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Zhou P, Yu W, Xia Q, He C. Tracheobronchial mucosal keratosis: A literature review of this rare disorder. Heliyon 2024; 10:e23701. [PMID: 38187287 PMCID: PMC10767502 DOI: 10.1016/j.heliyon.2023.e23701] [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: 09/21/2023] [Revised: 12/08/2023] [Accepted: 12/11/2023] [Indexed: 01/09/2024] Open
Abstract
Background Tracheobronchial mucosal keratosis (TBMK) is a rare airway disease that may cause refractory cough and airway stenosis. The characteristics of this disease remain unknown. In the present study, we describe this disorder based on a review of the current literature, emphasizing its diagnostic and therapeutic aspects. Methods A comprehensive search of TBMK was performed in Medline, Google Scholar, Web of Science, Cochrane Library (UK), Embase, China National Knowledge Infrastructure (CNKI) (China), and Wan Fang Med Online (China). The following data were collected: patient characteristics, chest imaging findings, bronchoscopy, histopathologic findings, pathogen testing, treatment, and prognosis. Results As of 2023, eighteen cases of TBMK have been reported. The main clinical manifestations were cough and expectoration. Chest imaging findings were non-specific. The main bronchoscopy findings were nodular protrusion of airway lumen and yellow-white purulent moss above the nodular lesion. The lesions were mainly located in the trachea and mainstem bronchus. The main pathological manifestations include keratinocytes or keratinocyte beads, squamous metaplasia, and mucosal inflammatory changes. The treatments that were administered include antibiotics, symptomatic treatment, and glucocorticoids. All methods were ineffective except for bronchoscopy-guided high-frequency electric knife and recombinant human epidermal growth factor treatment. Conclusions TBMK is a rare respiratory disease with atypical clinical manifestations and chest computed tomography findings. Bronchoscopy revealed that nodular hyperplasia of the airway and purulent fur-covered lesions are typical manifestations. The final diagnosis needs to be confirmed by histopathological examination. There is a lack of effective treatment for this disease, and bronchoscopy-guided intervention therapy may be a candidate treatment.
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Affiliation(s)
- Pengcheng Zhou
- Department of Respiratory Medicine, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu,Sichuan province, PR China
- Clinical Medical School, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan province, PR China
| | - Wei Yu
- Clinical Medical School, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan province, PR China
| | - Qianming Xia
- Department of Respiratory Medicine, AVIC 363 hospital, Chengdu,Sichuan province, PR China
| | - Chengshi He
- Department of Respiratory Medicine, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu,Sichuan province, PR China
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Smesseim I, Cobussen P, Thakrar R, Daniels H. Management of tracheobronchial amyloidosis: a review of the literature. ERJ Open Res 2024; 10:00540-2023. [PMID: 38333645 PMCID: PMC10851947 DOI: 10.1183/23120541.00540-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 10/29/2023] [Indexed: 02/10/2024] Open
Abstract
Introduction Tracheobronchial amyloidosis is a rare idiopathic disorder characterised by extracellular deposition of misfolded protein fibrils in the tracheobronchial tree. It presents with nonspecific symptoms. Deciding on the best treatment approach can be challenging due to the lack of a treatment guideline. We undertook a review to assess the therapeutic options for tracheobronchial amyloidosis and to highlight gaps within the existing evidence. Methods We performed a literature search from 1 January 1990 until 1 March 2022 to identify relevant literature regarding patient characteristics, symptoms, management and prognosis for patients with tracheobronchial amyloidosis. Results 77 studies consisting of 300 patients were included. We found a great heterogeneity in the management of tracheobronchial amyloidosis patients. Although a fifth of the reported patients were managed with a wait-and-see approach, many different treatments were used as a single intervention, or multiple treatments were combined. An interesting finding is the slightly higher percentage of patients with Sjögren syndrome (n=5, 1.7%) and tracheobronchial amyloidosis compared to the normal population (0.5-1.0%). Conclusions There is a great heterogeneity in the management of tracheobronchial amyloidosis patients. The treatment is still based on expert opinion due to the lack of a treatment guideline. Various treatment approaches include a wait-and-see approach, external beam radiotherapy, therapeutic bronchoscopy, immunosuppressive treatment and surgery.
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Affiliation(s)
- Illaa Smesseim
- Department of Respiratory Medicine, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Paul Cobussen
- Department of Radiation Oncology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Ricky Thakrar
- Department of Respiratory Medicine, University College London Hospitals, London, UK
| | - Hans Daniels
- Department of Respiratory Medicine, Amsterdam University Medical Center, Amsterdam, The Netherlands
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Demissie Z, Zemedkun N, Demile A, Nega B, Bekuretsion Y, Getachew B, Berhanu B. Primary Tracheobronchial Amyloidosis Presenting with an Upper Airway Obstruction. Int Med Case Rep J 2023; 16:757-761. [PMID: 38020579 PMCID: PMC10661957 DOI: 10.2147/imcrj.s438379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Accepted: 11/11/2023] [Indexed: 12/01/2023] Open
Abstract
This is a case of localized primary tracheobronchial amyloidosis in a patient who presented with upper airway obstruction. Tracheobronchial amyloidosis is a type of localized bronchopulmonary amyloidosis that is frequently overlooked. It involves the deposition of amyloid protein on the tracheal and bronchial tissue, leading to progressive tracheal stenosis and airway obstruction that can be seen on imaging as a tracheal mass. Because of its significant diagnostic difficulty and therapeutic conundrum, it ought to be considered in the differential diagnosis of upper airway symptoms with an unknown etiology.
