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Desai SS, Rizzo MG, Rush AJ, Rosenberg AE, Al Maaieh M. Amyloidoma: a review and case report. Skeletal Radiol 2021; 50:437-444. [PMID: 32705302 DOI: 10.1007/s00256-020-03560-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 07/10/2020] [Accepted: 07/20/2020] [Indexed: 02/02/2023]
Abstract
Amyloidoma is a solitary mass of amyloid protein that arises in patients with or without evidence of systemic amyloidosis, and can be found in a variety of different organ systems. Herein, we describe three cases of localized biopsy-positive amyloidomas with no evidence of systemic involvement-primary amyloidoma. Our cases include a patient with a paraspinal soft tissue amyloidoma, a patient with multiple primary amyloidomas involving the thoracic cavity and flank, and a patient with insulin-injection induced amyloidoma of the left shoulder. We present these cases to provide further insights into the clinical presentation of this uncommon clinical entity. We review the pathophysiology of amyloidosis and discuss our cases in the context of previous reports of amyloidoma.
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Affiliation(s)
- Sohil S Desai
- University of Miami Miller School of Medicine, 1611 NW 12th Ave, Miami, FL, 33136, USA.
| | - Michael G Rizzo
- Department of Orthopedics, University of Miami / Jackson Memorial Hospital, Miami, FL, USA
| | - Augustus J Rush
- Department of Orthopedics, University of Miami / Jackson Memorial Hospital, Miami, FL, USA
| | - Andrew E Rosenberg
- Department of Pathology and Laboratory Medicine, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Motasem Al Maaieh
- Department of Orthopedics, University of Miami / Jackson Memorial Hospital, Miami, FL, USA
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Pinto MV, Dyck PJB, Liewluck T. Neuromuscular amyloidosis: Unmasking the master of disguise. Muscle Nerve 2021; 64:23-36. [PMID: 33458861 DOI: 10.1002/mus.27150] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 12/11/2020] [Accepted: 12/17/2020] [Indexed: 12/16/2022]
Abstract
Amyloidosis refers to an etiologically heterogeneous group of protein misfolding diseases, pathologically characterized by extracellular amyloid fibrils producing congophillic amorphous deposits in organs and tissues, which may lead to severe organ dysfunction and mortality. Clinical presentations vary and are often nonspecific, depending on what organs or tissues are affected. In systemic amyloidosis, the peripheral nervous system is commonly affected, whereas the skeletal muscles are only rarely involved. Immunoglobulin light chain (AL) amyloidosis and hereditary transthyretin (ATTRv) amyloidosis are the most frequent types of systemic amyloidosis involving the neuromuscular system. Localized amyloidosis can occur in skeletal muscle, so-called isolated amyloid myopathy. Amyloid neuropathy typically involves small myelinated and unmyelinated sensory and autonomic nerve fibers early in the course of the disease, followed by large myelinated fiber sensory and motor deficits. The relentlessly progressive nature with motor, painful sensory and severe autonomic dysfunction, profound weight loss, and systemic features are distinct characteristics of amyloid neuropathy. Amyloid myopathy presentation differs between systemic amyloidosis and isolated amyloid myopathy. Long-standing symptoms, distal predominant myopathy, markedly elevated creatine kinase level, and lack of peripheral neuropathy or systemic features are highly suggestive of isolated amyloid myopathy. In ATTR and AL amyloidosis, early treatment correlates with favorable outcomes. Therefore, awareness of these disorders and active screening for amyloidosis in patients with neuropathy or myopathy are crucial in detecting these patients in the everyday practice of neuromuscular medicine. Herein, we review the clinical manifestations of neuromuscular amyloidosis and provide a diagnostic approach to this disorder.
