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Ichimata S, Hata Y, Yoshinaga T, Katoh N, Kametani F, Yazaki M, Sekijima Y, Nishida N. Amyloid-Forming Corpora Amylacea and Spheroid-Type Amyloid Deposition: Comprehensive Analysis Using Immunohistochemistry, Proteomics, and a Literature Review. Int J Mol Sci 2024; 25:4040. [PMID: 38612850 PMCID: PMC11012059 DOI: 10.3390/ijms25074040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 03/31/2024] [Accepted: 04/03/2024] [Indexed: 04/14/2024] Open
Abstract
This study aimed to elucidate the similarities and differences between amyloid-forming corpora amylacea (CA) in the prostate and lung, examine the nature of CAs in cystic tumors of the atrioventricular node (CTAVN), and clarify the distinctions between amyloid-forming CA and spheroid-type amyloid deposition. We conducted proteomics analyses using liquid chromatography-tandem mass spectrometry with laser microdissection and immunohistochemistry to validate the characteristics of CAs in the lung and prostate. Our findings revealed that the CAs in these organs primarily consisted of common proteins (β2-microglobulin and lysozyme) and locally produced proteins. Moreover, we observed a discrepancy between the histopathological and proteomic analysis results in CTAVN-associated CAs. In addition, while the histopathological appearance of the amyloid-forming CAs and spheroid-type amyloid deposits were nearly identical, the latter deposition lacked β2-microglobulin and lysozyme and exhibited evident destruction of the surrounding tissue. A literature review further supported these findings. These results suggest that amyloid-forming CAs in the lung and prostate are formed through a shared mechanism, serving as waste containers (wasteosomes) and/or storage for excess proteins (functional amyloids). In contrast, we hypothesize that while amyloid-forming CA and spheroid-type amyloid deposits are formed, in part, through common mechanisms, the latter are pathological.
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Affiliation(s)
- Shojiro Ichimata
- Department of Legal Medicine, Faculty of Medicine, University of Toyama, Toyama 930-0194, Japan
| | - Yukiko Hata
- Department of Legal Medicine, Faculty of Medicine, University of Toyama, Toyama 930-0194, Japan
| | - Tsuneaki Yoshinaga
- Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine, Matsumoto 390-8621, Japan; (T.Y.)
| | - Nagaaki Katoh
- Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine, Matsumoto 390-8621, Japan; (T.Y.)
| | - Fuyuki Kametani
- Department of Brain and Neurosciences, Tokyo Metropolitan Institute of Medical Science, Tokyo 156-8506, Japan;
| | - Masahide Yazaki
- Institute for Biomedical Sciences, Shinshu University, Matsumoto 390-8621, Japan;
| | - Yoshiki Sekijima
- Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine, Matsumoto 390-8621, Japan; (T.Y.)
| | - Naoki Nishida
- Department of Legal Medicine, Faculty of Medicine, University of Toyama, Toyama 930-0194, Japan
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Yamashita H, Fujimoto M, Yokogawa R, Taguchi T, Ohara J, Ogata H, Akiyama Y. Cerebral Amyloidoma Accompanied by Sjögren's Syndrome: A Case Report and Literature Review. NMC Case Rep J 2022; 8:781-786. [PMID: 35079548 PMCID: PMC8769455 DOI: 10.2176/nmccrj.cr.2021-0088] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 09/23/2021] [Indexed: 11/20/2022] Open
Abstract
We present a 69-year-old woman with colorectal cancer and a left frontal lobe tumor that was diagnosed as a cerebral amyloidoma after surgical resection. Further postoperative systemic evaluation revealed another amyloidoma in her hip as well as Sjögren's syndrome. Systemic amyloidosis was not present. To the best of our knowledge, this is the first case of cerebral amyloidoma presenting as one of the multiple localized amyloidomas accompanied by Sjögren's syndrome. We also present a systematic review of 65 cerebral amyloidoma cases reported in the literature over the past 40 years and discuss patient characteristics and pathological and imaging findings associated with prognosis.