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Affiliation(s)
- Zekewos Demissie
- Department of Internal Medicine, Lancet General Hospital, Addis Ababa, Ethiopia
| | - Nahom Zemedkun
- Department of Internal Medicine, Lancet General Hospital, Addis Ababa, Ethiopia
| | - Abraham Demile
- Department of Internal Medicine, Lancet General Hospital, Addis Ababa, Ethiopia
| | - Berhanu Nega
- Department of Surgery, Division of Cardiothoracic Surgery, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Yonas Bekuretsion
- Department of Pathology, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Bisrat Getachew
- Department of Otolaryngology, Head and Neck Surgery, St. Paul Millennium Medical College, Addis Ababa, Ethiopia
| | - Bethelhem Berhanu
- Department of Radiology, St. Paul Millennium Medical College, Addis Ababa, Ethiopia
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Aslam W, Najafi AG, Lamb CR. Severe tracheobronchial amyloidosis. Am J Med Sci 2022; 364:366-368. [DOI: 10.1016/j.amjms.2022.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 12/13/2021] [Accepted: 04/06/2022] [Indexed: 11/16/2022]
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Arulanantham J, Officer C, O'Connor C, Baillie T, Bass S, Williamson JP, Carew A. Localized tracheobronchial amyloidosis: A rare case presentation and tailored management approaches. Respirol Case Rep 2021; 9:e0820. [PMID: 34401188 PMCID: PMC8355433 DOI: 10.1002/rcr2.820] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 06/21/2021] [Accepted: 07/06/2021] [Indexed: 11/26/2022] Open
Abstract
Localized tracheobronchial amyloidosis (TBA) is a rare manifestation of pulmonary amyloid disease, and can result in central airway obstruction. The nature of presentation is variable and there may be a delayed diagnosis. TBA has a variable prognosis and the most commonly used strategy for management is airway recanalization. Here, we describe the tailored management approach for a 64-year-old Caucasian female presenting with localized TBA of the left main bronchus. Pulmonary function testing, computed tomography and positron emission tomography results are detailed. Rigid bronchoscopy was utilized for diagnostic and therapeutic intervention, which involved debulking and stent insertion. Amyloid deposition and localized inflammation were identified through histopathology. Focal external beam radiation therapy was administered following multidisciplinary discussion and review of the literature, with no evidence of active disease at 6 months follow-up.
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Affiliation(s)
- Jonathan Arulanantham
- Faculty of Medicine Health and Human SciencesMacquarie UniversityMacquarie ParkNew South WalesAustralia
| | - Charlotte Officer
- Faculty of Medicine Health and Human SciencesMacquarie UniversityMacquarie ParkNew South WalesAustralia
| | - Chelsie O'Connor
- GenesisCare, Radiation OncologyMacquarie University Hospital, Macquarie UniversityMacquarie ParkNew South WalesAustralia
| | - Tina Baillie
- Anatomical PathologyDouglass Hanly MoirMacquarie ParkNew South WalesAustralia
| | - Simon Bass
- Medical Services GroupSouth East Regional HospitalBegaNew South WalesAustralia
| | - Jonathan P. Williamson
- Faculty of Medicine Health and Human SciencesMacquarie UniversityMacquarie ParkNew South WalesAustralia
- South Western Sydney Clinical School, Liverpool HospitalThe University of New South WalesSydneyNew South WalesAustralia
- MQ Health Respiratory and SleepMacquarie University HospitalMacquarie ParkNew South WalesAustralia
| | - Alan Carew
- MQ Health Respiratory and SleepMacquarie University HospitalMacquarie ParkNew South WalesAustralia
- School of MedicineUniversity of QueenslandBrisbaneQueenslandAustralia
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Uzunhan Y, Jeny F, Kambouchner M, Didier M, Bouvry D, Nunes H, Bernaudin JF, Valeyre D. The Lung in Dysregulated States of Humoral Immunity. Respiration 2017; 94:389-404. [PMID: 28910817 DOI: 10.1159/000480297] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
In common variable immunodeficiency, lung manifestations are related to different mechanisms: recurrent pneumonias due to encapsulated bacteria responsible for diffuse bronchiectasis, diffuse infiltrative pneumonia with various patterns, and lymphomas, mostly B cell extranodal non-Hodgkin type. The diagnosis relies on significant serum Ig deficiency and the exclusion of any primary or secondary cause. Histopathology may be needed. Immunoglobulin (IgG) replacement is crucial to prevent infections and bronchiectasis. IgG4-related respiratory disease, often associated with extrapulmonary localizations, presents with solitary nodules or masses, diffuse interstitial lung diseases, bronchiolitis, lymphadenopathy, and pleural or pericardial involvement. Diagnosis relies on international criteria including serum IgG4 dosage and significantly increased IgG4/IgG plasma cells ratio in pathologically suggestive biopsy. Respiratory amyloidosis presents with tracheobronchial, nodular, and cystic or diffuse interstitial lung infiltration. Usually of AL (amyloid light chain) subtype, it may be localized or systemic, primary or secondary to a lymphoproliferative process. Very rare other diseases due to nonamyloid IgG deposits are described. Among the various lung manifestations of dysregulated states of humoral immunity, this article covers only those associated with the common variable immunodeficiency, IgG4-related disease, amyloidosis, and pulmonary light-chain deposition disease. Autoimmune connective-vascular tissue diseases or lymphoproliferative disorders are addressed in other chapters of this issue.