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Affiliation(s)
- Marcus V Pinto
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA.,Department of Neurology, Federal University of Rio de Janeiro, National Amyloidosis Referral Center (CEPARM), Rio de Janeiro, Brazil
| | - P James B Dyck
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Teerin Liewluck
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
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Pinheiro JP, Carneiro D, Tavares S, Rebelo O, Lopes A, Barbosa M. Management and Outcome of Solitary Spinal Amyloidoma-A Systematic Literature Review. World Neurosurg 2020; 140:325-331. [PMID: 32461181 DOI: 10.1016/j.wneu.2020.05.159] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 05/16/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Solitary spinal amyloidoma (SSA) is a rare and poorly characterized disease. There are few cases described, and the knowledge of this neoplasm is limited. A more accurate description of demographics, clinical findings, and outcomes may be useful for a better understanding of this pathology, as well as therapeutic intervention, adding value to the research of localized amyloidosis. METHODS A systematic search was carried out from when registries began until February 2020. We also include a case diagnosed and treated in our department. Descriptive statistics were used to evaluate data, demographics, clinical findings, diagnostic modalities, therapeutics, and finally neurologic outcomes. The Kaplan-Meier method was used to assess overall survival and progression-free survival. RESULTS The final cohort comprises 35 patients. The mean age at diagnosis was 61.97 years, and 68.60% of the patients were male. SSA developed more frequently in the thoracic spine (48.60%), followed by the cervical spine (17.10%). Intradural lesions were rare, and the average neoplastic score for spinal instability was 9.5 points. The most common symptoms were impaired motor function (74.29%) and axial back pain (65.70%). After surgery, neurologic recovery was reported in 82.90% of cases. Mean progression-free survival and mean overall survival were 47.26 and 156.66 months. CONCLUSIONS SSA is a rare subgroup of localized amyloidosis, usually being diagnosed in male patients between the sixth and eighth decades. The gold standard treatment seems to be surgical resection. SSA patients have excellent long-term survival and a low rate of local recurrence.
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Affiliation(s)
- João Páscoa Pinheiro
- Department of Neurosurgery, Coimbra University Hospital Centre, Coimbra, Portugal.
| | - Diogo Carneiro
- Department of Neurology, Coimbra University Hospital Centre, Coimbra, Portugal
| | - Sofia Tavares
- Department of Neurosurgery, Coimbra University Hospital Centre, Coimbra, Portugal
| | - Olinda Rebelo
- Department of Neurology, Coimbra University Hospital Centre, Coimbra, Portugal
| | - Armando Lopes
- Department of Neurosurgery, Coimbra University Hospital Centre, Coimbra, Portugal
| | - Marcos Barbosa
- Department of Neurosurgery, Coimbra University Hospital Centre, Coimbra, Portugal; Faculty of Medicine of the University of Coimbra, Coimbra, Portugal
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Rotter J, Dowlati E, Jha RT, Deng T, Mason RB. Primary cervical spine AL-κ amyloidoma: A case report and review of the literature. Neuropathology 2019; 39:231-239. [PMID: 31044465 DOI: 10.1111/neup.12556] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Revised: 03/13/2019] [Accepted: 03/14/2019] [Indexed: 12/16/2022]
Abstract
Of the myriad of variants of amyloidoses where abnormally folded proteins damage native tissue, primary cervical spine amyloidoma represents one of the rarest forms. Since clinical presentations and imaging findings appear similar to other pathologies, including abscesses, metastatic lesions, and inflammatory lesions, a definitive diagnosis requires a biopsy with specific immunohistochemical stains. We present the first known case of primary cervical amyloid light-chain (AL)-κ subtype amyloidoma and compare the clinical presentations, imaging findings, treatment options, and immunohistochemical subtypes of primary, hemodialysis, and multiple myeloma cervical amyloidomas. Our case is of a 58-year-old man who developed neck pain radiating to the left arm with bilateral upper extremity weakness over several months. Magnetic resonance imaging revealed a circumferential C1-C2 mass extending into the neural foramina inducing severe mass effect. The patient underwent C2 laminectomy and resection of the lesion which was discovered during surgery to be completely epidural. Postoperatively, his pain and weakness improved. A complete work-up was negative for systemic amyloidosis or inflammatory conditions. In the setting of a long clinical history of hemodialysis, this patient required specific staining and laboratory testing to correctly diagnose his primary cervical AL-κ subtype amyloidoma. Cervical amyloidomas comprise a very small minority of amyloid pathology with an exceptional prognosis following successful surgical resection and stabilization. It is recommended these patients undergo surgical resection with appropriate characterization and a complete work-up to rule out systemic disease.
