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The pattern of amyloid deposition in the lung.Malays
J Pathol. 1999 Jun;21(1):29-35.
A review of
routine histopathological samples and autopsies examined at the
Department of Pathology, University of Malaya revealed 15 cases of
amyloidosis of the lung. Two were localized depositions limited to
the lung while in the remainder, lung involvement was part of the
picture of systemic amyloidosis. Both cases of localized amyloidosis
presented with symptomatic lung/bronchial masses and a clinical
diagnosis of tumour. Histology revealed "amyloidomas" associated
with heavy plasma cell and lymphocytic infiltration and the presence
of multinucleated giant cells. In both cases, the amyloid deposits
were immunopositive for lambda light chains and negative for kappa
chains and AA protein. One was a known systemic lupus erythematosus
patient with polyclonal hypergammaglobulinaemia. The other patient
was found to have plasma cell dyscrasia with monoclonal IgG lambda
gammopathy. Both patients did not develop systemic amyloidosis. In
contrast, lung involvement in systemic AA amyloidosis was not
obvious clinically or macroscopically but was histologically evident
in 75% of cases subjected to autopsy. Amyloid was detected mainly in
the walls of arterioles and small vessels, and along the alveolar
septa. It was less frequently detected in the pleura, along the
basement membrane of the bronchial epithelium and around bronchial
glands. In one case of systemic AL amyloidosis associated with
multiple myeloma, an "amyloidoma" occurred in the subpleural region
reminiscent of localized amyloidosis. These cases pose questions on
(1) whether localized "tumour-like" amyloidosis is a forme fruste of
systemic AL amyloidosis and (2) the differing pattern of tissue
deposition of different chemical types of amyloid fibrils, with the
suggestion that light chain amyloid has a greater tendency to
nodular deposition than AA amyloid.
Nodular
pulmonary amyloidosis. Diagnosis by transbronchial biopsy.Mod
Pathol. 2000 Sep;13(9):934-40.
Nodular
amyloidomas (NA) of the lung are non-neoplastic inflammatory nodules
containing eosinophilic amyloid deposits and a lymphoplasmacytic
infiltrate. In some instances, the extensive amyloid deposits may
obscure an underlying lymphoproliferative disorder. The histologic
and immunohistologic features that discriminate these two
differential diagnostic possibilities were studied in this series of
six cases of NA and five cases of primary low-grade malignant
lymphomas of lung with secondary amyloid deposits (ML). Two of
lymphoma cases showed histopathologic and immunophenotypic features
of B-cell chronic lymphocytic leukemia/small lymphocytic lymphoma
(B-cell CLL/SLL), and three cases were low-grade B-cell lymphoma
derived from mucosa associated lymphoid tissue (MALT lymphoma). Key
discriminating morphologic features between NA and ML included
lymphatic tracking of the cellular infiltrate (3/5 ML; 1/6 NA),
pleural infiltration (3/5 ML; 0/6 NA), sheet-like masses of plasma
cells (5/5 ML; 0/6 NA) and reactive follicles (4/5 ML; 1/6 NA).
Lesional circumscription, vascular and bronchial destruction,
lymphoepithelial lesions, and granulomas were not helpful
discriminators. Immunohistochemical features indicating a dominant
CD20+, CD79a+ B-cell population (5/5 ML; 0/6 NA), light chain
restriction (4/5 ML; 0/6 NA), and aberrant antigen expression of
CD20/CD43 (2/5 ML; 0/6 NA) were helpful. Amyloid tumors with a
reactive lymphoplasmacytic infiltrate can be separated from
low-grade malignant lymphomas utilizing both histologic and
immunohistochemical features.
Nodular
pulmonary amyloidosis in a patient with rheumatoid arthritis.Clin
Rheumatol. 2007 Mar 2;
We describe
a 67-year-old white woman with a long-standing active rheumatoid
arthritis who refused treatment. Chest roentgenograms performed in
2000 revealed a pulmonary nodule in the mid-left lung. Progression
of the nodule was followed annually by computerized tomography (CT).