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Morales A, Pari M, López-Lisbona R, Cubero N, Dorca J, Rosell A. Colchicine Treatment for Tracheobronchial Amyloidosis. Respiration 2016; 91:251-5. [DOI: 10.1159/000443669] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2015] [Accepted: 12/21/2015] [Indexed: 11/19/2022] Open
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Anchored to asthma. Ann Am Thorac Soc 2015; 12:448-50. [PMID: 25786151 DOI: 10.1513/annalsats.201410-456cc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Zhang LQ, Zhao YC, Wang XW, Yang J, Lu ZW, Cheng YS. Primary localized tracheobronchial amyloidosis presenting with massive hemoptysis: a case report and literature review. CLINICAL RESPIRATORY JOURNAL 2015; 11:122-125. [PMID: 25832552 DOI: 10.1111/crj.12301] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2014] [Revised: 02/02/2015] [Accepted: 03/23/2015] [Indexed: 11/28/2022]
Abstract
Primary localized tracheobronchial amyloidosis (TBA) is a rare respiratory tract dysfunction, which is a heterogeneous group of diseases involving abnormal extracellular deposition of amyloid and autologous fibrillar protein material in β-pleated sheets. A 64-year-old man was referred to our hospital because of hemoptysis. Physical examination showed decreased breath sounds in the right lung on auscultation. Chest computed tomography scan displayed multiple nodules with varied size in main bronchia around bilateral hilus of the lung. After admission, bronchoscopy was performed for this patient, and roughness of mucosa in trachea and multiple nodules in respiratory tract were observed. Through further tissue biopsy, the diagnosis of primary TBA was confirmed.
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Affiliation(s)
- Li-Qin Zhang
- The Department of Respiratory Medicine, Yijishan Hospital, Wannan Medical College, Wuhu, China
| | - Yi-Chao Zhao
- The Department of Respiratory Medicine, Yijishan Hospital, Wannan Medical College, Wuhu, China
| | - Xiao-Wei Wang
- The Department of Respiratory Medicine, Yijishan Hospital, Wannan Medical College, Wuhu, China
| | - Jian Yang
- The Department of Respiratory Medicine, Yijishan Hospital, Wannan Medical College, Wuhu, China
| | - Zhi-Wei Lu
- The Department of Respiratory Medicine, Yijishan Hospital, Wannan Medical College, Wuhu, China
| | - Yu-Sheng Cheng
- The Department of Respiratory Medicine, Yijishan Hospital, Wannan Medical College, Wuhu, China
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Abstract
Amyloid cardiomyopathy should be suspected in any patient who presents with heart failure and preserved ejection fraction. In patients with echocardiographic evidence of ventricular thickening and without a clear history of hypertension, infiltrative cardiomyopathy should be considered. If imaging suggests the presence of amyloid deposits, confirmation by biopsy is required, although endomyocardial biopsy is generally not necessary. Assessment of aspirated subcutaneous fat and bone-marrow biopsy samples verifies the diagnosis in 40-80% of patients, dependent on the type of amyloidosis. Mass spectroscopy can be used to determine the protein subunit and classify the disease as immunoglobulin light-chain amyloidosis or transthyretin-related amyloidosis associated with mutant or wild-type TTR (formerly known as familial amyloid cardiomyopathy and senile cardiac amyloidosis, respectively). In this Review, we discuss the characteristics of cardiac amyloidosis, and present a structured approach to both the assessment of patients and treatment with emerging therapies and organ transplantation.
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Affiliation(s)
- Morie A Gertz
- Division of Hematology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Angela Dispenzieri
- Division of Clinical Biochemistry and Immunology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Taimur Sher
- Division of Hematology/Oncology, Cancer Center, and Breast Clinic, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, USA
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