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Affiliation(s)
- Juliana Rotter
- Department of Neurosurgery, Medstar Georgetown University Hospital, Washington, District of Columbia, USA
| | - Ehsan Dowlati
- Department of Neurosurgery, Medstar Georgetown University Hospital, Washington, District of Columbia, USA
| | - Ribhu T Jha
- Department of Neurosurgery, Medstar Georgetown University Hospital, Washington, District of Columbia, USA
| | - Tom Deng
- Department of Pathology, Medstar Washington Hospital Center, Washington, District of Columbia, USA
| | - Robert B Mason
- Department of Neurosurgery, Medstar Washington Hospital Center, Washington, District of Columbia, USA
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McKenzie GA, Broski SM, Howe BM, Spinner RJ, Amrami KK, Dispenzieri A, Ringler MD. MRI of pathology-proven peripheral nerve amyloidosis. Skeletal Radiol 2017; 46:65-73. [PMID: 27730358 DOI: 10.1007/s00256-016-2510-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Revised: 09/29/2016] [Accepted: 09/30/2016] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To highlight the MRI characteristics of pathologically proven amyloidosis involving the peripheral nervous system (PNS) and determine the utility of MRI in directing targeted biopsy for aiding diagnosis. MATERIALS AND METHODS A retrospective study was performed for patients with pathologically proven PNS amyloidosis who also underwent MRI of the biopsied or excised nerve. MRI signal characteristics, nerve morphology, associated muscular denervation changes, and the presence of multifocal involvement were detailed. Pathology reports were reviewed to determine subtypes of amyloid. Charts were reviewed to gather patient demographics, neurological symptoms and radiologist interpretation. RESULTS Four men and three women with a mean age of 62 ± 11 years (range 46-76) were identified. All patients had abnormal findings on EMG with mixed sensorimotor neuropathy. All lesions demonstrated diffuse multifocal neural involvement with T1 hypointensity, T2 hyperintensity, and variable enhancement on MRI. One lesion exhibited superimposed T2 hypointensity. Six of seven patients demonstrated associated muscular denervation changes. CONCLUSION Peripheral nerve amyloidosis is rare, and the diagnosis is difficult because of insidious symptom onset, mixed sensorimotor neurologic deficits, and the potential for a wide variety of nerves affected. On MRI, peripheral nerve involvement is most commonly characterized by T1 hypointensity, T2 hyperintensity, variable enhancement, maintenance of the fascicular architecture with fusiform enlargement, multifocal involvement and muscular denervation changes. While this appearance mimics other inflammatory neuropathies, MRI can readily detect neural changes and direct-targeted biopsy, thus facilitating early diagnosis and appropriate management.
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Affiliation(s)
- Gavin A McKenzie
- Department of Musculoskeletal Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
| | - Stephen M Broski
- Department of Musculoskeletal Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Benjamin M Howe
- Department of Musculoskeletal Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Robert J Spinner
- Department of Musculoskeletal Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Kimberly K Amrami
- Department of Musculoskeletal Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Angela Dispenzieri
- Department of Musculoskeletal Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Michael D Ringler
- Department of Musculoskeletal Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
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Shikino K, Suzuki S, Yokokawa D, Ohira Y, Ikusaka M. Dialysis-Related Spondyloarthropathy with Cervical Amyloidoma. Am J Med 2016; 129:e339-e340. [PMID: 27491462 DOI: 10.1016/j.amjmed.2016.06.057] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 06/30/2016] [Indexed: 11/18/2022]
Affiliation(s)
- Kiyoshi Shikino
- Department of General Medicine, Chiba University Hospital, Chiba, Japan.
| | - Shingo Suzuki
- Department of General Medicine, Chiba University Hospital, Chiba, Japan
| | - Daiki Yokokawa
- Department of General Medicine, Chiba University Hospital, Chiba, Japan
| | - Yoshiyuki Ohira
- Department of General Medicine, Chiba University Hospital, Chiba, Japan
| | - Masatomi Ikusaka
- Department of General Medicine, Chiba University Hospital, Chiba, Japan
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8
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André V, Pot-Vaucel M, Cozic C, Visée E, Morrier M, Varin S, Cormier G. Septic arthritis of the facet joint. Med Mal Infect 2015; 45:215-21. [PMID: 25958100 DOI: 10.1016/j.medmal.2015.04.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Revised: 02/26/2015] [Accepted: 04/02/2015] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Septic arthritis of the facet joint is a rare clinical entity. We report 11 cases of facet joint infections diagnosed in our institution. PATIENTS AND METHOD Patients were identified via the computerized patients record (PMSI). Their features were collected and compared with published data. RESULTS The clinical symptoms are similar to those of infectious spondylodiscitis: back pain with stiffness (11/11), fever (9/11), radicular pain (5/11), and asthenia. Ten patients presented with lumbar infection and 1 with dorsal infection. An inflammatory syndrome was observed in every case. A rapid access to spine MRI allowed making the diagnosis in every case, and assessing a potential extension of infection (epidural extension 5/11, paraspinal extension 5/11). Blood culture (8/11) or culture of spinal samples allowed identifying the causative bacterium in every case and adapting the antibiotic treatment. The bacteria identified in our series were different from previously reported ones, with less staphylococci. The origin of the infection was found in 4 cases. Another localization of infection was observed in 4 cases. The outcome was favorable with medical treatment in 10 cases. An abscess was surgically drained in 1 case. None of our patients presented with neurological complications, probably because of the rapid diagnosis. CONCLUSION Assessing the facet joint is essential in case of inflammatory back pain, and the radiologist must be asked to perform this examination.
