1
|
Kumar S, Grell GR, Joseph G, Wang JC. Axillary Lymphadenopathy as an Initial Presentation of Systemic Amyloidosis: A Case Report and Literature Review. J Investig Med High Impact Case Rep 2022; 10:23247096221133191. [PMID: 36300416 PMCID: PMC9619915 DOI: 10.1177/23247096221133191] [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: 11/07/2022] Open
Abstract
Amyloidosis rarely presents as localized lymphadenopathy. Various studies have elucidated the varied presentation and manifestations of this interesting disease. We reviewed the literature and found 36 cases of primary amyloidosis with lymph node enlargement as a presentation, and 17 of the 36 cases (47%) had systemic involvement on further work up. We describe a patient who presented with an isolated right axillary mass. Clinical examination and radiology were indicative of a lymph node enlargement with no evidence of malignancy in the breasts or lungs. Histopathological examination was indicative of amyloidosis. A further work up including serum, urine biochemistry, cardiac work up, bone marrow examination, and a kidney biopsy revealed systemic amyloidosis. Patient was treated with daratumumab and CyBorD (cyclophosphamide, bortezomib, and dexamethasone) followed by a stem cell transplantation. Patient is in remission for 1 year, at the time of submission of this report. Therefore, we conclude (1) systemic amyloidosis presenting as an isolated lymph node enlargement is rare, (2) a structured systemic work up is imperative for early diagnosis and proper management of amyloidosis, when there is an index of suspicion, and (3) use of novel therapeutic options such as CD38 + antibody (daratumumab) and stem cell transplant have positive impact on disease outcomes.
Collapse
Affiliation(s)
- Suneet Kumar
- Interfaith Medical Center, One Brooklyn
Health, Brooklyn, NY, USA
| | - Gilda-Rae Grell
- Interfaith Medical Center, One Brooklyn
Health, Brooklyn, NY, USA
| | - Gardith Joseph
- Brookdale University Hospital and
Medical Center, One Brooklyn Health, Brooklyn, NY, USA
| | - Jen C. Wang
- Brookdale University Hospital and
Medical Center, One Brooklyn Health, Brooklyn, NY, USA, Jen C. Wang, MD, Department of Hematology
and Oncology, Brookdale University Hospital and Medical Center, One Brooklyn
Health, 1 Brookdale Plaza, Brooklyn, NY 11212, USA.
| |
Collapse
|
2
|
Isolated Lymph Node Amyloidosis: Response Assessment to Chemotherapy on Serial 18F-FDG PET/CT Scans. Clin Nucl Med 2020; 45:705-706. [PMID: 32604112 DOI: 10.1097/rlu.0000000000003156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Amyloidosis is a disorder resulting from the deposition of fibrillary protein in the extracellular tissue and can be classified into primary, secondary, familial, and senile types. Isolated lymph node amyloidosis without any other organ involvement is very rarely seen in clinical parlance, and diagnosis remains very challenging owing to nonspecific imaging findings. We present a case of 50-year-old man with lymphadenopathy, which was later confirmed to be amyloidosis on biopsy and serum-free light chain assay with efficacious use of F-FDG PET/CT for response assessment to bortezomib, cyclophosphamide, and dexamethasone.