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Affiliation(s)
| | | | - Ryuta Yokogawa
- Department of Neurosurgery, Tenri Hospital, Tenri, Nara, Japan
| | - Tomoaki Taguchi
- Department of Neurosurgery, Tenri Hospital, Tenri, Nara, Japan
| | - Jiro Ohara
- Department of Neurosurgery, Tenri Hospital, Tenri, Nara, Japan
| | - Hideki Ogata
- Department of Neurosurgery, Tenri Hospital, Tenri, Nara, Japan
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Pace A, Lownes S, Shivane A, Hilton D, Weatherby S. A tale of the unexpected: Amyloidoma associated with intracerebral lymphoplasmacytic lymphoma. J Neurol Sci 2015; 359:404-8. [DOI: 10.1016/j.jns.2015.09.372] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Revised: 08/26/2015] [Accepted: 09/27/2015] [Indexed: 11/26/2022]
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Abstract
We present the case of a 62-year-old woman with chondromyxoid fibroma of the sphenoid sinus. Chondromyxoid fibroma is a rare bone tumor found most prevalently in long bones, so its presence at the cranial base is especially uncommon. The presence of a monoclonal gammopathy of undermined significance (MGUS) prompted consideration and investigation of a plasma cell disorder; however, CT and MRI findings followed by biopsy led to the correct diagnosis of chondromyxoid fibroma.
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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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Menetti F, Bartolomei I, Ambrosini-Spaltro A, Salvi F, Agati R, Leonardi M. Amyloidoma Involving the Orbit, Meckel's Cave and Infratemporal Fossa: 3T MRI Findings. Neuroradiol J 2009; 22:41-7. [PMID: 24206952 DOI: 10.1177/197140090902200107] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2009] [Accepted: 02/08/2009] [Indexed: 11/16/2022] Open
Abstract
Amyloidoma is a rare lesion characterized by tissue deposition of an abnormal fibrillary protein (amyloid). It is the focal and localized counterpart of systemic amyloidosis, where the deposition of amyloid diffusely involves several organs. The few literature reports of intracranial amyloidomas include lesions involving the pituitary gland, orbit, cerebral hemispheres, temporal bone, cerebellopontine angle and jugular foramen. We describe the case of a 27-year-old woman presenting with painless slowly progressive proptosis of the right eye. The patient underwent a contrast-enhanced CT study of the head, followed by 3T MRI which disclosed a homogeneous mass in the right Meckel's cave and cavernous sinus, extending through an enlarged foramen ovale to the infratemporal fossa. The right optic nerve and ocular muscles were enlarged and infiltrated along with the retrobulbar fat by contrast-enhancing tissue. Thin contrast-enhanced MRI scans through the area of interest showed the mass to extend posterior to the gasserian ganglion, involving the cerebellopontine angle cistern, where the intracisternal parts of the III, V, and VI nerves bilaterally appeared enlarged and showed perineural enhancement. The lesion closely mimicked a malignant tumor with perineural tumor infiltration, so we performed fine needle biopsy of the portion of the lesion near the right foramen ovale under fluoroscopic guidance. Histopathology revealed that the lesion was an amyloidoma. Further clinical and blood examinations, serum chemistry, followed by biopsy of the periumbilical fat showed no signs of systemic amyloidosis or an underlying inflammatory or neoplastic disorder. No further treatment was instituted, follow-up MRI six months later showed no enlargement of the mass.
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Affiliation(s)
- F Menetti
- Department of Neuroradiology; Bellaria Hospital, University of Bologna; Bologna, Italy -
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7
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Bookland MJ, Bagley CA, Schwarz J, Burger PC, Brem H. INTRACAVERNOUS TRIGEMINAL GANGLION AMYLOIDOMA. Neurosurgery 2007; 60:E574; discussion E574. [PMID: 17327767 DOI: 10.1227/01.neu.0000255361.32689.b3] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
OBJECTIVE
Isolated amyloidomas rarely manifest in nervous system tissues. To the authors' knowledge, there have been 52 documented cases of primary amyloid tumors of the central nervous system and closely associated structures. The authors present a case of a woman with a history of presumptive trigeminal neuralgia who was found to have an amyloidoma of the trigeminal ganglion.
