A CASE REPORT OF PRIMARY AMYLOIDOMA OF THE LUNG

Abstract

SESSION TITLE: Fellows Lung Pathology Posters SESSION TYPE: Fellow Case Report Posters PRESENTED ON: October 18-21, 2020 INTRODUCTION: Primary amyloidoma of the lung is rare and is usually found incidentally on chest radiographs in asymptomatic, elderly patients. Amyloid nodules may be solitary or much more commonly multiple. We present a case of primary amyloidoma of the lung. CASE PRESENTATION: A 79-year-old man, former smoker, with a history of COPD, DM, HTN, CKD, GERD, and adenocarcinoma of the colon presented with a few days of history of cough, dyspnea, and lethargy. Four days prior he was treated as an outpatient for pneumonia with levofloxacin and metronidazole. CT chest showed mild emphysema, RUL lung mass, and multiple bilateral non-calcified lung nodules. CT guided biopsy of RUL mass was consistent with amyloidoma. TTE did not show evidence of cardiac involvement. Immunoglobulin levels were unremarkable. SPEP and UPEP revealed no evidence of monoclonal protein. This was thought to be a localized process rather than diffuse parenchymal amyloidosis and decision was made to manage conservatively with surveillance rather than surgical excision. DISCUSSION: The term amyloid was first used by Rudolf Virchow in 1854.1 Amyloidosis is a heterogeneous group of diseases characterized by the deposition of misfolded insoluble proteins in extracellular tissue. Amyloidosis can be primary or secondary, and the deposition of amyloid proteins can be localized or systemic. Localized pulmonary amyloidosis was first described by Lesser in 1877. ¬¬2 It is divided into three main anatomical areas; tracheobronchial, parenchymal, and mediastinal.3 Tracheobronchial is the most common form of localized pulmonary amyloidosis.4 Patients can be asymptomatic or present with cough, dyspnea, and hemoptysis. A chest radiograph is nondiagnostic. CT findings ranges from a solitary nodule, multiple nodular lesions to more diffuse disease, with no pathognomonic features. Solitary amyloidoma of the lung may be confused with primary lung carcinoma. Multiple lesions may be difficult to differentiate from metastatic disease. Demonstration of apple-green birefringence with Congo red stain under polarized light is the gold standard for diagnosis. Isolated pulmonary amyloidoma is diagnosed by excluding other organ involvement. The treatment of pulmonary amyloidosis ranges from observation to bronchoscopic or surgical resection depending on the severity of the disease. Localized amyloidosis is usually treated with local interventions. Excisional therapy is the standard approach for tracheobronchial amyloidosis. Nd: YAG laser can be used to treat some nodular forms of tracheobronchial amyloidosis. Radiotherapy can be a viable option for the treatment of solitary pulmonary amyloidoma. CONCLUSIONS: Solitary pulmonary nodular amyloidosis is a rare diagnosis. Exclusion of systemic involvement is crucial in the management of these patients. The treatment ranges from observation to bronchoscopic or surgical resection based on the severity of the disease. Reference #1: 1. Saleiro S, Hespanhol V, Magalhães A. Endobronchial amyloidosis. J Bronchol. 2008;15:95–99. Reference #2: 2. Gillmore JD, Hawkins PN. Amyloidosis and the respiratory tract. Thorax. 1999;54:444–51. Reference #3: 3. Lachmann HJ, Hawkins PN. Amyloidosis and the lung. Chron Respir Dis. 2006;3:203–14. 4. Sugihara E, Dambara T, Okamoto M, Sonobe S, Koga H, Inui A, et al. Clinical features of 10 patients with pulmonary amyloidosis. J Bronchol. 2006;13:191–3. DISCLOSURES: No relevant relationships by Moises Cossio, source=Web Response No relevant relationships by Domingo Franco-Palacios, source=Web Response No relevant relationships by Kushagra Gupta, source=Web Response No relevant relationships by Shahzad Hussain, source=Web Response No relevant relationships by Katie Kennedy, source=Web Response No relevant relationships by Toribiong Uchel, source=Web Response