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Affiliation(s)
- V André
- Service de rhumatologie, centre hospitalier départemental, site de La-Roche-sur-Yon-Les Oudairies, 85925 La-Roche-sur-Yon, France.
| | - M Pot-Vaucel
- Service de rhumatologie, centre hospitalier départemental, site de La-Roche-sur-Yon-Les Oudairies, 85925 La-Roche-sur-Yon, France
| | - C Cozic
- Service de rhumatologie, centre hospitalier départemental, site de La-Roche-sur-Yon-Les Oudairies, 85925 La-Roche-sur-Yon, France
| | - E Visée
- Service d'imagerie médicale, centre hospitalier départemental, site de La-Roche-sur-Yon, Les Oudairies 85925, La-Roche-sur-Yon, France
| | - M Morrier
- Services d'infectiologie, centre hospitalier départemental, site de La-Roche-sur-Yon, Les Oudairies, 85925 La-Roche-sur-Yon, France
| | - S Varin
- Service de rhumatologie, centre hospitalier départemental, site de La-Roche-sur-Yon-Les Oudairies, 85925 La-Roche-sur-Yon, France
| | - G Cormier
- Service de rhumatologie, centre hospitalier départemental, site de La-Roche-sur-Yon-Les Oudairies, 85925 La-Roche-sur-Yon, France
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9
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Smitherman AD, Fung KM, Glenn CA, Martin MD. Intradural, extramedullary amyloidoma involving cervical and thoracic spine. J Clin Neurosci 2015; 22:1052-4. [PMID: 25778386 DOI: 10.1016/j.jocn.2014.12.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Revised: 12/09/2014] [Accepted: 12/09/2014] [Indexed: 12/14/2022]
Abstract
We present the case of a 46-year-old woman with insidious lower extremity paralysis and bowel and bladder disruption found to have an intradural, extramedullary amyloidoma from the levels of C4-T4. To our knowledge, this is the first known reported case of amyloidoma occurring in this location. Solitary amyloidoma of the spine is a rare entity typically manifesting as an extradural tumor with bony involvement.
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Affiliation(s)
- Adam D Smitherman
- Department of Neurosurgery, University of Oklahoma College of Medicine, Suite 400, 1000 North Lincoln Boulevard, Oklahoma City, OK 73104, USA.
| | - Kar-Ming Fung
- Department of Pathology, University of Oklahoma College of Medicine, Oklahoma City, OK, USA
| | - Chad A Glenn
- Department of Neurosurgery, University of Oklahoma College of Medicine, Suite 400, 1000 North Lincoln Boulevard, Oklahoma City, OK 73104, USA
| | - Michael D Martin
- Department of Neurosurgery, University of Oklahoma College of Medicine, Suite 400, 1000 North Lincoln Boulevard, Oklahoma City, OK 73104, USA
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10
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Klenke FM, Wirtz C, Banz Y, Keel MJB, Klass ND, Novak U, Benneker LM. Multiple myeloma-associated amyloidoma of the sacrum: case report and review of the literature. Global Spine J 2014; 4:109-14. [PMID: 25061549 PMCID: PMC4078136 DOI: 10.1055/s-0033-1360724] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Accepted: 09/24/2013] [Indexed: 11/12/2022] Open
Abstract
Study Design Case report. Objectives With only two previously reported cases, localized amyloidosis of the sacrum is extremely rare. Here we report a 64-year-old woman with a large osteolytic lesion accompanied by weakness and paresthesia of the right leg and difficulties in bladder control. Methods Fine needle biopsy and standard staging procedures revealed a primary solitary amyloidoma that was treated with intralesional resection, lumbopelvic stabilization, and consolidation radiotherapy. Results Clinical follow-up revealed the diagnosis of multiple myeloma 9 months after initial treatment. At 12 months, no local recurrence has occurred, the neurologic symptoms have resolved, and the systemic disease is in remission. Conclusions Intralesional resection with adjuvant radiotherapy of the amyloidoma achieved good local tumor control with limited morbidity.