In the last CT in 2002, we observed multiple nodules in both lungs
in the absence of lymph gland involvement. The patient was operated
by videothoracoscopy to resect one of the pulmonary nodules.
Pathological examination of the excised tissue revealed amyloid
A-type (AA) amyloidosis. Although pulmonary amyloidosis is rare in
patients with systemic AA amyloidosis, we recommend that this
possibility be considered when confronted with a patient with these
characteristics.
Pulmonary nodular
amyloidosis.Cir Esp. 2007
Jan;81(1):43-5.
Amyloidosis
is a systemic disease caused by extracellular accumulation of
amyloid in different parts of the body. Pulmonary involvement is
infrequent and nodular amyloidosis is extremely rare. We present the
case of a 72-year-old man with chronic obstructive pulmonary disease
in whom a 3-cm pulmonary nodule was discovered during routine
radiological follow-up. After various complementary investigations
failed to identify the etiology of the nodule, surgical excision was
performed. Subsequent histopathological study revealed the presence
of amyloid deposits with characteristic apple-green birefringence
when stained with Congo-red under polarized light microscopy.
A case of
multiple nodular pulmonary amyloidosis complicated with primary
Sjogren syndrome.Nihon
Kokyuki Gakkai Zasshi. 2007
Apr;45(4):356-60.
A
79-year-old woman was admitted to the Department of Orthopedics
Surgery for treatment of osteoarthritis in her knee. Multiple
pulmonary nodular lesions were found on preoperative chest x-ray
film screening. Metastatic lung tumor was suspected, but no tumorous
lesions were detected in other organs. CT guided lung biopsy was
performed. Histopathological examination revealed amyloid consisting
of homogenous eosinophilic materials. No amyloid deposits were
detected in other organs, so we diagnosed localized nodular
pulmonary amyloidosis. She was subsequently given a diagnosis of
primary Sjögren syndrome. We believe that such a case of multiple
nodular pulmonary amyloidosis with Sjögren syndrome is rare, and the
case showed interesting radiological findings, such as mimicking
metastatic lung tumor.
Nodular
pulmonary amyloidosis.
Jpn J Thorac Cardiovasc Surg. 2006
Sep;54(9):399-401.
A
72-year-old woman with a diagnosis of suspected rheumatoid arthritis
was admitted with multiple pulmonary nodules in the bilateral lung
field. To obtain a diagnosis, a nodule was resected using
video-assisted thoracic surgery. Microscopically, amorphous
eosinophilic acellular substances were surrounded by inflammatory
infiltrates, which were confirmed to be amyloid deposits by congo
red staining. Thus, a diagnosis of pulmonary amyloidosis was
obtained. The clinical features and diagnostic process are
discussed.
Primary
pulmonary nodular amyloidosis.Monaldi
Arch Chest Dis. 2005 Sep;63(3):173-5.
Primary nodular amyloidosis of the lung is an uncommon
manifestation. The disease runs a benign course, but offers
diagnostic problems due to non-specific radiological features
entering the big field of the solitary nodule. We describe the case
of a 60 year old man with multiple nodules on the left lung operated
on diagnostic and therapeutic video-assisted thoracoscopy and
discuss the possibilities, if any, of suspecting such a disease
through radiologic characteristics along with findings from the
patient's history, physical examination and laboratory tests.
Amyloid-like
pulmonary nodules, including localized light-chain deposition:
clinicopathologic analysis of three cases.
Am J Clin Pathol. 2004
Feb;121(2):200-4.
