor Teaching Hospital , Créteil , France.,School of Medicine, University Paris-Est Creteil (UPEC) , Créteil , France.,INSERM U955 - Institut Mondor de Recherche Biomedicale , Créteil , France.,CNRS ERL 7240 , Créteil , France
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17
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Wu X, Zhang J, Wei C. Curative effect of cold micro forceps and CO 2 laser in the treatment of laryngeal amyloidosis. Acta Otolaryngol 2019; 139:1122-1127. [PMID: 31642730 DOI: 10.1080/00016489.2019.1680864] [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: 10/25/2022]
Abstract
Background: Amyloidosis is a benign, slowly progressive disease. However, the treatment of laryngeal amyloidosis (LA) has not been studied systematically.Objectives: To investigate the treatment results of cold micro forceps or carbon dioxide laser under microlaryngoscope in the treatment of LA.Methods: A retrospective review was conducted for the cases collected from January 1990 to March 2016 at our department.Results: One hundred and eighteen patients (44 males and 74 females, with an average age of 51.7 years) with LA were identified. The amyloidosis was not found in organs other than the larynges and tracheas. The patients most commonly presented with hoarseness and dyspnea. All patients underwent surgical removal of the amyloid deposits (via micro forceps or CO2 laser). Twenty-nine patients developed recurrences requiring further treatments. The mean interval from treatments to recurrences in these patients was 16.5 months. Five patients were treated more than once. No significant difference was found between cold micro forceps and CO2 laser methods in recurrences.Conclusions: LA generally behaves as a benign disease. Resection of LA either via cold micro forceps or CO2 laser under microlaryngoscope is both safe and effective methods. Regular follow-up with laryngoscopy is indicated for early diagnosis of recurrence.
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Affiliation(s)
- Xiufa Wu
- Department of Otolaryngology – Head and Neck Surgery, Eye, Ear, Nose, and Throat Hospital of Fudan University, Shanghai, PR China
| | - Jing Zhang
- Department of Facial Plastic and Reconstructive Surgery, Eye, Ear, Nose, and Throat Hospital of Fudan University, Shanghai, PR China
| | - Chunsheng Wei
- Department of Otolaryngology – Head and Neck Surgery, Eye, Ear, Nose, and Throat Hospital of Fudan University, Shanghai, PR China
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18
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Localized Amyloidosis of the Upper Aerodigestive Tract: Complex Analysis of the Cellular Infiltrate and the Amyloid Mass. Anal Cell Pathol (Amst) 2019; 2019:6165140. [PMID: 31531279 PMCID: PMC6721467 DOI: 10.1155/2019/6165140] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 06/24/2019] [Accepted: 07/24/2019] [Indexed: 12/11/2022] Open
Abstract
Objectives The aim of this study was to analyse the composition of amyloid mass and the plasmacytic infiltrate of localized amyloidosis of the upper aerodigestive tract. Methods Biopsy materials were studied by light microscopy, immunohistochemistry (IHC), and mRNA in situ hybridization (mRNA-ISH). The amyloid mass was also analysed with high-performance liquid chromatography mass spectrometry- (HPLC-MS-) based proteomics. Results Nodular and diffuse forms of amyloid deposition were detected. IHC analysis revealed λ-light chain (LC) in two cases, κ-LC in one case. The remaining two were positive with both. Proteins, well known from other amyloidoses like amyloid A (AA), prealbumin/transthyretin (PA), apolipoprotein A-I (ApoAI), and amyloid P component (APC), and also keratin were found with variable intensities in the cases. HPLC-MS revealed dozens of proteins with both LCs in all the lesions but sometimes with surprisingly small intensities. mRNA-ISH analysis revealed identical λ and κ dominance and only one normal κ/λ cell ratio. Conclusion Cellular infiltrate and protein components in the amyloid showed congruent results in all but one case. The only exception with normal cell ratio and λ-dominant amyloid could be originated from the different protein-secreting activity of plasma cell clones. HPLC-MS analysis explored both LCs in all the amyloid in variable amount, but other proteins with much higher intensities like keratins, apolipoprotein A-IV (ApoAIV), were also detected. Proteins like AA, PA, ApoAI, and APC, previously known about amyloid-forming capability, also appeared. This indicates that localized amyloid in the upper aerodigestive tract is not a homogenous immunoglobulin mass but a mixture of proteins. The sometimes very low light chain intensities might also suggest that not all the localized amyloidosis cases of the upper aerodigestive tract are of convincingly AL type, and the analysis of the cellular infiltrate might indicate that not all are monoclonal.