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Affiliation(s)
- F. M. Klenke
- Department of Orthopaedic Surgery, Inselspital, Bern University Hospital, Bern, Switzerland,Address for correspondence Frank M. Klenke, MD, PhD Department of Orthopaedic Surgery, InselspitalBern University Hospital, Freiburgstrasse, CH-3010 BernSwitzerland
| | - C. Wirtz
- Department of Orthopaedic Surgery, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Y. Banz
- Institute of Pathology, University of Bern, Bern, Switzerland
| | - M. J. B. Keel
- Department of Orthopaedic Surgery, Inselspital, Bern University Hospital, Bern, Switzerland
| | - N. D. Klass
- Department of Radiation Oncology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - U. Novak
- Department of Medical Oncology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - L. M. Benneker
- Department of Orthopaedic Surgery, Inselspital, Bern University Hospital, Bern, Switzerland
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Werner BC, Shen FH, Shimer AL. Primary cervical amyloidoma: a case report and review of the literature. Spine J 2013; 13:e1-7. [PMID: 23669122 DOI: 10.1016/j.spinee.2013.04.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2012] [Revised: 02/02/2013] [Accepted: 04/03/2013] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Primary solitary amyloidosis or amyloidoma is a disease process characterized by the focal deposition of amyloid in the absence of a plasma cell dyscrasia with normal serum protein measurements. Solitary amyloidomas affecting the vertebrae are very uncommon but typically affect the thoracic spine. Primary cervical amyloidosis is an exceedingly rare entity with exceptionally good prognosis, but requires diligence of the treating physician to establish the diagnosis and implement the appropriate surgical intervention. PURPOSE This study aimed to present a rare case of primary cervical amyloidosis with long-term follow-up and review the clinical presentation, characteristic imaging findings, diagnostic pathology, differential diagnosis, treatment algorithm, and prognosis of the disease entity. This case demonstrates the progressive resorption of the amyloidoma over time after surgical stabilization. Previous reported cases of primary cervical amyloidosis will also be reviewed. STUDY DESIGN This study is a report and review of the literature. METHODS A 77-year-old woman presented with a several-week history of gradual progressive weakness in her upper and lower extremities. Computed tomography and magnetic resonance imaging demonstrated a retro-odontoid nonenhancing soft-tissue mass, with erosive bony changes and severe mass effect on the upper cervical cord. The patient was taken to the operating room for decompression and posterior spinal stabilization. RESULTS Intraoperative tissue specimens demonstrated amyloidosis and extensive systemic workup did not reveal any inflammatory processes, systemic amyloidosis, or plasma cell dyscrasia. Postoperatively, the patient regained full strength and ambulatory status. The patient remains asymptomatic at a 2-year follow-up. A postoperative follow-up magnetic resonance imaging demonstrated complete resorption of the residual amyloidoma. CONCLUSIONS Primary solitary amyloidosis is a rare form of amyloidosis that is important to differentiate given its excellent prognosis with surgical management. Treatment should include surgical decompression and spinal stabilization. This is the first case report to clinically and radiographically demonstrate the progressive resorption of a primary amyloidoma over time after surgical stabilization in the upper cervical spine. It is imperative that surgeons encountering such lesions maintain a high suspicion for this rare disease entity and advise their pathologists accordingly to establish the correct diagnosis.