Amyloid-like
pulmonary nodules have been described in patients with systemic
light-chain deposition disease, but their significance in other
clinical contexts is unknown. We examined biopsy specimens of
amyloid-like pulmonary nodules from 3 women without systemic
light-chain deposition disease. Patient 1 (aged 62 years) had
multiple pulmonary nodules and underwent 2 separate lung biopsies,
the first showing nodules composed of kappa light-chain deposits
accompanied by low-grade lymphoplasmacytic lymphoma limited to the
lung and the second, obtained after chemotherapy 9 months later,
showing only residual nodules without persistent lymphoma. Patients
2 (aged 65 years) and 3 (aged 69 years) had asymptomatic solitary
pulmonary nodules. In all cases, electron microscopic examination
showed dense granular extracellular deposits without the fibrillary
characteristics of amyloid. Amyloid-like nodules should be
distinguished from nodular amyloidosis and, in some patients, might
represent a localized form of light-chain deposition.
Localized
amyloidosis of the respiratory system: CT features.J
Comput Assist Tomogr. 1999
Jul-Aug;23(4):627-31.
PURPOSE:
Amyloidosis includes a spectrum of diseases associated with an
abnormal extracellular deposition of amyloid. The respiratory system
is involved in approximately 50% of patients with amyloidosis. The
purpose of this review is to present the CT findings of localized
amyloidosis of the respiratory system. METHODS: We reviewed the CT
findings of localized amyloidosis of the respiratory system from the
previous reports and our experiences. RESULTS: Three patterns of
involvement in respiratory system are presented: tracheobronchial
nodular and diffuse parenchymal. CT demonstrates nodules, plaques,
or diffuse thickening of the airways with calcification.
Postobstructive collapse is associated in case of diffuse airway
involvement. Parenchymal nodules have sharp and lobulated margins
with peripheral or subpleural locations. High-resolution CT shows
reticular opacities, interlobular septal thickening, and small,
well-defined nodules of 2 to 4-mm in diameter predominantly in the
subpleural regions. CONCLUSION: Amyloidosis of respiratory system
has variable findings and CT scans clearly depict extent and
distribution of the disease, its postobstructive pulmonary
complication, and other associated findings such as calcification
and lymphadenopathy.
Nodular
amyloidosis of the lung from intravenous drug abuse: an uncommon
cause of multiple pulmonary nodules.South
Med J. 1998 Apr;91(4):402-4.
Bilateral
pulmonary nodules in an immunocompromised host may offer a
diagnostic dilemma. We present a case of a human immunodeficiency
virus positive patient with history of intravenous drug abuse (IVDA)
who was incidentally found to have bilateral multiple pulmonary
nodules. She was diagnosed as having nodular pulmonary amyloidosis,
presumably serum amyloid A derived (AA) in origin but confirmed not
to be of amyloid light chain derived origin (AL), histologically
associated with focal birefringent material and foreign body giant
cell reaction, probably due to IVDA. Asymptomatic multiple pulmonary
nodules in amyloidosis are usually of AL origin; however, recently
similar changes have been found in the AA form in patients with
Sjogren's syndrome or Crohn's disease. It has not been previously
described in association with IVDA. Thus, this case documents a
unique cause of bilateral pulmonary nodules due to amyloidosis
consequent to IVDA.
Nodular
pulmonary amyloidosis associated with asbestos exposure.Pathol
Int. 1996 Jan;46(1):66-70.
A 71 year
old man was admitted for the purpose of diagnosis of a right
solitary pulmonary nodule. The size of the nodule was 18 x 18 mm in
diameter 2 years ago, but it has become large, 25 x 25 mm in
diameter. The nodule was resected by thoracotomy. Microscopically,
eosinophilic amorphous, acellular substances were surrounded by
inflammatory infiltrates. It stained with Congo red stain and showed
green birefringence with polarizing microscopy. Amyloid fibrils were
observed electron microscopically. Asbestos bodies were observed in
the lung parenchyma around the nodule. This case shows that a nodule
in nodular pulmonary amyloidosis can grow gradually and suggests the
possibility of asbestos fibers as one of the etiologic factors in
nodular pulmonary amyloidosis.
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