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19
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Affiliation(s)
- Lee M. Akst
- From the Department of Pathology, Woodland Hills Medical Center, Southern California Kaiser Permanente Group, Woodland Hills, Calif
| | - Lester D.R. Thompson
- From the Department of Pathology, Woodland Hills Medical Center, Southern California Kaiser Permanente Group, Woodland Hills, Calif
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20
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Amyloidosis of the Upper Aerodigestive Tract: Management of a Rare Disease and Review of the Literature. Dysphagia 2018; 34:179-191. [DOI: 10.1007/s00455-018-9956-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 10/20/2018] [Indexed: 01/23/2023]
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21
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Abstract
Amyloidosis of the nasopharynx is a rare presentation of localized amyloidosis. The majority of systemic amyloidosis cases involve the heart, gastrointestinal tract, kidneys, and upper and lower respiratory tract. Localized amyloidosis involving only one site is less common, but has been observed in the head and neck area, particularly in the larynx or the oral cavity. Amyloidosis in the nasopharynx has been reported in only seven previous cases in the English literature.
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Affiliation(s)
- Jonathan A. Lesserson
- Department of Otolaryngology-Head and Neck Surgery, New York Eye and Ear Infirmary, New York, New York Presented at the International Advanced Sinus Symposium, Philadelphia, Pennsylvania, July 21–24, 1993
| | - Douglas G. Finn
- Department of Otolaryngology-Head and Neck Surgery, New York Eye and Ear Infirmary, New York, New York Presented at the International Advanced Sinus Symposium, Philadelphia, Pennsylvania, July 21–24, 1993
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22
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Behura SK, Tizioto PC, Kim J, Grupioni NV, Seabury CM, Schnabel RD, Gershwin LJ, Van Eenennaam AL, Toaff-Rosenstein R, Neibergs HL, Regitano LCA, Taylor JF. Tissue Tropism in Host Transcriptional Response to Members of the Bovine Respiratory Disease Complex. Sci Rep 2017; 7:17938. [PMID: 29263411 PMCID: PMC5738336 DOI: 10.1038/s41598-017-18205-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Accepted: 12/07/2017] [Indexed: 01/11/2023] Open
Abstract
Bovine respiratory disease (BRD) is the most common infectious disease of beef and dairy cattle and is characterized by a complex infectious etiology that includes a variety of viral and bacterial pathogens. We examined the global changes in mRNA abundance in healthy lung and lung lesions and in the lymphoid tissues bronchial lymph node, retropharyngeal lymph node, nasopharyngeal lymph node and pharyngeal tonsil collected at the peak of clinical disease from beef cattle experimentally challenged with either bovine respiratory syncytial virus, infectious bovine rhinotracheitis, bovine viral diarrhea virus, Mannheimia haemolytica or Mycoplasma bovis. We identified signatures of tissue-specific transcriptional responses indicative of tropism in the coordination of host's immune tissue responses to infection by viral or bacterial infections. Furthermore, our study shows that this tissue tropism in host transcriptional response to BRD pathogens results in the activation of different networks of response genes. The differential crosstalk among genes expressed in lymphoid tissues was predicted to be orchestrated by specific immune genes that act as 'key players' within expression networks. The results of this study serve as a basis for the development of innovative therapeutic strategies and for the selection of cattle with enhanced resistance to BRD.
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Affiliation(s)
- Susanta K Behura
- Division of Animal Sciences, University of Missouri, Columbia, MO, United States of America
| | - Polyana C Tizioto
- Division of Animal Sciences, University of Missouri, Columbia, MO, United States of America.,Embrapa Southeast Livestock, São Carlos, SP, Brazil
| | - JaeWoo Kim
- Division of Animal Sciences, University of Missouri, Columbia, MO, United States of America
| | - Natalia V Grupioni
- Departamento de Ciencias Exatas, UNESP - Univ Estadual Paulista, Faculdade de Ciencias Agrarias e Veterinarias, Jaboticabal, SP, 14884-900, Brazil
| | - Christopher M Seabury
- Department of Veterinary Pathobiology, College of Veterinary Medicine, Texas A&M University, College Station, TX, United States of America
| | - Robert D Schnabel
- Division of Animal Sciences, University of Missouri, Columbia, MO, United States of America.,Informatics Institute, University of Missouri, Columbia, MO, United States of America
| | - Laurel J Gershwin
- Department of Pathology, Microbiology & Immunology, School of Veterinary Medicine, University of California, Davis, California, United States of America
| | - Alison L Van Eenennaam
- Department of Animal Science, College of Agriculture, University of California, Davis, CA, United States of America
| | - Rachel Toaff-Rosenstein
- Department of Animal Science, College of Agriculture, University of California, Davis, CA, United States of America
| | - Holly L Neibergs
- Department of Animal Sciences, College of Agriculture and Natural Resource Sciences, Washington State University, Pullman, WA, United States of America
| | | | - Jeremy F Taylor
- Division of Animal Sciences, University of Missouri, Columbia, MO, United States of America.