CLINICAL PRESENTATION
A 32-year-old Caucasian patient presented with a chief complaint of severe numbness and pain throughout the right side of her face. Her symptoms had been progressive over the previous 3 years. Medical management of her presumptive diseases with Zoloft (Pfizer Inc., New York, NY) and Neurontin (Pfizer Inc.) failed to improve or halt her right facial numbness and pain. Brain magnetic resonance imaging was acquired, demonstrating abnormal contrast enhancement and enlargement of the right trigeminal ganglion. The lesion abutted and indented the right internal carotid artery and extended from Meckel's cave into the inferior cavernous sinus and distally to the foramen ovale.
INTERVENTION
The patient underwent a right frontotemporal craniotomy for resection of the gasserian ganglion lesion. A delicate incision was made in the wall of the cavernous sinus, allowing confirmatory biopsy of the lesion. With the site of the tumor within the cavernous sinus verified by pathology, the remainder of the tumor was removed. A final pathological review of the resected tumor confirmed a diagnosis of amyloidoma of the trigeminal ganglion.
CONCLUSION
We present the case of a patient with a rare trigeminal ganglion amyloidoma that closely mimicked idiopathic trigeminal neuralgia. Even in the absence of systemic signs of amyloidosis, this benign protein deposition disease should be considered in the differential for atypical dysesthesias of the trigeminal dermatomes. Furthermore, central and peripheral nervous system amyloidomas respond well to surgical resection and rarely recur.
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Affiliation(s)
- Markus J Bookland
- Department of Neurosurgery, The Johns Hopkins School of Medicine, Baltimore, Maryland 21287, USA
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Iplikcioglu AC, Bek S, Gokduman CA, Cosar M, Sav A. Primary solitary cervical amyloidosis: case report and review of the literature. Spine (Phila Pa 1976) 2007; 32:E45-7. [PMID: 17202880 DOI: 10.1097/01.brs.0000251016.54203.71] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A case report and literature review are presented. OBJECTIVE To describe and review the clinical presentations, characteristic findings from imaging studies, types, differential diagnosis, prognosis, and treatment of amyloidoma arising within the vertebrae. SUMMARY OF BACKGROUND DATA Amyloidoma can occur in the bone, skin, larynx, lymph nodes, urinary bladder, eye, tongue, and gastrointestinal system. However, amyloidomas affecting the vertebral bones are very rare. To our knowledge, only 3 cases of amyloidoma involving cervical spine have been reported previously. METHODS In this report, we present a case of solitary amyloidosis of the cervical spine. RESULTS The differential diagnosis of primary solitary spinal amyloidoma includes metastasis, infection, primary bone tumors, plasmocytoma, and Potts abscess. The correct diagnosis can be achieved only after the specific staining of tissue. The prognosis of amyloidosis is related to the specific form of amyloidosis. However, primary solitary amyloidosis has the best prognosis, although a limited number of patients without long-term follow-up studies have been reported. CONCLUSIONS Primary solitary amyloidosis is a rare form of the amyloidosis, which is different from the other forms of amyloidosis because of excellent prognosis with surgical excision. Combined surgical excision and spinal stabilization is the best treatment.
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Affiliation(s)
- A Celal Iplikcioglu
- Neurosurgery Clinic, Ministry of Health Okmeydani Teaching and Research Hospital, Basibuyuk-Maltepe, Istanbul, Turkey
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Joung CI, Kang TY, Park YW, Lee WS, Lee YY, Park MH, Joo KB, Yoo DH. Muscular amyloidoma presenting as inguinal masses in multiple myeloma. Scand J Rheumatol 2005; 34:152-4. [PMID: 16095014 DOI: 10.1080/03009740510026355] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
We report a case with protruding inguinal masses for 6 months, in whom muscular amyloidoma was not suspected before muscle biopsy. On pelvic magnetic resonance imaging (MRI), round masses showing peripheral rim enhancement with gadolinium were observed in iliopsoas and iliacus muscles of both inguinal areas. The same lesions were also observed in gluteus muscles. The biopsy showed Congo red positive materials in a dense fibrous background. Serum and urine electrophoresis showed Bence Jones protein, lambda type. In bone marrow section, myeloma cells were found. Peripheral blood stem cell transplantation (PBSCT) following four cycles of VAD (vincristine, adriamycin, dexamethasone) chemotherapy was performed and the result was satisfactory. Amyloidoma lesions decreased in size and number on the following MRI.
