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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.
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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.
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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.
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Affiliation(s)
- Julie Fu
- Amyloidosis Center, Boston University School of Medicine , Boston, MA , USA and
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Matsuda M, Katoh N, Ikeda SI. Clinical manifestations at diagnosis in Japanese patients with systemic AL amyloidosis: a retrospective study of 202 cases with a special attention to uncommon symptoms. Intern Med 2014; 53:403-12. [PMID: 24583427 DOI: 10.2169/internalmedicine.53.0898] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE To retrospectively investigate the clinical manifestations at diagnosis in Japanese patients with systemic AL amyloidosis. METHODS We reviewed the medical records of 230 Japanese patients who had visited our hospital and been diagnosed with AL amyloidosis, and abstracted those with the systemic type. The clinical data at diagnosis of systemic AL amyloidosis, including laboratory and imaging findings, were analyzed. RESULTS Two hundred and two patients (mean, 58.7±9.5 years) were enrolled in this study. Immunofixation or immunoelectrophoresis was performed in 173 patients, 144 of whom were positive for M-protein in the serum and/or urine (κ:λ=30:114). The primary clinical manifestations at diagnosis were proteinuria and/or renal dysfunction (54.0%), congestive heart failure (24.8%), peripheral neuropathy (10.4%), hepatomegaly (7.9%) and arrhythmia (5.0%). The remaining patients developed unusual manifestations, such as solitary tumor, lymphadenopathy, gastrointestinal bleeding, intestinal pseudoobstruction, hemorrhagic tendencies and polyarthralgia. Dilatation of the intestine with marked thickening of the gastrointestinal wall on computed tomography and multiple nodular lesions with associated mucosal friability on endoscopy are characteristic findings of systemic AL amyloidosis. CONCLUSION The clinical pictures of Japanese patients with systemic AL amyloidosis are similar to those previously reported from the US and European nations; however, some patients with this disease develop uncommon symptoms. Conducting laboratory and histological examinations for systemic AL amyloidosis is necessary when making a differential diagnosis of these symptoms.
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Affiliation(s)
- Masayuki Matsuda
- Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine, Japan
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Abstract
Amyloidosis is a disease related to abnormal protein folding and deposition of that abnormal protein between cells of the body in various tissues and organs, resulting in multiple clinical manifestations. We report a case of amyloidosis with atypical features, isolated to the mediastinum, in a 75-year-old male who presented with fatigue and shortness of breath. Amyloidosis that is isolated to the mediastinum without pulmonary parenchymal involvement is exceptionally rare. It has been hypothesized that localized mediastinal amyloidosis manifesting as amyloidomas is a distinct clinical subtype with a better prognosis than classic systemic amyloidosis. This paper describes the radiologic features of localized mediastinal amyloidosis (along with its pathologic correlation) and compares systemic and isolated disease.
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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
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MATSUGUMA H, SUZUKI H, ISHIKAWA Y, NAKAHARA R, IZUMI T, IGARASHI S, MIYAZAWA N. Localized mediastinal lymph node amyloidosis showing an unusual unsynchronized pattern of enlargement and calcification on serial CT. Br J Radiol 2008; 81:e228-30. [DOI: 10.1259/bjr/22456532] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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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.
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Affiliation(s)
- Masayuki Matsuda
- Department of Medicine (Neurology and Rheumatology, Shinshu University School of Medicine, Matsumoto, Japan.
