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Yin M, Ouyang L, Tan J, Liu W, Zhang W. CT showed multiple pulmonary balloon lesions with intermediate balloon calcification in a case of nodular pulmonary amyloidosis: A case report. Medicine (Baltimore) 2023; 102:e34964. [PMID: 37682150 PMCID: PMC10489398 DOI: 10.1097/md.0000000000034964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 08/07/2023] [Indexed: 09/09/2023] Open
Abstract
RATIONALE Amyloidosis is a rare disease characterized by the misfolding of autologous proteins and extracellular deposition of fibrils, which can involve 1 or more vital organs in the body. Nodular pulmonary amyloidosis with extensive pulmonary cysts is even less common. This study discusses the diagnosis and treatment of a case of pulmonary nodular amyloidosis with extensive pulmonary cysts and calcification in the middle of the cysts on chest computed tomography, and reviews the related literature. We hope that this rare case will raise awareness of this disease among clinicians. PATIENT CONCERNS Multiple pulmonary nodules and cysts were found on computed tomography of the chest, and the patient was eager to further clarify the nature of the nodules and the next treatment plan. DIAGNOSES Amyloidosis of pulmonary nodules. INTERVENTIONS AND OUTCOMES Since the patient's primary lesion was outside the bronchial lumen near the hilum, we opted for endobronchial ultrasound-guided tunnel biopsy to obtain pathological specimens, and confirmed the diagnosis of nodular pulmonary amyloidosis. After a definite diagnosis, the patient was regularly followed without any specific treatment. LESSONS For patients with multiple pulmonary nodules combined with extensive pulmonary cysts, we also need to be alert to the possibility of pulmonary nodule amyloidosis. Secondly, when the main lesion is located outside the bronchial cavity near the hilum of the lung, the method of pathological tissue biopsy should also consider endobronchial ultrasound-guided tunnel biopsy.
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Affiliation(s)
- Mingquan Yin
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Hunan Normal University/Hunan Provincial People’s Hospital, Changsha, China
| | - Lecong Ouyang
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Hunan Normal University/Hunan Provincial People’s Hospital, Changsha, China
| | - Jianlong Tan
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Hunan Normal University/Hunan Provincial People’s Hospital, Changsha, China
| | - Wei Liu
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Hunan Normal University/Hunan Provincial People’s Hospital, Changsha, China
| | - Weidong Zhang
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Hunan Normal University/Hunan Provincial People’s Hospital, Changsha, China
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Tambuzzi S, Gentile G, Boracchi M, Marasciuolo L, Zoja R. Post-Mortem Diagnosis of a Rare Case of Massive Nodular Pulmonary Amyloidosis in a Forensic Setting. Acad Forensic Pathol 2023; 13:41-47. [PMID: 37091197 PMCID: PMC10119865 DOI: 10.1177/19253621231164023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 02/24/2023] [Indexed: 04/25/2023]
Affiliation(s)
| | - Guendalina Gentile
- Guendalina Gentile BSc, Sezione di Medicina
Legale—Dipartimento di Scienze Biomediche per la Salute—Università degli Studi, via Luigi
Mangiagalli, 37, 20133 Milano, Italy;
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Patel H, Sheikh A, Medarametla GD, Selvam SA, Mahmood SN, Johal G, Arunachalam J, Radhakrishnan H, Shah V, Vallath AL, Patel D, Palasamudram Shekar S, Patel U, Changawala N. Uncommon Presentation of Undiagnosed B-Cell Lymphoproliferative Disorder as Nodular Pulmonary Amyloidosis. J Med Cases 2023; 14:36-43. [PMID: 36755997 PMCID: PMC9881482 DOI: 10.14740/jmc4026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 01/11/2023] [Indexed: 01/20/2023] Open
Abstract
B-cell lymphoproliferative disorders are characterized by the accumulation of mature B lymphocytes in the bone marrow, lymphoid tissues, and/or peripheral blood. They can cause amyloid deposits in the lungs. In rare cases, lung nodules can be the first sign of this disorder. We present the case of an 89-year-old woman with stable shortness of breath and lung nodules on imaging. A positron emission tomography-computed tomography (PET-CT) scan showed the most intense hypermetabolic nodule in the patient's lung, which was 1.5 × 1.4 cm. A biopsy of this nodule showed amyloid material with trapped plasma cell infiltrate on microscopy. Congo red stain under polarizing microscopy showed apple-green birefringence, which is diagnostic for amyloidosis. Immunohistochemistry showed a mixture of kappa-positive and lambda-positive cells. B-cell gene rearrangement-clonal gene rearrangements were detected in the immunoglobulin heavy chain (IgH) gene and the kappa light chain (IGK). These findings suggest a B-cell lymphoproliferative disorder, such as a plasmacytoma or a marginal cell lymphoma with plasma cell differentiation. The patient was diagnosed with a B-cell lymphoproliferative disorder and pulmonary amyloidosis. Isolated amyloidosis in the lungs usually has a good prognosis, but it can be a sign of autoimmune diseases or B-cell lymphoproliferative disorders, as in this case. Early diagnosis of B-cell lymphoproliferative disorder can lead to successful treatment and prevents complications.