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23
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Milani P, Basset M, Russo F, Foli A, Palladini G, Merlini G. The lung in amyloidosis. Eur Respir Rev 2017; 26:26/145/170046. [DOI: 10.1183/16000617.0046-2017] [Citation(s) in RCA: 79] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Accepted: 05/31/2017] [Indexed: 01/10/2023] Open
Abstract
Amyloidosis is a disorder caused by misfolding of autologous protein and its extracellular deposition as fibrils, resulting in vital organ dysfunction and eventually death. Pulmonary amyloidosis may be localised or part of systemic amyloidosis.Pulmonary interstitial amyloidosis is symptomatic only if the amyloid deposits severely affect gas exchange alveolar structure, thus resulting in serious respiratory impairment. Localised parenchymal involvement may be present as nodular amyloidosis or as amyloid deposits associated with localised lymphomas. Finally, tracheobronchial amyloidosis, which is usually not associated with evident clonal proliferation, may result in airway stenosis.Because the treatment options for amyloidosis are dependent on the fibril protein type, the workup of all new cases should include accurate determination of the amyloid protein. Most cases are asymptomatic and need only a careful follow-up. Diffuse alveolar-septal amyloidosis is treated according to the underlying systemic amyloidosis. Nodular pulmonary amyloidosis is usually localised, conservative excision is usually curative and the long-term prognosis is excellent. Tracheobronchial amyloidosis is usually treated with bronchoscopic interventions or external beam radiation therapy.
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24
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Rudy SF, Jeffery CC, Damrose EJ. Clinical characteristics of laryngeal versus nonlaryngeal amyloidosis. Laryngoscope 2017; 128:670-674. [PMID: 28868800 DOI: 10.1002/lary.26846] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 05/30/2017] [Accepted: 07/24/2017] [Indexed: 12/28/2022]
Abstract
OBJECTIVES/HYPOTHESIS Amyloidosis represents a heterogeneous group of disorders marked by abnormal protein formation and deposition. Laryngeal amyloidosis is rare and classically thought to remain isolated with little risk of systemic involvement or associated malignancy. This study sought to further characterize differences in clinical characteristics between patients with laryngeal and nonlaryngeal amyloidosis. STUDY DESIGN Retrospective case-control study. METHODS The Stanford Translational Research Integrated Database Environment was searched to identify patients with biopsy-confirmed laryngeal amyloidosis and patients with amyloidosis without laryngeal involvement on endoscopy. Mann-Whitney U and χ2 tests were used for statistical analysis. RESULTS Of 865 patients treated for amyloidosis between 1996 and 2016, 22 (2.5%) patients with biopsy-proven laryngeal amyloidosis were identified. An additional 22 patients with amyloidosis of a different organ and negative laryngoscopy-and therefore without laryngeal amyloidosis-were identified as controls. Compared to these controls with nonlaryngeal amyloidosis, patients with laryngeal amyloidosis were younger (mean age 52.8 years vs. 68.4 years, P < .0006), and 18% had additional organ involvement. Immunoglobulin light-chain amyloidosis was the most common subtype in both groups of patients. Eighty-six percent of patients with laryngeal amyloidosis required surgical excision, and of these patients, over 30% required multiple excisions. CONCLUSIONS There is a significant rate (18%) of multiorgan involvement in patients with laryngeal amyloidosis, which contradicts conventional concepts that this is an isolated disorder. This finding could have a significant impact on the evaluation and management of patients with laryngeal amyloidosis. LEVEL OF EVIDENCE 3b. Laryngoscope, 128:670-674, 2018.
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Affiliation(s)
- Shannon F Rudy
- Department of Otolaryngology-Head and Neck Surgery, Stanford School of Medicine, Stanford University, Stanford, California, U.S.A
| | - Caroline C Jeffery
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Edward J Damrose
- Department of Otolaryngology-Head and Neck Surgery, Stanford School of Medicine, Stanford University, Stanford, California, U.S.A
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25
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Laryngeal amyloidosis: diagnosis, pathophysiology and management. The Journal of Laryngology & Otology 2017; 131:S41-S47. [DOI: 10.1017/s0022215117000780] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractBackground:Laryngeal amyloidosis represents approximately 1 per cent of all benign laryngeal lesions, and can cause variable symptoms depending on anatomical location and size. Treatment ranges from observation through to endoscopic microsurgery, laser excision and laryngectomy.Objectives:To highlight the diversity of presentations, increase awareness of paediatric amyloidosis and update the reader on current management.Case series:Five cases are illustrated. Four adult patients were female, and the one child, the second youngest in the literature, was male. Amyloid deposits were identified in all laryngeal areas, including the supraglottis, glottis and subglottis. Treatment consisted of balloon dilatation, endoscopic excision, laser cruciate incision, and resection with carbon dioxide laser, a microdebrider and coblation wands.Conclusion:Laryngeal amyloidosis remains a rare and clinically challenging condition. Diagnosis should be considered for unusual appearing submucosal laryngeal lesions. Treatment of this disease needs to be evaluated on a case-by-case basis and managed within an appropriate multidisciplinary team.