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Prokaeva T, Spencer B, Kaut M, Ozonoff A, Doros G, Connors LH, Skinner M, Seldin DC. Soft tissue, joint, and bone manifestations of AL amyloidosis: clinical presentation, molecular features, and survival. ACTA ACUST UNITED AC 2007; 56:3858-68. [PMID: 17968927 DOI: 10.1002/art.22959] [Citation(s) in RCA: 108] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To characterize symptoms and signs of AL amyloidosis that may bring patients to the attention of rheumatologists, evaluate Ig V(L) gene usage in this subgroup of patients, and assess the impact of soft tissue and bone involvement and V(L) gene usage on survival. METHODS Clinical features of soft tissue and bone involvement were assessed in 191 patients with AL amyloidosis. V(L) gene sequencing was carried out to determine light-chain family, rate of somatic mutation, and evidence of antigen selection. The association of soft tissue and bone involvement with V(L) gene usage was assessed by logistic regression analysis, and survival time was analyzed using log rank tests and Cox regression models. RESULTS Soft tissue and bone involvement occurred in 42.9% of the patients, and 9.4% had dominant soft tissue and bone involvement. The most common manifestations were submandibular gland enlargement, macroglossia, and carpal tunnel syndrome. Dominant soft tissue and bone involvement was significantly associated with V(L)kappaI gene usage. Mutation rate and evidence of antigen selection in the V(L) genes were not found to be confounding factors, providing evidence against a contribution of autoimmunity in this type of AL amyloidosis. Survival time was initially longer in patients with dominant soft tissue and bone involvement than in patients with other dominant organ involvement; however, this difference diminished over time. CONCLUSION Amyloid infiltration into soft tissue, joints, periarticular structures, and bones can bring patients with AL amyloidosis to the attention of rheumatologists. Recognition of the presenting symptoms is essential for accurate diagnosis and appropriate treatment, since the long-term outlook for untreated patients with dominant soft tissue and bone involvement is not better than that for patients with other dominant features of AL amyloidosis.
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Affiliation(s)
- Tatiana Prokaeva
- Boston University School of Medicine, Boston, Massachusetts 02118-2526, USA.
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Turner CA, Tung K. CT appearances of amyloid lymphadenopathy in a patient with non-Hodgkin's lymphoma. Br J Radiol 2007; 80:e250-2. [DOI: 10.1259/bjr/56686654] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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10
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Vogel MN, Wehrmann M, Horger MS. Massive Cervical and Abdominal Lymphadenopathy Caused by Localized Amyloidosis. J Clin Oncol 2007; 25:343-4. [PMID: 17235052 DOI: 10.1200/jco.2006.08.9656] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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11
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Terrier B, Hummel A, Servais A, Delarue R, Fournier P, Fakhouri F. An unusual cause of lymph nodes enlargement. Am J Med 2007; 120:e1-3. [PMID: 17208059 DOI: 10.1016/j.amjmed.2006.04.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2006] [Revised: 04/12/2006] [Accepted: 04/24/2006] [Indexed: 10/23/2022]
Affiliation(s)
- Benjamin Terrier
- Department of Nephrology, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
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Güz G, Ozdemir BH, Sezer S, Yakupoglu U, Demirhan B, Ozdemir FN, Haberal M. High frequency of amyloid lymphadenopathy in uremic patients. Ren Fail 2001; 22:613-21. [PMID: 11041293 DOI: 10.1081/jdi-100100902] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Amyloid lymphadenopathy has only been reported in case report form, or in small groups of patient groups within large series. We believe that amyloid lymphadenopathy is common in uremic patients, and thus designed this study to determine the frequency of this condition in hemodialysis patients, and to assess its types and patterns. We reevaluated 46 uremic patients' lymph node biopsies for amyloid deposits. We also immunohistochemically identified the protein origin of these deposits using Amyloid A, kappa, lambda, beta2 microglobulin, and transthyretin antibodies. Histopathologically, we observed for vascular involvement, follicular deposition, and diffuse deposition. We detected amyloid deposits in 10 of the 46 (22%) patients' lymph nodes. The patterns of deposition were vascular involvement alone in six specimens, vascular involvement plus follicular deposition in three, and vascular involvement plus diffuse deposition in one specimen. Amyloid AA type protein was present in seven nodes, beta2 microglobulin-related amyloid in two nodes, and immunoglobulin-derived protein (AL) in one node. We assessed these 10 patients for causes of end-stage renal disease (ESRD) and other conditions that might relate to amyloidosis. The cause of ESRD in the seven patients with AA amyloid were renal amyloidosis secondary to Familial Mediterranean Fever in four, glomerulonephritis in one patient who had bronchiectasis and Castleman's disease, unknown in one patient who had bronchial asthma, and pyelonephritis in one patient who had no characteristics that could be linked with AA type amyloidosis. The causes of ESRD in the two individuals with beta2 microglobulin-related amyloidosis who had been on long-term hemodialysis were pyelonephritis and glomerulonephritis. The cause of ESRD in the patient with AL type protein was glomerulonephritis, and this patient had no systemic disease. We conclude that amyloid lymphadenopathy is, indeed, common in uremic patients. Amyloid type AA is the most prevalent form of amyloid protein in uremic patients, but amyloid type does not always correspond with underlying cause of renal failure, or with the presence of systemic disease.