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Affiliation(s)
- C I Joung
- Department of Rheumatology, Konyang University Hospital, Daejeon, Korea
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Haridas A, Basu S, King A, Pollock J. Primary Isolated Amyloidoma of the Lumbar Spine Causing Neurological Compromise: Case Report and Literature Review. Neurosurgery 2005; 57:E196; discussion E196. [PMID: 15987561 DOI: 10.1227/01.neu.0000163423.45514.bc] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2004] [Accepted: 02/07/2005] [Indexed: 12/27/2022] Open
Abstract
Abstract
OBJECTIVE AND IMPORTANCE:
We describe a patient with cauda equina compression secondary to amyloidoma to alert other clinicians to this rare cause of a compressive epidural lesion. It is the fourth published report of primary lumbar amyloidoma causing neurological compromise.
CLINICAL PRESENTATION:
A 53-year-old, previously fit salesman presented with several years history of back pain and recent weakness, especially in the left leg. He also had numbness and tingling radiating down the left leg. On examination, the left knee jerk was diminished, and both ankle jerks were absent. Power was reduced to 4/5 in ankle dorsiflexion bilaterally. A magnetic resonance imaging scan of the lumbar spine revealed an extradural mass, compressing the theca at L3–L4. This was enhancing in T1-weighted images and had low signal intensity in T2-weighted images. There was no evidence of systemic amyloidosis or development of multiple myeloma.
INTERVENTION:
L3–L4 laminectomy was performed, with removal of the epidural mass. The patient had complete resolution of sciatica and regained normal power in both lower limbs. There was no evidence of any recurrence at 1-year follow-up.
CONCLUSION:
Lumbar epidural amyloidoma is an extremely rare cause of cauda equina compression. Clinical presentation can be nonspecific, and radiologically, it can be indistinguishable from a tumor. Diagnosis is made at histological examination of a Congo red-stained section under polarized light. Complete resection of the localized epidural amyloid mass is associated with a good prognosis.
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Affiliation(s)
- Avinash Haridas
- Department of Neurosurgery, Essex Center for Neurological Sciences, Oldchurch Hospital, Essex, England
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Abstract
The authors report the case of a patient with amyloidoma of the thoracic spine. A 34-year-old man presented with a 2-month history of upper-back pain, bilateral lower-extremity weakness, and numbness below the nipple. A computerized tomography study revealed an extradural mass with destruction of the T-2 lamina and pedicle. Intraoperatively, there was a pinkish, partially suctionable mass infiltrating the muscle plane and causing destruction of the T-2 lamina. Histological examination showed typical amyloid masses that demonstrated apple-green double refraction on examination of the Congo red-stained section under polarized light. Amyloidomas are rare benign lesions that, unlike other forms of amyloidosis, have an excellent prognosis. A cure is possible with complete resection of the mass.
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Affiliation(s)
- V S Suri
- Department of Pathology, G. B. Pant Hospital, New Delhi, India
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12
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Matsumoto T, Tani E, Fukami M, Kaba K, Yokota M, Hoshii Y. Amyloidoma in the gasserian ganglion: case report. SURGICAL NEUROLOGY 1999; 52:600-3. [PMID: 10660026 DOI: 10.1016/s0090-3019(99)00128-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Amyloidoma in the central nervous system is extremely rare. We describe a rare case of amyloidoma in the gasserian ganglion manifesting as trigeminal neuropathy. METHODS A 41-year-old woman was admitted to our hospital with progressive numbness and hypalgesia in the distribution of the second and third divisions of the left trigeminal nerve. There was no evidence of chronic inflammatory disorder or immunological abnormalities. Magnetic resonance images showed a mass in the left Meckel's cave that was brightly enhanced with gadolinium. RESULTS A reddish, firm mass was successfully removed via a left temporal craniotomy. Histologically, the tumor was composed of larger acellular deposits of eosinophilic material. The acellular deposits were positive for potassium permanganate-resistant Congo red staining, showing apple-green birefringence under polarized light and expression of immunoglobulin lambda light chain-derived proteins (A lambda) immunohistochemically. CONCLUSION The present case revealed an A lambda amyloidoma in the left gasserian ganglion. Although the incidence is rare, amyloidoma should be suspected in patients who complain of progressive trigeminal neuropathies and show an enhanced lesion in the gasserian ganglion on MR images.