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Abstract
CONTEXT -Amyloidosis is a heterogeneous group of diseases characterized by the deposition of congophilic amyloid fibrils in the extracellular matrix of tissues and organs. To date, 31 fibril proteins have been identified in humans, and it is now recommended that amyloidoses be named after these fibril proteins. Based on this classification scheme, the most common forms of amyloidosis include systemic AL (formerly primary), systemic AA (formerly secondary), systemic wild-type ATTR (formerly age-related or senile systemic), and systemic hereditary ATTR amyloidosis (formerly familial amyloid polyneuropathy). Three different clinicopathologic forms of amyloidosis can be seen in the lungs: diffuse alveolar-septal amyloidosis, nodular pulmonary amyloidosis, and tracheobronchial amyloidosis. OBJECTIVE -To clarify the relationship between the fibril protein-based amyloidosis classification system and the clinicopathologic forms of pulmonary amyloidosis and to provide a useful guide for diagnosing these entities for the practicing pathologist. DATA SOURCES -This is a narrative review based on PubMed searches and the authors' own experiences. CONCLUSIONS -Diffuse alveolar-septal amyloidosis is usually caused by systemic AL amyloidosis, whereas nodular pulmonary amyloidosis and tracheobronchial amyloidosis usually represent localized AL amyloidosis. However, these generalized scenarios cannot always be applied to individual cases. Because the treatment options for amyloidosis are dependent on the fibril protein-based classifications and whether the process is systemic or localized, the workup of new clinically relevant cases should include amyloid subtyping (preferably with mass spectrometry-based proteomic analysis) and further clinical investigation.
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27
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Abstract
Amyloidosis is a disorder of protein folding in which normally soluble plasma proteins aggregate in an abnormal fibrillar form causing progressive disruption to tissue structure and organ function. This review covers systemic AA and AL amyloidosis which may arise as a consequence of chronic respiratory conditions; the manifestations of both systemic and of localised amyloid deposition within the respiratory tract and provides a summary of current approaches to diagnosis and management.
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Affiliation(s)
- H J Lachmann
- National Amyloidosis Centre and Centre for Amyloidosis and Acute Phase Proteins, Department of Medicine, Royal Free and University College Medical School, Royal Free Campus, London, UK.
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Bartels H, Dikkers FG, van der Wal JE, Lokhorst HM, Hazenberg BPC. Laryngeal Amyloidosis: Localized versus Systemic Disease and Update on Diagnosis and Therapy. Ann Otol Rhinol Laryngol 2016; 113:741-8. [PMID: 15453534 DOI: 10.1177/000348940411300913] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The clinical and pathological characteristics, possibility of systemic disease, and effect of local therapy were studied in laryngeal amyloidosis. Records of all patients with localized laryngeal amyloidosis in a single tertiary referral center were examined retrospectively at diagnosis and after local therapy. Of 188 new patients with amyloidosis between 1990 and 2003, 5 patients had localized laryngeal amyloidosis. A sixth patient with localized laryngeal amyloidosis turned out to have systemic AL (immunocyte-derived) amyloidosis 8 years later. Free light chains were found in this patient, as well as in 1 of the other 5 patients. Amyloid interfering with laryngeal or airway function was removed during microlaryngoscopy with a carbon dioxide laser or cold endoscopic excision. The best results were seen when glottic deposits were removed by cold endoscopic excision, and supraglottic deposits by a carbon dioxide laser. Four patients had recurrent disease. A systematic workup, including measurement of free light chains, helps to rule out systemic disease.
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Affiliation(s)
- Hilke Bartels
- Department of Otorhinolaryngology, University Hospital Groningen, Groningen, the Netherlands
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29
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Une cause rare de dysphonie. Rev Med Interne 2014; 35:843-5. [DOI: 10.1016/j.revmed.2014.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Revised: 01/03/2014] [Accepted: 01/25/2014] [Indexed: 11/17/2022]
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30
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Bouaity B, Darouassi Y, Touati MM, Chihani M, Nadour K, Ammar H. Laryngeal amyloidosis, report of a new case and review of the literature. ACTA ACUST UNITED AC 2014. [DOI: 10.1016/j.ejenta.2014.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Deviprasad D, Pujary K, Balakrishnan R, Nayak DR. KTP Laser in Laryngeal Amyloidosis: Five Cases with Review of Literature. Indian J Otolaryngol Head Neck Surg 2013; 65:36-41. [PMID: 24427613 PMCID: PMC3718958 DOI: 10.1007/s12070-011-0435-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2010] [Accepted: 12/20/2011] [Indexed: 10/14/2022] Open
Abstract
To study the clinical presentation and review the options in the management of laryngeal amyloidosis. To study the efficacy of KTP 532 laser in the excision of laryngeal amyloidosis. Study was conducted in our department in a tertiary care hospital between Jan 2001 and Feb 2010. We report five patients who presented with hoarseness of voice and localized laryngeal lesions. The biopsy proven laryngeal amyloidosis lesions were excised microendoscopically using KTP 532 laser in three patients and other two patients were kept only on follow-up as they refused further surgery. The patients were evaluated for systemic amyloidosis. The average duration of follow up was 2.6 years (3 months 6 years). All the five patients in our study were asymptomatic with no evidence of recurrence at their last follow up. In our small case series, KTP 532 laser excision of the laryngeal amyloidosis had a favorable outcome. Long term follow up is required to rule out recurrence and systemic involvement.