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Affiliation(s)
- G Güz
- Department of Nephrology, Baskent University Faculty of Medicine, Ankara, Turkey.
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Ben Ghorbel I, Houman MH, Lamloum M, Romdhane NB, Daniel L, M'Timet B, Miled M. [Pseudotumoral adenopathies, an unusual means of detecting systemic amyloidosis]. Rev Med Interne 1999; 20:1037-40. [PMID: 10586443 DOI: 10.1016/s0248-8663(00)87085-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
INTRODUCTION It is uncommon that lymph node enlargement is diagnostic of systemic amyloidosis as found in the case reported in this study. EXEGESIS This study examined the case of a 49-year old male with chronic bronchitis in whom in 1990 the presence had been detected of an isolated cervical lymphadenopathy, 2 cm in diameter, and which had previously remained unnoticed. In 1993, a significant number of other peripheral adenopathies also appeared in various locations, i.e., cervical, axillary, inguinal. Chest and abdominal CT-scans revealed several mediastinal and abdominal lymphadenopathies. The histological study with Congo red stain of a cervical lymph node biopsy determined the diagnosis of amyloidosis. The patient was at that time asymptomatic. In September 1997, upon physical examination the following were found: lower limb edema, superior vena cava syndrome, and several cervical lymphadenopathies. Abdominal ultrasonography showed enlarged kidneys, and homogeneous splenomegaly. Biological examination determined the existence of a nephrotic syndrome with renal failure and creatinemia of 350 mumol/L. Due to superior vena cava syndrome worsening, cervical lymph node removal was performed. However, the patient died after rapid renal failure. CONCLUSION Although it is a rare occurrence, amyloidosis should be taken into consideration in the differential diagnosis of isolated lymphadenopathy. Congo red stain amongst others, and an immunohistochemical study should be performed in cases of uncertain diagnosis.
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Affiliation(s)
- I Ben Ghorbel
- Service de médecine interne, hôpital La Rabta, Tunis, Tunisie
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Spitale LS, Jimenez DB, Montenegro RB. Localised primary amyloidosis of inguinal lymph node with superimposed bone metaplasia. Pathology 1998; 30:321-2. [PMID: 9770203 DOI: 10.1080/00313029800169546] [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: 10/25/2022]
Abstract
We present here a case of localised primary amyloidosis of the right inguinal lymph node in a 42 year old female. On gross examination the specimen was 4.0 x 4.0 x 3.2 cm in size with a tan-pink color and two whitish-yellow areas of hard consistency. Histologically the lymph node was replaced by an eosinophilic amorphous material, alkaline Congo red, crystal violet, thioflavine T and sodium sulphate-alcian blue (SAB). We observed areas of mature bone metaplasia alternating with sheets of plasma cells and clusters of foreign body giant cell reaction. Immunohistochemical study showed anti-lambda chain staining within the amorphous material. The negative clinical history, physical examination, normal serum electrophoresis and bone marrow and rectal biopsy allowed us to make the diagnosis of localised primary amyloidosis of lymph node. The patient is alive and without evidence of disease progression to systemic amyloidosis or plasma cell dyscrasia, after clinical follow-up of seven years.
