Nephrotic Syndrome Associated with Lung Cancer: A Rare Case of Malignancy Associated with AA Amyloidosis

Gueutin, Victor; Langlois, Anne-Lyse; Shehwaro, Nathalie; Elharraqui, Ryme; Rouvier, Philippe; Izzedine, Hassane

doi:10.1155/2013/831903

Cited by 9 publications

(12 citation statements)

References 12 publications

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“…However, 10 of 12 case reports, including the present case, showed the diagnosed period of lung cancer to be the same as or prior to that of amyloidosis (Table 1) [19–29]. These clinical time courses suggest the prior onset of lung cancer may contribute to the deposition of amyloid through paraneoplastic mechanisms.…”

Section: Discussionmentioning

confidence: 53%

Lung adenocarcinoma expressing receptor for advanced glycation end-products with primary systemic AL amyloidosis: a case report and literature review

et al. 2017

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BackgroundReceptor for advanced glycation end-products (RAGE), a receptor for amyloids, is constitutively expressed in lungs and generally observed to be downregulated in lung cancer tissues. However, increasing levels of RAGE or serum amyloids is associated with poor outcome in lung cancer patients. We report a rare case of primary systemic amyloid light-chain (AL) amyloidosis in biopsy-proven multiple organs with early-stage non-small cell lung cancer (NSCLC) that displayed strong staining for RAGE in the tumour tissue. Interestingly, compared with randomly selected lung cancer biopsy samples, including all representative histological subtypes of NSCLC and small-cell lung cancer, only the NSCLC in the present case showed strong expression for RAGE that can bind amyloids.Case presentationA 71-year-old woman was admitted to our hospital for comprehensive investigation of nephrotic syndrome. Computed tomography showed a small nodule in the right upper lung lobe with hilar mediastinal lymph node enlargement. Pathological examination of transbronchial biopsy samples of the nodule yielded a diagnosis of lung adenocarcinoma. Furthermore, the pathological detection of amyloid deposition in biopsy samples of a subcarinal lymph node, gastric and duodenal mucosa, cardiac muscle, and bone marrow led to a diagnosis of primary systemic AL amyloidosis with nephrotic syndrome and cardiomyopathy. In addition, RAGE was detected in lung tumour tissues surrounded by normal lung tissues with amyloid deposition.ConclusionThe RAGE positivity of the lung cancer cells in this case suggests an interaction between amyloid-containing tissues and RAGE-expressing cancer cells. Lung adenocarcinoma with RAGE expression may be a complication of underlying amyloidosis.

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Section: Discussionmentioning

confidence: 53%

Lung adenocarcinoma expressing receptor for advanced glycation end-products with primary systemic AL amyloidosis: a case report and literature review

et al. 2017

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“…AA amyloidosis is associated with diseases such as chronic infections, aging, chronic inflammatory diseases, Hodgkin disease and solid tumors [16] . The incidence of systemic AA amyloidosis in cancer patients is 0.1% to 0.4% [9] . Among solid tumors, hypernephroma, and renal cell carcinoma are the most associated with AA amyloidosis, and at autopsy, 2% to 3% of patients with renal carcinoma are found to have amyloids [8,9] .…”

Section: Discussionmentioning

confidence: 99%

“…[16] The incidence of systemic AA amyloidosis in cancer patients is 0.1% to 0.4%. [9] Among solid tumors, hypernephroma, and renal cell carcinoma are the most associated with AA amyloidosis, and at autopsy, 2% to 3% of patients with renal carcinoma are found to have amyloids. [8,9] Only 1 case of amyloidosis was detected in a series of 4033 lung cancer cases.…”