Collapse
|
3
|
Gupta A, Metcalf C, Taylor D. Review of axillary lesions, emphasising some distinctive imaging and pathology findings. J Med Imaging Radiat Oncol 2017; 61:571-581. [DOI: 10.1111/1754-9485.12579] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2016] [Accepted: 12/07/2016] [Indexed: 12/28/2022]
Affiliation(s)
- Amber Gupta
- Flinders Medical Centre; Bedford Park South Australia Australia
| | | | - Donna Taylor
- Royal Perth Hospital; Perth Western Australia Australia
- University of Western Australia; Crawley Western Australia Australia
| |
Collapse
|
4
|
Grover A, Kaur G, Kumar A, Gupta V, Bakshi P, Jain S, Arora A, Verma K. Abdominal lymphadenopathy: An interesting and rare case diagnosed on endoscopic ultrasound-guided fine needle aspiration cytology. Cytojournal 2016; 13:8. [PMID: 27081396 PMCID: PMC4812873 DOI: 10.4103/1742-6413.178997] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Accepted: 01/10/2016] [Indexed: 11/04/2022] Open
Affiliation(s)
- Ankita Grover
- Address: Department of Cytopathology, Sir Ganga Ram Hospital, New Delhi, India
| | - Gagandeep Kaur
- Address: Department of Cytopathology, Sir Ganga Ram Hospital, New Delhi, India
| | - Ashish Kumar
- Department of Gastroenterology, Sir Ganga Ram Hospital, New Delhi, India
| | - Varun Gupta
- Department of Gastroenterology, Sir Ganga Ram Hospital, New Delhi, India
| | - Pooja Bakshi
- Address: Department of Cytopathology, Sir Ganga Ram Hospital, New Delhi, India
| | - Sunila Jain
- Department of Histopathology, Sir Ganga Ram Hospital, New Delhi, India
| | - Anil Arora
- Department of Gastroenterology, Sir Ganga Ram Hospital, New Delhi, India
| | - Kusum Verma
- Address: Department of Cytopathology, Sir Ganga Ram Hospital, New Delhi, India
| |
Collapse
|
5
|
Akbar N, Kubbara A, Nawras A. Primary Amyloidosis of Celiac/Para-Pancreatic Lymph Nodes Diagnosed by Endosonography-Guided Fine Needle Aspiration. J Investig Med High Impact Case Rep 2015; 3:2324709615607916. [PMID: 26904706 PMCID: PMC4748505 DOI: 10.1177/2324709615607916] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction. Primary amyloidosis is a disorder resulting from the deposition of fibrillary protein in extracellular tissue. Diagnosis of primary amyloidosis in the celiac/para-pancreatic lymph nodes via endoscopic ultrasound-guided fine needle aspiration has not been reported in the literature. In this article, we report our first observation. Our patient is a 64-year-old Caucasian man who was referred to our institution from an outlying hospital for recurrent abdominal pain. Radiological imaging revealed an enlarged abdominal lymph node that was already biopsied under computed tomography needle guidance but diagnosis was not achieved on pathological examination. At our institution, endoscopic ultrasound-guided fine needle aspiration showed enlarged para-celiac/pancreatic lymph nodes. Endosonography-guided fine needle aspiration revealed the diagnosis of primary amyloidosis. The patient tolerated the procedure well with follow-up as an outpatient. Conclusions. Lymph node involvement in amyloidosis is not uncommon. However, the involvement of the pancreatic/celiac lymph nodes by amyloidosis is obscure in this case. This case shows a rare presentation of amyloidosis diagnosed for the first time by the technique of endosonography-guided fine needle aspiration. In the future, this might serve as an establishment to standardize diagnosing abdominal lymph node amyloidosis, once suspected, by endosonography-guided fine needle aspiration.
Collapse
Affiliation(s)
| | - Aahd Kubbara
- University of Toledo Medical Center, Toledo, OH, USA
| | - Ali Nawras
- University of Toledo Medical Center, Toledo, OH, USA
| |
Collapse
|
6
|
Fu J, Seldin DC, Berk JL, Sun F, O'Hara C, Cui H, Sanchorawala V. Lymphadenopathy as a manifestation of amyloidosis: a case series. Amyloid 2014; 21:256-60. [PMID: 25208081 DOI: 10.3109/13506129.2014.958610] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Lymphadenopathy as a manifestation of amyloidosis is rare. Of 3008 new patients with amyloidosis evaluated from 1994 to 2013 at a single center, 47 (1.6%) presented with lymph node enlargement leading to a biopsy and the diagnosis. We conducted a retrospective review of the initial presentation, time to progression, and treatment outcomes for these patients. Upon initial evaluation, 14 (30%) had isolated lymphadenopathy while 33 (70%) had evidence of vital organ involvement. Thirty-nine patients (83%) had systemic AL amyloidosis at initial evaluation or developed it on follow up; there was a single case each of AA, wtTTR and V122ITTR and one untyped amyloidosis. Eleven patients (23%) had IgM monoclonal gammopathy and 3 (6%) had histology consistent with lymphoplasmacytic lymphoma. Of the 14 patients with isolated lymphadenopathy, 10 (71%) eventually progressed to other organ disease requiring treatment at a median time of 10 months (range 4-71). This series demonstrates that patients presenting with amyloid lymphadenopathy usually have AL amyloidosis, and should have a thorough evaluation for other organ involvement at diagnosis. If present, treatment should be similar to that of other patients with systemic AL amyloidosis, but if not, patients should be monitored regularly for development of other organ disease over time.