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Affiliation(s)
- L S Spitale
- Department of Anatomical Pathology, School of Medicine, Córdoba National University, Argentina
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Simmonds PD, Cottrell BJ, Mead GM, Wright DH, Whitehouse JM. Lymphadenopathy due to amyloid deposition in non-Hodgkin's lymphoma. Ann Oncol 1997; 8:267-70. [PMID: 9137796 DOI: 10.1023/a:1008250604411] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Amyloidosis is a rare complication of non-Hodgkin's lymphoma. Most of the reported patients have had systemic amyloidosis and have died as a result of complications of this disease. MATERIALS AND METHODS The clinical cases of two patients with lymphoplasmacytic non-Hodgkin's lymphoma who presented with lymphadenopathy due to localised amyloid deposition are reviewed. Immunohistochemical studies were performed on the amyloid deposits and adjacent lymphoma. RESULTS The amyloid deposits in both patients were derived from monoclonal light chains of the same isotype as those expressed by the lymphoma cells and were localised to areas adjacent to the lymphoma despite the presence of circulating light chains. Both patients had an indolent clinical course and treatment appeared to have little influence on the amyloid deposition. CONCLUSIONS Non-Hodgkin's lymphoma may be associated with localised amyloidosis secondary to local production and deposition of amyloid from monoclonal light chains synthesised by the lymphoma cells. This is a rare cause of lymphadenopathy which does not respond to treatment of the underlying lymphoma.
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Affiliation(s)
- P D Simmonds
- CRC Wessex Medical Oncology Unit, Royal South Hants Hospital, Southampton, UK
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Moran CA, Suster S, Abbondanzo SL. Inflammatory pseudotumor of lymph nodes: a study of 25 cases with emphasis on morphological heterogeneity. Hum Pathol 1997; 28:332-8. [PMID: 9042798 DOI: 10.1016/s0046-8177(97)90132-5] [Citation(s) in RCA: 68] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The clinicopathological and immunohistochemical findings in 25 cases of inflammatory pseudotumor of lymph nodes (IPT) are presented. The patients were 13 women and 12 men between 8 and 81 years of age. Clinically, symptoms of prior infection, fatigue, abdominal pain, weight loss, fever of unknown origin, pelvic inflammatory disease, or nausea and night sweats were obtained in 15 patients, whereas six patients presented with asymptomatic lymphadenopathy. In four additional patients, no clinical information was obtained. The involved nodes included cervical, supraclavicular, inguinal, mesenteric, and mediastinal lymph nodes. In two cases, there was synchronous involvement of separate lymph node groups (inguinal and cervical in one case and cervical and mediastinal in another case), whereas in a third patient there was synchronous involvement of the spleen and a paraaortic lymph node. Histologically, the lesions were characterized by a fibrosing/inflammatory process that showed marked heterogeneity and striking variation from case to case. Based on their histological features, the lesions could be classified into three different groups: Stage I was characterized by the appearance of single or multiple small foci containing a spindle cell proliferation admixed with a prominent inflammatory background, with complete preservation of the remainder of the nodal architecture; stage II was characterized by more diffuse involvement of the lymph node with a marked inflammatory response admixed with a prominent myofibroblastic proliferation leading to subtotal effacement of the nodal architecture, often with extension of the process beyond the capsule into perinodal fat; and stage III was characterized by almost complete replacement of the lymph node by diffuse sclerosis with scant residual inflammatory elements and total loss of the normal nodal architecture. Immunohistochemical studies in 20 cases showed a striking number of vimentin- and actin-positive myofibroblastic cells with moderate increase in CD20/CD45+ small lymphocytes and polyclonal plasma cells in the stage I lesions, the emergence of numerous CD68+ histiocytes admixed with lymphocytes, plasma cells, and abundant fibromyofibroblastic cells in the stage II lesions, and only few remaining scattered CD68+ histiocytes and fibroblasts in the stage III lesions. Our findings suggest that inflammatory pseudotumor of lymph node represents an evolving, dynamic process that may adopt different morphological appearances depending on its stage of evolution. Recognition of the various stages of this process may be of importance for differential diagnosis with other fibrosing/inflammatory conditions of lymph nodes.
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Affiliation(s)
- C A Moran
- Department of Pulmonary and Mediastinal Pathology, Armed Forces Institute of Pathology, Washington, DC 20306-6000, USA
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Segalov E, Gibson J, Joshua DE, Kronenberg H. Primary amyloidosis co-presenting with cervical and massive intra-abdominal lymphadenopathy. Leuk Lymphoma 1995; 19:519-20. [PMID: 8590857 DOI: 10.3109/10428199509112215] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Although primary amyloidosis may present in a variety of ways, it has only rarely been described to present with massive lymphadenopathy. We describe such a patient who was initially referred with a provisional diagnosis of lymphoma.