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Affiliation(s)
- T Matsumoto
- Department of Neurosurgery, Hyogo College of Medicine, Nishinomiya, Japan
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Dee CH, Missirian RJ, Chernoff IJ. Primary amyloidoma of the spine. A case report and review of the literature. Spine (Phila Pa 1976) 1998; 23:497-500. [PMID: 9516708 DOI: 10.1097/00007632-199802150-00019] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
STUDY DESIGN A rare case is reported of primary or idiopathic amyloidoma of the spine derived from production of light chain immunoglobulins. The tumor was successfully treated by anterior decompression and fusion with a fibula strut allograft. OBJECTIVE To describe a rare case of AL amyloidoma of the spine. SUMMARY OF BACKGROUND DATA Radiographic characteristics of this benign deposit are similar to harmful aggressive conditions afflicting the spine. RESULTS The patient returned to full function after the surgery with no evidence of systemic amyloidosis or development of multiple myeloma. METHODS An isolated AL amyloidoma of the spine was resected and successfully reconstructed with a fibula strut allograft and internal fixation. CONCLUSIONS Isolated deposits of amyloid in the spine occur very rarely. When no evidence of myeloproliferative disease or systemic amyloidosis is found, prognosis is excellent. The deposit, when it occurs in the spine has a predilection for the thoracic region and can cause neurologic compromise, pain, and deformity that is responsive to decompression and fusion. The diagnosis of primary amyloidoma requires histologic studies for confirmation.
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Affiliation(s)
- C H Dee
- Division of Orthopaedic Surgery, Southern Illinois University, Springfield, USA
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Laeng RH, Altermatt HJ, Scheithauer BW, Zimmermann DR. Amyloidomas of the nervous system: a monoclonal B-cell disorder with monotypic amyloid light chain lambda amyloid production. Cancer 1998; 82:362-74. [PMID: 9445195 DOI: 10.1002/(sici)1097-0142(19980115)82:2<375::aid-cncr18>3.0.co;2-w] [Citation(s) in RCA: 65] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Amyloidomas or localized tumor-like amyloid deposits rarely affect the nervous system. To the authors' knowledge, no comprehensive studies on central and peripheral nervous system amyloidomas have been published. The amyloid subtype of amyloidomas of the nervous system only recently was characterized and almost invariably was found to be of amyloid light chain (AL) lambda type. The nature of the plasma cell population responsible for AL amyloid production has not been investigated further. METHODS The current analysis included the clinical findings, neuroimaging characteristics, and pathology of seven amyloidomas (four cerebral and three involving peripheral nerves). All were subjected to histochemical staining (Congo red, thioflavine S) and to immunohistochemical study using primary antibodies detecting serum amyloid component P, serum amyloid protein A (SAA), transthyretin, beta2 microglobulin (beta2m), and free immunoglobulin (Ig) light chain. For the detection of mRNA of light chain Ig, fluorescein-conjugated kappa and lambda mRNA oligonucleotide probes were used. For the assessment of B-cell clonality, polymerase chain reaction (PCR) was applied on extracted DNA from two cases using VH FRIII and JH primers. Two cases were assessed ultrastructurally. RESULTS All amyloidomas were organ restricted and unrelated to systemic amyloidosis. The clinical symptoms of the cerebral lesions were nonspecific, whereas neurologic deficits were noted in the distribution of the involved peripheral nerves. Cerebral deposits, either solitary or multiple, were associated spatially with the choroid plexus and secondarily extended into white matter. All peripheral nerve amyloidomas involved the gasserian ganglion of the trigeminal nerve. Imaging by computed tomography and magnetic resonance imaging scans revealed hyperdense and contrast-enhancing mass lesions unassociated with significant edema. Immunohistochemically, the amyloid was present in the interstitium and within the walls of the intralesional vessels, was invariably of AL lambda subtype, and was negative for free Ig kappa light chains, SAA, transthyretin, and beta2m. Plasma cells along the perivascular sheaths and occasionally squeezed between amyloid masses showed no cytologic atypia. In situ hybridization for Ig light chain mRNA reflected a massive preponderance of lambda-producing cells. PCR revealed monoclonal rearrangement of the heavy chain Ig gene. CONCLUSIONS The results of the current study provide strong support for the concept that amyloidomas of the nervous system are neoplasms of an AL lambda-producing B-cell clone capable of terminal differentiation. Nevertheless, all seven patients lacked clinical evidence of an aggressive or systemic lymphoplasmacytic neoplasm. Unlike plasmacytomas, the relatively indolent course of most nervous system amyloidomas is reminiscent of the similarly indolent biologic behavior of extranodal, low grade B-cell lymphoma of mucosa-associated lymphoid tissue (MALT) type.