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Affiliation(s)
- D. Deviprasad
- Department of Otorhinolaryngology and Head and Neck surgery, Kasturba Medical College, Manipal University, Manipal, 576104 India
| | - K. Pujary
- Department of Otorhinolaryngology and Head and Neck surgery, Kasturba Medical College, Manipal University, Manipal, 576104 India
| | - R. Balakrishnan
- Department of Otorhinolaryngology and Head and Neck surgery, Kasturba Medical College, Manipal University, Manipal, 576104 India
| | - D. R. Nayak
- Department of Otorhinolaryngology and Head and Neck surgery, Kasturba Medical College, Manipal University, Manipal, 576104 India
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32
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Park JH, Cheng HM. Isolated laryngeal amyloidosis in a patient with a hoarse voice. BMJ Case Rep 2013; 2013:bcr-2012-008450. [PMID: 23563679 DOI: 10.1136/bcr-2012-008450] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
We present a case of a 59-year-old woman with a hoarse voice of 3 weeks duration. A polypoid lesion involving the anterior aspect of the left vocal cord was detected by flexible fibreoptic endoscopic examination. Flexible bronchoscopic examination was unremarkable. Microlaryngoscopy and excisional biopsy of the laryngeal lesion were carried out. Histology of the biopsy showed stroma exhibiting birefringence under polarised light and a diagnosis of laryngotracheal amyloidosis was made. Systemic amyloidosis was ruled out by further investigations including positron emission tomography scan. Her hoarse voice improved following the excisional biopsy and regular follow-up was arranged for early diagnosis of recurrence.
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Affiliation(s)
- Jae Hong Park
- Department of Otolaryngology Head and Neck Surgery, Royal Perth Hospital, Perth, Western Australia, Australia.
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Chow V, Gardner K, Howlett D. Primary localized laryngeal amyloidosis presenting with dysphonia: a case report. J Surg Case Rep 2012; 2012:rjs005. [PMID: 24968392 PMCID: PMC3852952 DOI: 10.1093/jscr/rjs005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Localized laryngeal amyloidosis is a rare disease with poorly understood aetiology. The commonest symptom at presentation is dysphonia and for a correct diagnosis of amyloidosis to be made a high index of suspicion is needed [Fraihat A, Ardah A. Laryngeal amyloidosis: a case report. J R Med Serv 2005;17:57–9; Passerotti GH, Caniello M, Hachiya A, Santoro PP, Imamura R, Tsuji DH. Multiple sited amyloidosis in the upper aerodigestive tract: case report and literature review. Rev Bras Otorrinolaringol 2008;74:462–6]. We present a case of a 48-year-old male who was investigated over a 5-year period for persistent and progressive hoarseness of voice before the accurate diagnosis of localized amyloidosis was reached. Management of this case consisted of local treatment with endoscopic carbon dioxide laser excision of laryngeal lesions to good effect and exclusion of systemic disease with yearly follow-up for monitoring disease progression.
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Affiliation(s)
- Vanessa Chow
- Department of Otolaryngology, Eastbourne District General Hospital, East Sussex, UK
| | - Kate Gardner
- Department of Haematology, Eastbourne District General Hospital, East Sussex, UK
| | - David Howlett
- Department of Radiology, Eastbourne District General Hospital, East Sussex, UK
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Li Y, Liu N, Xu Y, Wang J, Wu L, Zhou Y, Zhu X, Jin X, Chen Q, Zeng X, Zeng X. Widespread purple bulla-like masses of the oral mucosa. Oral Surg Oral Med Oral Pathol Oral Radiol 2012; 114:552-7. [DOI: 10.1016/j.oooo.2011.11.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2011] [Revised: 10/30/2011] [Accepted: 11/08/2011] [Indexed: 12/13/2022]
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Abstract
Amyloidosis is a rare group of diseases characterized by deposition of amyloid fibrils in soft tissues. More than 28 types of amyloid have been identified. They all share common ultrastructural and chemical characteristics. Treatments are available for many types but are type specific. Therefore, confirmation and typing of amyloid are essential before initiating treatment. Monoclonal protein studies should be performed on suspected cases, but the diagnosis requires a tissue biopsy. Congo red stain and electron microscopy are helpful to discriminate between amyloid and other pathologic fibrils. Once amyloid is confirmed, typing should be performed. Immunofluorescence and immunohistochemistry are frequently used and are helpful, but this approach has limitations, such as availability, specificity and sensitivity of commercial antibodies. Genetic mutational analysis is vital for ruling in and out hereditary amyloidoses but is unhelpful in nonmutated forms. The most advanced technique of amyloid typing is laser microdissection followed by mass spectrometry. Using proteomics, laser microdissection followed by mass spectrometry can directly identify proteins with or without mutations. Finally, imaging studies, such as cardiac MRI with gadolinium and (123)I-labeled SAP scintigraphy not only assist in evaluation of patients with known amyloidosis but cardiac MRI has detected amyloid in patients previously unsuspected of the disease.