Collapse
Affiliation(s)
- Julie Fu
- Amyloidosis Center, Boston University School of Medicine , Boston, MA , USA and
| | | | | | | | | | | | | |
Collapse
|
7
|
Preoperative workflow for lymph nodes staging. Int J Comput Assist Radiol Surg 2009; 4:99-104. [PMID: 20033607 DOI: 10.1007/s11548-008-0272-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2008] [Accepted: 09/23/2008] [Indexed: 10/21/2022]
Abstract
PURPOSE Accurate staging of lymph nodes relies mainly on surgical exploration and manual palpation. We present a new non-invasive diagnostic approach: simulated palpation through virtual laparoscopic instruments. METHODS We set up a diagnostic process to extract lymph nodes shape and position from CTs and to analyze the trend of pixels intensities to determine tissue properties in order to feedback the force information. RESULTS We have integrated the model, obtained from both the morphological information and stiffness values, in our laparoscopy simulator and surgeons can virtually palpate, with a haptic device, the lymph nodes. We evaluated the workflow extracting lymph nodes from a case study: the feedback provided through the simulator greatly helps the surgeon in the correct staging. CONCLUSIONS Results show the feasibility of the approach and in the future we will clinically evaluate this new diagnostic methodology. We are studying the possibility to integrate CTs with other imaging systems to increase the accuracy.
Collapse
|
8
|
Park JH, Kwon JH, Kim JW, Cho HJ, Kim KH, Chung DH, Kim I, Yoon SS, Park S, Kim BK. Generalized Primary Amyloid Lymphadenopathy. THE KOREAN JOURNAL OF HEMATOLOGY 2009. [DOI: 10.5045/kjh.2009.44.4.320] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Jin Hyun Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Ji Hyun Kwon
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Ji Won Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Hyeon Jin Cho
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Ki Hwan Kim
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Doo Hyun Chung
- Department of Pathology, Seoul National University College of Medicine, Seoul, Korea
| | - Inho Kim
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Clinical Research Institute, Seoul National University Hospital, Seoul, Korea
| | - Sung-Soo Yoon
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Clinical Research Institute, Seoul National University Hospital, Seoul, Korea
| | - Seonyang Park
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Clinical Research Institute, Seoul National University Hospital, Seoul, Korea
| | - Byoung Kook Kim
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Clinical Research Institute, Seoul National University Hospital, Seoul, Korea
| |
Collapse
|
9
|
Matsuda M, Gono T, Shimojima Y, Yoshida T, Katoh N, Hoshii Y, Yamada T, Ikeda SI. AL amyloidosis manifesting as systemic lymphadenopathy. Amyloid 2008; 15:117-24. [PMID: 18484338 DOI: 10.1080/13506120802006047] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
We report three patients with AL amyloidosis manifesting as systemic lymphadenopathy, mainly in the cervical and supraclavicular regions. Histopathology of lymph nodes showed massive deposition of AL amyloid with no abnormal findings suggestive of lymphoproliferative disorders. Two of the patients were considered to be classifiable as primary systemic AL amyloidosis based on the presence of M-protein in serum and abnormal plasma cells or lymphoplasmacytoid cells in the bone marrow probably producing the precursor immunoglobulin, although no visceral organs were affected. The size of the involved lymph nodes in these two patients increased gradually, and one was treated with rituximab and VAD (vincristine, doxorubicin and dexamethasone) followed by high-dose melphalan with autologous peripheral blood stem cell transplantation (auto-PBSCT). The remaining patient showed no obvious change in the size of lymph nodes or detectable M-protein in serum. The prognosis of AL amyloidosis manifesting as lymphadenopathy is usually good as long as there are no hematological malignancies or rapid increases in the size of lymph nodes, but in cases of the systemic type, intensive chemotherapy, such as high-dose melphalan with auto-PBSCT, should be actively considered in order to avoid possible involvement of visceral organs.
Collapse
Affiliation(s)
- Masayuki Matsuda
- Department of Medicine (Neurology and Rheumatology, Shinshu University School of Medicine, Matsumoto, Japan.
| | | | | | | | | | | | | | | |
Collapse
|