Section: Discussionmentioning

confidence: 99%

Lung cancer combined with diffuse peritoneal and mesenteric amyloidosis detected on 18F-FDG PET/CT

et al. 2021

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Rationale:Amyloidosis is a heterogeneous group of diseases characterized by extracellular deposition of amyloid fibrils. Lung carcinoma is rarely reported to be associated with AA amyloidosis. With regard to the manifestation of amyloidosis infiltrating organs, most of the cases focus on the heart, liver, kidneys, and peripheral nervous system. Amyloidosis with diffuse abdominal involvement in combination with pulmonary squamous cell carcinoma carcinoma is an exceptionally rare occurrence.Patient concerns:A 70-year-old man was admitted to hospital for a 2-month history of repeated cough, low grade fever, hemoptysis and left back shoulder pain, which was not relieved by nonsteroid anti-inflammatory drugs. Meanwhile, he complained of intermittent diffuse abdominal discomfort and chronic persistent constipation.Diagnoses:The patient was diagnosed with poorly differentiated lung squamous cell carcinoma and diffuse peritoneal and mesenteric amyloidosis based on the pathological biopsy.Interventions:The patient received surgery and chemotherapy for lung tumor. He did not receive any treatment against amyloidosis.Outcomes:The patient died of a severe respiratory infection.Lessons:This case indicates that lung carcinoma is suspected to play a causative role in the development of amyloidosis. In addition, amyloidosis should be considered in the differential diagnosis in cases in which diffuse greater omentum, peritoneal, and mesenteric calcifications on 18F-2-fluoro-2-deoxy-D-glucose(18F-FDG) photon emission computed tomography (PET/CT).

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“…A case of partially treated lung cancer leading to renal AA amyloidosis has been reported in the literature. 9 AA amyloidosis can also complicate heritable disorders characterized by periodic fevers (hereditary amyloidosis). Examples of such disorders include familial Mediterranean fever (FMF), cryopyrin-associated periodic syndromes (CAPS), or cryopyrinopathies (familial cold auto-inflammatory syndrome, Muckle-Wells syndrome, and neonatal onset multisystem inflammatory disorder), tumor necrosis factor receptor-1 (TNFR1)-associated periodic syndrome or so-called TRAPS, formerly known as familial Hibernian fever or familial periodic fever, and finally, hyper-IgD syndrome.…”

Section: Discussionmentioning

confidence: 99%

“…It is still possible that in all cases described above, perhaps there is an underlying occult malignancy present that could be causing the AA amyloidosis rather than the ICI therapy. Gueutin et al 9 presented a case of chemo-unresponsive advanced lung malignancy and AA amyloidosis. This could be evident in case 2 of our series, however, our case differs in that the lung cancer in our patient was in partial remission.…”

Section: Discussionmentioning

confidence: 99%

Immune checkpoint inhibitor–associated renal amyloid A amyloidosis: A case series and review of the literature

Lapman¹,

Whittier

Parikh

et al. 2020

Journal of Onco-Nephrology

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Immune checkpoint inhibitors are a cornerstone in the management of many oncological disorders, and their indications continue to grow. However, as with any therapy we must remain vigilant of the possible adverse effects. Although interstitial nephritis is a reported cause of immune checkpoint inhibitor–related kidney injury, immune-mediated glomerular disease has rarely been described. Here, we present three patients being treated with checkpoint inhibitors for colon cancer, metastatic squamous cell carcinoma of the lung, and melanoma, who developed biopsy-proven amyloid A amyloidosis. In all three cases, the malignancies were in remission, yet continued inflammation and amyloid deposition occurred, pointing toward a primary role of the immune checkpoint inhibitor. Treatment generally remains a challenge due to a paucity of reported cases, thus further study of cytokine profile is prudent. In one case, the patient was given tocilizumab in the setting of elevated interleukin-6 levels; unfortunately no appreciable renal benefit was noted and the patient became dialysis dependent. In the other two cases, the patients were treated with colchicine and steroids. One patient had a substantial decrease in proteinuria and inflammatory markers while no significant response was noted in the other. Knowledge of immune checkpoint inhibitor–associated amyloid A amyloidosis is important for the oncologist and the nephrologists.

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Nephrotic Syndrome Associated with Lung Cancer: A Rare Case of Malignancy Associated with AA Amyloidosis

Cited by 9 publications

References 12 publications

Lung adenocarcinoma expressing receptor for advanced glycation end-products with primary systemic AL amyloidosis: a case report and literature review

Lung adenocarcinoma expressing receptor for advanced glycation end-products with primary systemic AL amyloidosis: a case report and literature review

Lung cancer combined with diffuse peritoneal and mesenteric amyloidosis detected on 18F-FDG PET/CT

Immune checkpoint inhibitor–associated renal amyloid A amyloidosis: A case series and review of the literature

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