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Abstract
The term amyloid describes the deposition in the extracellular space of certain proteins in a highly characteristic, insoluble fibrillar form. Amyloidosis describes the various clinical syndromes that occur as a result of damage by amyloid deposits in tissues and organs throughout the body. The clinical significance of amyloid varies enormously, ranging from incidental asymptomatic deposits to localized disease through to rapidly fatal systemic forms that can affect multiple vital organs. Currently available therapy is focused on reducing the supply of the respective amyloid fibril precursor protein and supportive medical care, which together have greatly improved survival. Chemotherapy and anti-inflammatory treatment for the disorders that underlie AL and AA amyloidosis are guided by serial measurements of the respective circulating amyloid precursor proteins, i.e. serial serum free light chains in AL and serum amyloid A protein in AA type. Quality of life and prognosis of some forms of hereditary systemic amyloidosis can be improved by liver and other organ transplants. Various new therapies, ranging from silencing RNA, protein stabilizers to monoclonal antibodies, aimed at inhibiting fibril precursor supply, fibril formation or the persistence of amyloid deposits, are in development; some are already in clinical phase.
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Affiliation(s)
- Jennifer H Pinney
- UCL Centre for Nephrology, UCL Medical School, Royal Free Hampstead NHS Trust, Rowland Hill Street, London NW3 2PF, UK.
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Abstract
Benign and malignant lesions of the larynx and hypopharynx present an interesting and diverse spectrum of diagnostic entities, which may be infrequently encountered in routine surgical pathology practice. This article places emphasis on illustrating the classical pathologic characteristics, differential diagnosis, clinical significance, and presentation of common lesions unique to these sites. The initial diagnosis of these lesions is via small endoscopic biopsy. Many of the entities have overlapping histologic features which necessitate optimizing the information available in a small sample. The focus of this article is to provide useful criteria to enable separating the more common types of lesions encountered in these sites.
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Affiliation(s)
- Joaquín J García
- Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, 200 First Street Southwest, Rochester, MN 55905, USA
| | - Mary S Richardson
- Medical University of South Carolina, 171 Ashley Avenue, MSC 908, Charleston, SC 29425, USA
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38
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Abstract
Laryngeal amyloidosis is uncommon and poorly understood, with limited long-term studies. Although primary localized laryngeal amyloidosis is extremely rare, it frequently involves the ventricles and the false and true vocal cords. We present a 58-year-old woman with localized laryngeal amyloidosis who presented no symptoms. On indirect laryngoscopic examination, the mass involved both arytenoids only, and had a likeness to a "boxer glove." She was treated surgically by microlaryngoscopy under general anesthesia and the mass was excised using a carbon dioxide laser. We present this case and a review of literature.
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Laryngeal amyloidosis: a case report. Indian J Otolaryngol Head Neck Surg 2011; 63:85-6. [PMID: 22319723 DOI: 10.1007/s12070-010-0066-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2008] [Accepted: 02/23/2009] [Indexed: 10/18/2022] Open
Abstract
We report a case of Amyloidosis of larynx in a 60-year-old adult who reported to us with hoarseness of voice of 3 years long duration and no other symptoms. Patient was treated successfully with endoscopic curettage of the mass with no inadvertent ill effects.
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40
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Neuner GA, Badros AA, Meyer TK, Nanaji NM, Regine WF. Complete resolution of laryngeal amyloidosis with radiation treatment. Head Neck 2010; 34:748-52. [DOI: 10.1002/hed.21626] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2010] [Accepted: 08/12/2010] [Indexed: 11/07/2022] Open
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Hammami B, Mnejja M, Kallel S, Bouguecha L, Chakroun A, Charfeddine I, Ghorbel A. Hypopharyngeal amyloidosis: A case report. Eur Ann Otorhinolaryngol Head Neck Dis 2010; 127:83-5. [PMID: 20822762 DOI: 10.1016/j.anorl.2010.02.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2009] [Accepted: 01/19/2010] [Indexed: 11/16/2022]
Abstract
Hypopharyngeal amyloidosis is rare. Management depends on etiology. We report a case of hypopharyngeal amyloidosis and review the characteristics of this exceptional pathology. A 60-year-old woman with a history of diabetes and chronic cervicalgia consulted for dysphagia and deteriorated general health status, which had been evolving for 2 months. Clinical examination found two ulcerations of the lateral edge of the tongue and right pyriform sinus salivary stasis. Panendoscopy found regular swelling of the posterior wall of the hypopharynx and cervical esophagus. The pyriform sinuses and larynx were normal. Cervical CT and MRI showed thickening of the posterior wall of the hypopharynx. Biopsy found amorphous acellular eosinophil interstitial deposits, shown to be amyloid on Congo red staining, leading to a diagnosis of amyloidosis. Etiological assessment pointed to myeloma. The patient was managed by chemotherapy associating melphalan and prednisone. Evolution at 12 months' follow-up was good. Localized amyloidosis is a rare lesion of the superior aerodigestive tract, predominating in the larynx. Hypopharyngeal involvement is exceptional. Diagnosis is histological. Management depends on etiology. Local treatment is exceptional other than in case of complication. Systemic forms with associated myeloma are of poor prognosis.