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Affiliation(s)
- Harsh Patel
- Department of Family Medicine, Central Jersey Urgent Care, Green Brook, NJ 08812, USA,Corresponding Author: Harsh Patel, Department of Family Medicine, Central Jersey Urgent Care, Green Brook, NJ 08812, USA.
| | - Aaiyat Sheikh
- Era’s Lucknow Medical College, Lucknow, Uttar Pradesh 226003, India
| | | | - Sri Abirami Selvam
- Department of Internal Medicine, St Mary Medical Center, Langhorne, PA 19047, USA
| | - Syed Nazeer Mahmood
- Department of Medicine, Section of Pulmonary/Critical Care, MedStar Washington Hospital Center, Washington, DC 20770, USA
| | - Gurleen Johal
- Department of Medicine, Hackensack Meridian Palisades Medical Center, North Bergen, NJ 07047, USA
| | - Janani Arunachalam
- Department of Biomedical Engineering, University of Houston, Houston, TX 77021, USA
| | | | - Viray Shah
- Department of Hospital Medicine, Medstar Good Samaritan Hospital, Baltimore, MD 21239, USA
| | - Aditya Lal Vallath
- Department of Emergency Medicine, Peerless Hospital and BK Roy Research Center, Kolkata, West Bengal 700094, India
| | | | - Saketh Palasamudram Shekar
- Interventional Pulmonology, Department of Pulmonary and Critical care Medicine, Pulmonary and Sleep Associates of Huntsville, Huntsville Hospital, Huntsville, AL 35801, USA
| | - Urvish Patel
- Department of Public Health and Neurology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
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Nikzad S, Al‐Arnawoot AA, Cabaero M, Rogalla P. An unusual case of nodular pulmonary amyloidosis. Clin Case Rep 2021; 9:e04562. [PMID: 34401154 PMCID: PMC8347630 DOI: 10.1002/ccr3.4562] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 06/23/2021] [Accepted: 06/23/2021] [Indexed: 11/18/2022] Open
Abstract
Nodular pulmonary amyloidosis is a rare and localized manifestation of amyloid deposition in the lungs. This rare entity, though asymptomatic, is often misdiagnosed on imaging alone, due to its resemblance to metastatic pulmonary nodules. This report highlights the significance of histologic confirmation before treatment, as a preventive measure against overtreatment.
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Affiliation(s)
- Sarina Nikzad
- Department of Medical ImagingToronto General HospitalTorontoONCanada
| | | | - Michael Cabaero
- Department of Medical ImagingToronto General HospitalTorontoONCanada
| | - Patrik Rogalla
- Department of Medical ImagingToronto General HospitalTorontoONCanada
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Polo-Nieto JF, Quiroga-Dussan MDP, Castañeda-González JP, Fierro-Rodríguez DM, Durán-Acuña R, Carrillo-Bayona JA. Perilymphatic micronodular pattern as a manifestation of pulmonary amyloidosis on high-resolution computed tomography. Radiol Case Rep 2021; 16:850-854. [PMID: 33552338 PMCID: PMC7850939 DOI: 10.1016/j.radcr.2021.01.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 01/05/2021] [Accepted: 01/11/2021] [Indexed: 12/26/2022] Open
Abstract
The term amyloidosis describes a group of diseases caused by the fibrillar deposit of poorly folded proteins in tissues with a secondary alteration of their function. Diffuse parenchymal lung disease associated with amyloidosis is rare and is most often diagnosed in autopsy. A 45-year-old male patient presented an acute episode of cough with mucoid expectoration. He had also dyspnea, dry cough, chest pain, and constitutional symptoms of 6 months of evolution. Initially the case was treated as acute pneumonia. After taking radiological images of the thorax, a diagnostic suspicion of lymphangitic spread of neoplasia was assumed. Histopathological findings of an open pulmonary biopsy demonstrated interstitial thickening with perivascular eosinophilic invasion. Congo Red staining and immunohistochemistry studies were done and turned out to be positive for amyloid. The perilymphatic micronodular pattern as a radiological manifestation of parenchymal pulmonary amyloidosis has been very rarely described in the literature, therefore it must be considered as a differential diagnosis in patients with this pattern in CT scan and should be an incentive for its histopathological study once a neoplasm is ruled out.
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Affiliation(s)
- José Fernando Polo-Nieto
- Fundación Universitaria de Ciencias de la Salud, Bogotá, Colombia
- Department of Pathology. Hospital de San José, Bogotá, Colombia
| | - Maria Del Pilar Quiroga-Dussan
- Fundación Universitaria de Ciencias de la Salud, Bogotá, Colombia
- Department of Pathology. Hospital de San José, Bogotá, Colombia
| | - Juan Pablo Castañeda-González
- Fundación Universitaria de Ciencias de la Salud, Bogotá, Colombia
- Department of Pathology. Hospital de San José, Bogotá, Colombia
| | - Diana Marcela Fierro-Rodríguez
- Fundación Universitaria de Ciencias de la Salud, Bogotá, Colombia
- Department of Radiology. Hospital de San José, Bogotá, Colombia
| | - Ricardo Durán-Acuña
- Fundación Universitaria de Ciencias de la Salud, Bogotá, Colombia
- Department of Pulmonology. Hospital de San José, Bogotá, Colombia
| | - Jorge Alberto Carrillo-Bayona
- Fundación Universitaria de Ciencias de la Salud, Bogotá, Colombia
- Department of Radiology. Hospital de San José, Bogotá, Colombia
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