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Affiliation(s)
- E Segalov
- Haematology Department, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
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Hamaya K, Kitamura M, Doi K. Primary amyloid tumors of the jejunum producing intestinal obstruction. ACTA PATHOLOGICA JAPONICA 1989; 39:207-11. [PMID: 2741699 DOI: 10.1111/j.1440-1827.1989.tb01502.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The proximal jejunum, containing four separate amyloid tumors, was resected from a chronically constipated 71-year-old male exhibiting IgG lambda monoclonal gammopathy. Amyloid was deposited in the jejunal wall, mesentery and regional lymph nodes, but was not seen in gastric and rectal biopsy samples. Two years after surgery, the patient is well, but the monoclonal gammopathy persists.
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Affiliation(s)
- K Hamaya
- Anatomic Pathology, Surgery, Okayama Saiseikai General Hospital, Japan
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Abstract
Cutaneous lesions are present in up to 40% of patients with primary and myeloma-associated systemic amyloidosis and occur as a result of tissue deposition of immunoglobulin light chain material derived from a circulating paraprotein. The occurrence of waxy, purpuric mucocutaneous lesions provides a crucial early pointer to underlying occult plasma cell dyscrasia; the combination of the symptoms of the carpal tunnel syndrome, macroglossia, and specific mucocutaneous lesions is highly characteristic. Although secondary systemic (reactive) amyloidosis rarely gives rise to clinically evident cutaneous lesions, it may be etiologically related to a number of chronic dermatoses. Lesions of nodular primary localized cutaneous amyloidosis are indistinguishable from those of primary and myeloma-associated systemic amyloidosis, and they result from local plasma cell infiltration. Macular and papular (lichen amyloidosus) variants of primary localized cutaneous amyloidosis may have a familial or racial basis and are characterized by a tendency for keratinocytes to undergo filamentous degeneration and apoptosis. The prognosis of patients with plasma cell dyscrasia-related systemic amyloidosis remains poor, since there is little response to therapy with cytotoxic agents, colchicine, or dimethylsulfoxide. Colchicine is the drug of choice in the prevention and treatment of the renal amyloidosis associated with familial Mediterranean fever, and dimethylsulfoxide may be useful in the management of patients with secondary systemic amyloidosis. Macular amyloid and lichen amyloidosus generally follow a chronic course with intractable pruritus; there have been isolated reports of the beneficial effect of dermabrasion, topical dimethylsulfoxide, and therapy with the aromatic retinoid, etretinate.
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Affiliation(s)
- S M Breathnach
- Department of Medicine (Dermatology), Charing Cross and Westminster Medical School, London, U.K
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Kanoh T, Okada H. Amyloid lymphadenopathy in a patient with mixed (type II) cryoglobulinemia. ARTHRITIS AND RHEUMATISM 1986; 29:1050-2. [PMID: 3741516 DOI: 10.1002/art.1780290817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Ough YD, Miller WM, Leeb B, Holbrook DL, Klos JR. Immunoblastic lymphoma with extracellular and intravascular immunoglobulin deposits: immunocytochemical and electron microscopic studies. Cancer 1983; 51:623-30. [PMID: 6401592 DOI: 10.1002/1097-0142(19830215)51:4<623::aid-cncr2820510414>3.0.co;2-c] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Immunoblastic lymphoma (IBL) showing features of angioimmunoblastic lymphadenopathy (AIBL) is described. Abundant eosinophilic extracellular deposits were present in lymph nodes. Electron microscopic and immunoperoxidase studies showed this material was composed of degenerating tumor cells and polyclonal immunoglobulins (Mu and Alpha heavy chains and Kappa and Lambda light chains). Numerous arborizing vessels were thickened with monoclonal IgM(K) immunoglobulins. The tumor cell lysis and degeneration are though to be due to the high cell turnover and immune reaction to unrecognized substances.
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Breathnach SM, Black MM. Systemic amyloidosis and the skin: a review with special emphasis on clinical features and therapy. Clin Exp Dermatol 1979; 4:517-36. [PMID: 394889 DOI: 10.1111/j.1365-2230.1979.tb01650.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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