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Affiliation(s)
- B Hammami
- ENT and Head and Neck Surgery Department, Habib Bourguiba Teaching Hospital, Sfax 3029, Tunisia.
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42
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Bhat A, Selmi C, Naguwa SM, Cheema GS, Gershwin ME. Currents concepts on the immunopathology of amyloidosis. Clin Rev Allergy Immunol 2010; 38:97-106. [PMID: 19626465 DOI: 10.1007/s12016-009-8163-9] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Amyloidosis is defined as the extracellular accumulation at systemic or organ-specific level of insoluble low molecular weight protein fibrils manifesting a beta pleated sheet configuration and a characteristic staining pattern. Several different types of proteins may lead to this phenomenon, and amyloidosis is defined by the biochemical nature of the protein in the deposits and further classified according to whether the deposits are localized or systemic, acquired or inherited, and by the resulting clinical phenotype. Amyloidosis includes subtypes such as light chain, associated with serum amyloid A protein, heritable and familial forms, dialysis-related disease, and organ-specific conditions. The pathogenesis and clinical features of these clinical and pathological entities will be critically discussed in this review article.
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Affiliation(s)
- Anupama Bhat
- Division of Rheumatology, Allergy and Clinical Immunology, Genome and Biomedical Sciences Facility, University of California at Davis School of Medicine, 451 Health Sciences Drive, Suite 6510, Davis, CA 95616, USA
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43
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Gallivan GJ, Gallivan HK. Laryngeal Amyloidosis Causing Hoarseness and Airway Obstruction. J Voice 2010; 24:235-9. [DOI: 10.1016/j.jvoice.2008.07.006] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2008] [Accepted: 07/24/2008] [Indexed: 11/30/2022]
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Ozyigit LP, Kiyan E, Okumus G, Yilmazbayhan D. Isolated laryngo-tracheal amyloidosis presenting as a refractory asthma and longstanding hoarseness. J Asthma 2009; 46:314-7. [PMID: 19373642 DOI: 10.1080/02770900802660956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Respiratory tract amyloidosis is characterized by deposition of amyloid fibril protein at any site along the respiratory tract ranging from the larynx to the pulmonary parenchyma. Usually, it is not associated with primary systemic amyloidosis. We report a case with isolated laryngotracheal amyloidosis, which is relatively a rare condition, together with a history of refractory asthma accompanied with longstanding hoarseness.
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Affiliation(s)
- Leyla Pur Ozyigit
- Department of Chest Medicine, Istanbul University, Istanbul Medical Faculty, Istanbul, Turkey
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46
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Gaurav K, Panda M. An uncommon cause of bilateral pulmonary nodules in a long-term smoker. J Gen Intern Med 2007; 22:1617-20. [PMID: 17846845 PMCID: PMC2219804 DOI: 10.1007/s11606-007-0324-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2006] [Revised: 01/17/2007] [Accepted: 07/19/2007] [Indexed: 10/22/2022]
Abstract
BACKGROUND Dyspnea caused by pulmonary disease is a common symptom encountered by internists. The most likely diagnosis of pulmonary nodules in a long-term smoker is lung cancer. PATIENT/PARTICIPANT: We report a case of an elderly male with a 70-pack-year smoking history, presenting with exertional dyspnea for 6 months. INTERVENTIONS Detailed review of history was negative. Examination was normal except for diminished breath sounds in all lung fields. Chest x-ray showed bilateral nodular opacities. Computed tomography of thorax revealed multiple bilateral lung masses. A whole-body positron emission tomography revealed enhancement only of the pulmonary masses. Bronchoalveolar lavage was negative for acid fast bacilli, nocardia, and fungi. MAIN RESULTS Lung biopsy showed findings consistent with amyloidosis. Bone marrow biopsy done to investigate primary amyloidosis showed no clonal plasma cells or amyloid staining, thus suggesting a diagnosis of localized pulmonary amyloidosis. Patient is being managed conservatively with close follow-up for signs of progression.