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Affiliation(s)
- Brian C Werner
- Department of Orthopedic Surgery, University of Virginia Health System, PO Box 800159, Charlottesville, VA 22908, USA
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12
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Aono H, Kakunaga S, Koide S, Tobimatsu H, Kuroda M, Kudawara I, Mori K, Konishi E, Ueda T. Primary amyloidoma in epidural and paravertebral space of the lumbar spine. Spine J 2013; 13:e27-30. [PMID: 23890946 DOI: 10.1016/j.spinee.2013.05.051] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2012] [Revised: 03/19/2013] [Accepted: 05/28/2013] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Localized amyloid deposits result in a mass, that is, so-called amyloidoma; it has been reported in every anatomic site, although systemic amyloid deposition is much more common. However, primary lumbar epidural amyloidoma without bony involvement is extremely rare. To the best of our knowledge, only one case has been reported previously. PURPOSE To report and review the clinical presentations, imaging studies, and treatment of epidural and paravertebral amyloidoma. STUDY DESIGN A case report and review of the literature. METHODS Lumbar epidural and paravertebral amyloidoma in a 75-year-old man with neurologic compromise is presented. Laminectomy with mass resection was performed. RESULTS After surgery, almost complete neurologic improvement was observed. Histologically, definite diagnosis was obtained only after the specific staining of tissue. No sign of local recurrence was evident 1 year after surgery. CONCLUSIONS Primary amyloidoma, although rare, should be included in the differential diagnosis of epidural mass of the spine. Diagnosis before surgery is difficult as there were no characteristic findings in clinical and imaging studies. Special histologic technique and stains are useful to make a definite diagnosis.
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Affiliation(s)
- Hiroyuki Aono
- Department of Orthopedic Surgery, Osaka National Hospital, 2-1-14 Hoenzaka Chuo-ku Osaka, Osaka 5400006, Japan.
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13
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Loavenbruck AJ, Chaudhry V, Zeldenrust SR, Spinner RJ, Theis JD, Klein CJ. Mass spectrometry analysis reveals non-mutated apolipoprotein A1 lumbosacral radiculoplexus amyloidoma. Muscle Nerve 2012; 46:817-22. [PMID: 23055319 DOI: 10.1002/mus.23415] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION In rare instances, amyloidosis presents as a focal, macroscopic lesion involving peripheral neural tissues (amyloidoma). In all known reported cases, peripheral nerve amyloidomas have had immunoglobulin light-chain fibril composition and occurred in the context of paraproteinemia. METHODS A 46-year-old man presented with progressive insidious-onset right lumbosacral radiculoplexus neuropathy without paraproteinemia. MRI-targeted fascicular nerve biopsy was performed on an enlarged sciatic nerve after earlier distal fibular nerve biopsy was nondiagnostic. Laser dissected mass spectroscopy of the discovered amyloid protein was performed after immunohistochemistry failed to identify the specific amyloid protein. Complete gene sequencing of apolipoprotein A1 (ApoA1) was performed. RESULTS Only wild-type ApoA1 amyloid was found in the congophilic component in the nerve. CONCLUSIONS This case highlights the utility of MRI-guided fascicular nerve biopsy combined with laser-dissected mass spectrometric analysis. Importantly, the case expands the known causes of amyloidomas to include wild-type ApoA1.
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Affiliation(s)
- Adam J Loavenbruck
- Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905, USA
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Xu L, Frazier A, Burke A. Isolated pulmonary amyloidomas: report of 3 cases with histologic and imaging findings. Pathol Res Pract 2012; 209:62-6. [PMID: 23218762 DOI: 10.1016/j.prp.2012.10.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2012] [Revised: 10/09/2012] [Accepted: 10/24/2012] [Indexed: 02/08/2023]
Abstract
Amyloid tumors presenting as lung masses are rare. We report 3 patients seen over a 2-year period with multiple lung masses, 2 that were suspicious for metastasis, and one in a patient with chest pain. Pathologic evaluation demonstrated amyloid tumor in each case. Two demonstrated a prominent macrophage giant cell reaction; scattered polyclonal plasma cells were present in two of the cases. PET scanning of 2 of the patients revealed an SUV of 1.9 and 4.0, respectively. Short-term follow-up revealed that none of the 3 cases were associated with lymphoproliferative disorders. This small series and a literature review suggest that pulmonary amyloidomas are usually isolated lesions, and that PET may show increased uptake simulating a neoplasm.
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Affiliation(s)
- Lauren Xu
- Department of Pathology and Radiology, University of Maryland Medical Center, Baltimore, MD, USA
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15
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Thawait SK, Chaudhry V, Thawait GK, Wang KC, Belzberg A, Carrino JA, Chhabra A. High-resolution MR neurography of diffuse peripheral nerve lesions. AJNR Am J Neuroradiol 2010; 32:1365-72. [PMID: 20966057 DOI: 10.3174/ajnr.a2257] [Citation(s) in RCA: 131] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
High-resolution MR imaging of peripheral nerves is becoming more common and practical with the increasing availability of 3T magnets. There are multiple reports of MR imaging of peripheral nerves in compression and entrapment neuropathies. However, there is a relative paucity of literature on MRN appearance of diffuse peripheral nerve lesions. We attempted to highlight the salient imaging features of myriad diffuse peripheral nerve disorders and imaging techniques for MRN. Using clinical and pathologically proved relevant examples, we present the MRN appearance of various types of diffuse peripheral nerve lesions, such as traumatic, inflammatory, infectious, hereditary, radiation-induced, neoplastic, and tumor variants.