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Affiliation(s)
- R H Laeng
- Department of Pathology, Kantonsspital, Aarau, Switzerland
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15
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Abstract
STUDY DESIGN Second published report of a patient with amyloidoma of the upper cervical spine. OBJECTIVES To describe a patient with rare radiculopathy to alert other physicians to consider amyloid tumor as a differential diagnosis of locally destructive spine lesions. SUMMARY OF BACKGROUND DATA Localized amyloid tumor of the bone is a rare disease. Only seven cases of spine involvement have been reported. Appropriate tissue sampling is required to establish the diagnosis. Histopathologic examination shows pathognomonic apple-green birefringence under polarized light. When bone is involved with amyloid, it is most commonly associated with multiple myeloma or other plasma cell-dyscrasias. METHOD This case was described, and pertinent literature was reviewed. RESULTS The patient showed persistent neurologic improvement after transoral complete tumor removal, followed by a secondary posterior stabilization procedure using transarticular C1-C2 screws. CONCLUSIONS Amyloidomas are benign lesions with no associated documented risk for the development of plasmocytoma-related diseases. The clinical and radiographic manifestations of this lesion are nonspecific. A cure is possible with complete resection of the tumor and no adjuvant management procedures.
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Affiliation(s)
- F Porchet
- Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
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Mullins KJ, Meyers SP, Kazee AM, Powers JM, Maurer PK. Primary solitary amyloidosis of the spine: a case report and review of the literature. SURGICAL NEUROLOGY 1997; 48:405-8. [PMID: 9315141 DOI: 10.1016/s0090-3019(96)00488-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Amyloidosis is a term that encompasses a group of disorders that have as their common feature the intercellular deposition of the amyloid protein by several different pathogenetic mechanisms. Primary solitary amyloidosis, or amyloidoma, is a rare subset of amyloidosis in which the amyloid deposition is focal and not secondary to a systemic process or plasma cell dyscrasia. We present the second reported case of a cervical spine amyloidoma and discuss its presentation and management. METHODS This 58-year-old man presented with a 1-year history of intermittent chest pain that would radiate into both legs precipitated by valsalva maneuvers. A magnetic resonance imaging (MRI) of the cervical spine revealed a homogenously enhancing lesion focally involving the C-7 vertebral level with significant spinal cord compression. He underwent combined anterior and posterior decompressive procedures with instrumentation for spinal stabilization. Histopathology revealed amyloid deposits and a systemic work-up was negative for amyloidosis. RESULTS The patients is free of any tumor recurrence at 24 months and has a stable spine construct. CONCLUSIONS Primary solitary amyloidosis is a rare subtype of amyloidosis which, unlike other forms of amyloidosis, has an excellent prognosis with local resection. Diagnosis requires special stains and therefore a degree of suspicion for the disease. Management of vertebral amyloidoma involves aggressive local resection of the tumor when feasible and stabilization of the spine as mandated by the degree of tumor involvement. Complete evaluation for the diagnosis of systemic amyloidosis is essential for the management and prognostication of each case.