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Affiliation(s)
- Kumar Gaurav
- Department of Medicine, University of Tennessee, College of Medicine-Chattanooga Unit, 975 East Third St., P.O. Box 94, Chattanooga, Tennessee 37403, USA.
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47
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Abstract
AbstractBoth laryngocele and laryngeal amyloidosis are uncommon, and simultaneous occurrences of these entities are extremely rare. A case of laryngeal amyloidosis with laryngocele in which the computed tomography (CT) and magnetic resonance (MR) imaging of the larynx, clearly demonstrating both disease processes, is discussed. Diagnosis is confirmed by histopathologic specimens. Only two cases have been reported in the world literature, and this is the third case of laryngeal amyloidosis associated with laryngocele.
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48
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Gheriani H, Tewary R, O'Sullivan TJ. Amyloidosis of the External Auditory Canal and Middle Ear: Unusual Ear Tumor. EAR, NOSE & THROAT JOURNAL 2007. [DOI: 10.1177/014556130708600211] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Amyloidosis of the ear is rare. We describe the case of a 41-year-old man who had localized amyloidosis that involved the external auditory canal and middle ear. To the best of our knowledge, only 4 other cases of amyloidosis involving the external auditory canal have been previously reported; in none of these cases was the middle ear involved. We also discuss the clinical importance of this condition and its treatment.
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Affiliation(s)
- Heitham Gheriani
- From the Department of Otolaryngology–Head and Neck Surgery, South Infirmary, Victoria Hospital, Cork, Ireland
| | - Rajesh Tewary
- From the Department of Otolaryngology–Head and Neck Surgery, South Infirmary, Victoria Hospital, Cork, Ireland
| | - Timothy J. O'Sullivan
- From the Department of Otolaryngology–Head and Neck Surgery, South Infirmary, Victoria Hospital, Cork, Ireland
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49
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Kojima M, Sugihara S, Iijima M, Ono T, Yoshizumi T, Masawa N. Marginal zone B-cell lymphoma of minor salivary gland representing tumor-forming amyloidosis of the oral cavity. A case report. J Oral Pathol Med 2006; 35:314-6. [PMID: 16630297 DOI: 10.1111/j.1600-0714.2006.00408.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
We report here a case of mucosa-associated lymphoid tissue (MALT)-type lymphoma arising from the minor salivary gland of the oral cavity exhibiting tumor-forming amyloidosis. The patient was a 64-year-old Japanese woman who presented with 4-year history of a left soft palate mass. Despite multiple and multifocal recurrences including the lip, soft palate, tongue, oral base and vocal code and soft palate, the tumor remained localized in the upper aerodigestive tract, and the patient did not develop multiple myeloma during the course of disease. Histologically, the majority of the lesion was occupied by amyloid deposition. Only the periphery of the lesion contained numerous plasmacytoid cells, along with occasional centrocyte-like cells. In addition, lymphoepithelial lesion and follicular colonization were noted. The present case indicates that primary minor salivary gland MALT-type lymphoma appears to be the cause of tumor-forming amyloidosis of the upper aerodigestive tract including the larynx.
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Affiliation(s)
- Masaru Kojima
- Department of Pathology and Clinical Laboratories, Gunma Cancer Center Hospital, Ohta, Japan.
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50
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Paccalin M, Hachulla E, Cazalet C, Tricot L, Carreiro M, Rubi M, Grateau G, Roblot P. Localized amyloidosis: a survey of 35 French cases. Amyloid 2005; 12:239-45. [PMID: 16399649 DOI: 10.1080/13506120500351174] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Since the prognosis of localized amyloidosis remains unclear, we conducted a survey to define the characteristics and the course of this disease. The charts of 35 patients with either laryngeal (14 patients), tracheobronchial (10 patients), colonic (1 patient), or lower urinary tract amyloidosis (10 patients) were analyzed. The average age at diagnosis was 52.7+/-12 years (range 33-73 years). The amyloid protein type was specified to be amyloid light chain (AL) in 15 cases. All patients had undergone additional biopsies (accessory salivary glands, rectal, fat pad and bone marrow aspirates) to rule out a systemic disease. Symptomatic treatments included endoscopic excision and laser therapy. Colchicine and chemotherapy with prednisone and melphalan were prescribed with limited success. During a mean follow-up period of 6.1+/-5.3 years no patient developed a systemic form of amyloidosis. Six deaths were reported, one related to the disease because of a fatal airway hemorrhage. We suggest that immunolabeling studies should be more routinely performed. There was no risk of developing a systemic disease from local amyloid deposits in our survey. However, local evolution can be life-threatening. Such patients should be referred to specialist centers for further evaluation. Management requires close follow-up to exclude recurrence and to determine the appropriate symptomatic treatment.
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Affiliation(s)
- Marc Paccalin
- Department of Internal Medicine, Hôpital Jean Bernard, BP 577, 86021, Poitiers cedex, France.
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