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Affiliation(s)
- S K Thawait
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Hospital, Baltimore, Maryland, USA
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Abstract
Nontumor lesions of the spinal cord and spine include developmental disorders, cystic tumor-like lesions, vascular disorders, infective diseases, demyelinating diseases, degenerative diseases, metabolic and toxic disorders, and spinal cord injury. In addition, diseases of the spine and extradural spaces secondarily cause spinal cord injury. Aside from tumors, these include developmental abnormalities, inflammatory diseases, nontumor space-occupying lesions, and tumor-like lesions such as lipomas, vascular malformations, and cysts. Awareness is required of hemostatic agents used during surgery and subsequently presenting as space-occupying lesions, which have to be differentiated from recurrent lesions. On the therapeutic front, stem cell transplantation into spinal cord for treatment of neurodegenerative disorders, spinal cord injury, and multiple sclerosis is a challenging prospect.
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Affiliation(s)
- Medha Tatke
- Department of Pathology, G.B. Pant Hospital, New Delhi, India.
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17
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Sadek I, Mauermann ML, Hayman SR, Spinner RJ, Gertz MA. Primary Systemic Amyloidosis Presenting With Asymmetric Multiple Mononeuropathies. J Clin Oncol 2010; 28:e429-32. [DOI: 10.1200/jco.2009.26.2014] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Ibrahim Sadek
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | | | - Suzanne R. Hayman
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | | | - Morie A. Gertz
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN
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18
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Ajlani H, Zaouia K, Chtourou A, Elleuch M, Bellil S, Sellami S. Amylose primitive et étagée du rachis dorsolombaire compliquée d’une paraplégie. ACTA ACUST UNITED AC 2008; 94:498-502. [DOI: 10.1016/j.rco.2008.03.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2008] [Indexed: 11/25/2022]
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19
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Urculo E, Samprón N, Alfaro R, Arrazola M, Linazasoro G. Compresión medular por lipoma epidural dorsal. Neurocirugia (Astur) 2008. [DOI: 10.1016/s1130-1473(08)70239-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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20
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Navarro San Francisco C, Luepke Estefan E, Camacho Siles J. [Spinal amyloidoma as the first manifestation of multiple myeloma]. Med Clin (Barc) 2007; 129:278-9. [PMID: 17683711 DOI: 10.1157/13108357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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21
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Sahin F, Soyer NA, Saydam G, Vural F, Tombuloglu M, Argin M, Ertan Y. Amyloid deposition in knee and ankle joints in the course of multiple myeloma. Joint Bone Spine 2007; 74:209-11. [PMID: 17350311 DOI: 10.1016/j.jbspin.2006.04.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2006] [Accepted: 04/25/2006] [Indexed: 12/14/2022]
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22
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Ladha SS, Dyck PJB, Spinner RJ, Perez DG, Zeldenrust SR, Amrami KK, Solomon A, Klein CJ. Isolated amyloidosis presenting with lumbosacral radiculoplexopathy: description of two cases and pathogenic review. J Peripher Nerv Syst 2007; 11:346-52. [PMID: 17117943 DOI: 10.1111/j.1529-8027.2006.00107.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
In this study, we present two cases of infiltrative, localized amyloidosis involving lumbosacral root and plexus, e.g., isolated amyloidomas. Rare and poorly understood amyloidomas may occur in both neurologic and non-neurologic tissues. The described cases emphasize potential for localized peripheral amyloidomas: (1) potential for associated lambda light chain lymphoplasmacytic lymphoma association; (2) e isolated amyloidosis without evidence for systemic plasma cell dyscrasia; (3) features suggestive of potential pathogenesis; and (4) discussion of treatment options including immunotherapy and resection. The limited literature and experience among other cases is described.
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Affiliation(s)
- Shafeeq S Ladha
- Department of Neurology, Mayo Clinic College of Medicine, Rochester, MN 55905, USA
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