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Affiliation(s)
- K J Mullins
- Division of Neurological Surgery, Strong Memorial Hospital, University of Rochester School of Medicine, NY 14642-8670, USA
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Pambuccian SE, Horyd ID, Cawte T, Huvos AG. Amyloidoma of bone, a plasma cell/plasmacytoid neoplasm. Report of three cases and review of the literature. Am J Surg Pathol 1997; 21:179-86. [PMID: 9042284 DOI: 10.1097/00000478-199702000-00007] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Tumoral amyloidosis (amyloidoma) of bone is a rare condition characterized by the massive destructive deposition of AL amyloid in bones. We report three cases. The patients ranged in age from 45 to 78 years and had tumors located in the lumbar spine, scapula, and humeral head measuring 6.5 to 18 cm. The radiologic diagnosis was chondrosarcoma in two cases. Microscopically, there were large, rounded deposits of amorphous eosinophilic material surrounded by numerous giant cells and a sparse lymphoplasmacytic infiltrate. The deposits proved to be composed of AL amyloid showing potassium permanganate resistant congophilia. Immunohistochemistry showed immunoglobulin IgG lambda, IgG kappa, and IgM lambda monoclonality of the plasma cell and (in one case) lymphoid infiltrate. The tumors were classified by morphology and immunohistochemistry as solitary plasmacytomas of bone (two cases) and plasmacytoid lymphoma (one case). During the relatively short follow-up period, one patient progressed to symptomatic generalized amyloidosis and died, one patient died of recurrent tumor, and one patient is alive with no evidence of disease. An extensive review of the world literature showed 34 well-documented similar cases, occurring most often in the spine and skull, causing neurologic symptoms, tending to occur in middle-aged men and frequently progressing to generalized disease. Most if not all AL amyloidomas of bone represent solitary plasmacytomas of bone or plasmacytoid lymphomas.
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MESH Headings
- Aged
- Amyloid/analysis
- Amyloidosis/pathology
- Amyloidosis/therapy
- Anatomy, Cross-Sectional
- Bone Neoplasms/chemistry
- Bone Neoplasms/pathology
- Bone Neoplasms/therapy
- Fatal Outcome
- Female
- Humans
- Immunohistochemistry
- Leukemia, Lymphocytic, Chronic, B-Cell/chemistry
- Leukemia, Lymphocytic, Chronic, B-Cell/pathology
- Leukemia, Lymphocytic, Chronic, B-Cell/therapy
- Male
- Microscopy, Electron
- Middle Aged
- Plasmacytoma/chemistry
- Plasmacytoma/pathology
- Plasmacytoma/therapy
- Tomography, X-Ray Computed
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Affiliation(s)
- S E Pambuccian
- Department of Pathology, Lenox Hill Hospital, New York, New York, USA
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Hidalgo F, Aguilera C, Monfort JL, Reñé M, Muntané A, Pons LC. Amyloidoma of the skull: plain radiographs, CT and MRI. Neuroradiology 1996; 38:44-6. [PMID: 8773275 DOI: 10.1007/bf00593216] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Amyloidomas involving bone are rare. The 67-year-old man reported here had a large amyloidoma of the left frontal, parietal, sphenoid (greater wing) and temporal bones causing neural compression. Plain radiographs CT and MRI are shown.
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Affiliation(s)
- F Hidalgo
- Department of Neuroradiology, Ciutat Sanitària i Universitària de Bellvitge, Barcelona, Spain
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O'Brien TJ, McKelvie PA, Vrodos N. Bilateral trigeminal amyloidoma: an unusual case of trigeminal neuropathy with a review of the literature. Case report. J Neurosurg 1994; 81:780-3. [PMID: 7931626 DOI: 10.3171/jns.1994.81.5.0780] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Isolated amyloidomas may, albeit rarely, involve the central nervous system. There are three previous reports of amyloidomas that involved the gasserian ganglion and caused unilateral trigeminal neuropathies. The authors report the case of a 49-year-old woman with apparently isolated amyloidomas that caused slowly progressive bilateral trigeminal neuropathies. Magnetic resonance imaging of the brain revealed mild swelling of the left trigeminal nerve within the cavernous sinus and uniform enhancement with gadolinium throughout the length of the nerve. At craniotomy, the trigeminal nerve and ganglion were observed to be infiltrated by a tumor-like mass. Biopsy showed extensive infiltration of the nerve and ganglion by amyloid. Immunocytochemical studies of the amyloid were negative for immunoglobulins, kappa and lambda light chains, beta-amyloid A4 protein, transthyretin, beta 2-microglobulin, cystatin C, and gelsolin, but weak focal immunoreactivity with antiamyloid AA antibody was seen in the amyloid in vessels and in some intraneural deposits. Extensive investigations failed to reveal evidence of either systemic amyloidoses or an underlying inflammatory disorder or malignancy.
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Affiliation(s)
- T J O'Brien
- Department of Clinical Neuroscience, St. Vincent's Hospital, Melbourne, Australia
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