Solitary pleural amyloid nodules occurring as coin lesions diagnosed by fine‐needle aspiration biopsy

Kaw, Yao Tek; Esparza, Alfredo R.

doi:10.1002/dc.2840070319

Cited by 12 publications

(4 citation statements)

References 9 publications

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“…[22][23][24][25] A less invasive alternative in suspected disease is fine needle aspiration and this has been used successfully in the respiratory tract. 26,27 Positive histology for amyloid must be followed up by immunohistochemistry to determine the fibril protein type. 28 Suitable antibodies are widely available but, although immunohistochemistry usually yields definitive results in AA amyloidosis, it is frequently not diagnostic with AL deposits.…”

Section: Diagnosis and Evaluation Of Amyloidosismentioning

confidence: 99%

Amyloidosis and the lung

Lachmann

Hawkins

2006

Chron Respir Dis

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Amyloidosis is a disorder of protein folding in which normally soluble plasma proteins aggregate in an abnormal fibrillar form causing progressive disruption to tissue structure and organ function. This review covers systemic AA and AL amyloidosis which may arise as a consequence of chronic respiratory conditions; the manifestations of both systemic and of localised amyloid deposition within the respiratory tract and provides a summary of current approaches to diagnosis and management.

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Section: Diagnosis and Evaluation Of Amyloidosismentioning

confidence: 99%

Amyloidosis and the lung

Lachmann

Hawkins

2006

Chron Respir Dis

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“…The risk of haemorrhage should be considered when performing endobronchial or transbronchial biopsies, particularly in patients with factor IX and X deficiencies [9,10]. Less invasive procedures, such as fine needle aspiration, have been attempted successfully [11,12]. Since the clinical characteristics of the different forms of amyloidosis are similar, but treatment differs radically, targeting different precursors and pathogenic mechanisms, the unequivocal identification of the amyloid type is vital to avoid therapeutic errors.…”

Section: Introductionmentioning

confidence: 99%

The lung in amyloidosis

et al. 2017

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Amyloidosis is a disorder caused by misfolding of autologous protein and its extracellular deposition as fibrils, resulting in vital organ dysfunction and eventually death. Pulmonary amyloidosis may be localised or part of systemic amyloidosis.Pulmonary interstitial amyloidosis is symptomatic only if the amyloid deposits severely affect gas exchange alveolar structure, thus resulting in serious respiratory impairment. Localised parenchymal involvement may be present as nodular amyloidosis or as amyloid deposits associated with localised lymphomas. Finally, tracheobronchial amyloidosis, which is usually not associated with evident clonal proliferation, may result in airway stenosis.Because the treatment options for amyloidosis are dependent on the fibril protein type, the workup of all new cases should include accurate determination of the amyloid protein. Most cases are asymptomatic and need only a careful follow-up. Diffuse alveolar-septal amyloidosis is treated according to the underlying systemic amyloidosis. Nodular pulmonary amyloidosis is usually localised, conservative excision is usually curative and the long-term prognosis is excellent. Tracheobronchial amyloidosis is usually treated with bronchoscopic interventions or external beam radiation therapy.

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“…Various biopsy approaches, including bronchoscopic biopsy, percutaneous needle aspiration, 13,14 and open lung biopsy, 1,15 have been described. In the largest series describing the use of bronchoscopic biopsy for the diagnosis of amyloidosis, bleeding of more than 100 mL was reported in 2 of 11 patients.…”

Section: Clinical Presentationmentioning

confidence: 99%

Multiple Lung Nodules in an Asymptomatic Patient

Joshi¹,

Raza²,

Schapira³

et al. 2006

Clinical Pulmonary Medicine

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Primary pulmonary amyloidosis is an uncommon condition that may involve the pulmonary parenchyma or tracheobronchial tree manifested radiographically as a single nodule or multiple lung nodules. The diagnosis is confirmed by a lung biopsy that exhibits apple green birefringence under a polarized microscope after staining with Congo red dye. The clinical and radiographic features and diagnostic aspects of primary pulmonary amyloidosis are reviewed.Key Words: primary pulmonary amyloidosis, pulmonary nodules, apple green birefringence (Clin Pulm Med 2006;13: 368 -371) T he differential diagnosis of multiple pulmonary nodules is broad. Pulmonary nodules are commonly caused by a number of neoplastic (carcinoma, lymphoma) and infectious (mycobacterial, fungal, bacterial) processes and less commonly by sarcoidosis and collagen vascular diseases (Wegener granulomatosis and rheumatoid arthritis). Primary pulmonary amyloidosis is a rare cause of pulmonary nodules and its appearance may mimic nodules of other causes. 1 CASE REPORTA 57-year-old man was referred to the pulmonary clinic after initial radiologic evaluation demonstrated the presence of multiple pulmonary nodules. He had no respiratory complaints. Four weeks earlier, he was hospitalized for cellulitis of the right leg that resolved with antibiotic treatment. At that time, a chest radiograph detected the pulmonary nodules. He had a history of diabetes mellitus, hypertension, and obstructive sleep apnea. On examination, he appeared morbidly obese with a weight of 397 lbs. He was afebrile with a blood pressure of 120/60 mm Hg, pulse of 92 beats/min, respirations of 14 breaths/min, and room air pulse oximetry of 95%. Tongue and buccal mucus membranes were normal. Palatal arches were not present. Respiratory and cardiac examinations were normal. There was no rash, clubbing of the digits, or lymphadenopathy. Lower extremities showed changes of stasis dermatitis.Complete blood count and basic chemistry tests were normal. Total serum protein and serum protein electrophoresis were normal. Pulmonary function tests showed normal mechanics with a restrictive impairment: forced vital capacity 2.07 L (48% of predicted), forced expiratory volume in 1 second/forced vital capacity (%) of 84, and total lung capacity 3.45 L (54% of predicted). Chest radiography showed nodular opacities in the left mid and right lower zones (Fig. 1A). Thoracic computed tomography revealed multiple bilateral pulmonary nodules, the largest 2.9 cm in diameter ( Fig. 1B-D). Fiberoptic bronchoscopy showed no endobronchial abnormalities and a transbronchial biopsy of a right lower lobe was obtained. Congo red stain of the lung biopsy specimen under polarized microscopy revealed apple green birefringence characteristic of amyloid (Fig. 2). Bone marrow aspiration biopsy showed normal marrow cellularity without plasmacytosis. A diagnosis of primary pulmonary nodular amyloidosis was made.

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Solitary pleural amyloid nodules occurring as coin lesions diagnosed by fine‐needle aspiration biopsy

Cited by 12 publications

References 9 publications

Amyloidosis and the lung

Amyloidosis and the lung

The lung in amyloidosis

Multiple Lung Nodules in an Asymptomatic Patient

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