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A Case of Solitary Nodular Pulmonary Amyloidosis FREE TO VIEW

Augustine Andoh-Duku, MBChB; Dhaval Raval, MBBS; Samaan Rafeq, MD; Hisushi Tsukada, MD
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St Elizabeth Medical Center, West Roxbury, MA

Chest. 2014;146(4_MeetingAbstracts):625A. doi:10.1378/chest.1994702
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SESSION TYPE: Affiliate Case Report Slide

PRESENTED ON: Monday, October 27, 2014 at 11:00 AM - 12:00 PM

INTRODUCTION: Pulmonary amyloidosis has been recognized in three different forms; diffuse parenchymal, nodular, and tracheobronchial. The most common form is nodular amyloidosis, a rare condition with good prognosis that presents in older individuals as asymptomatic nodules identified on routine chest x-rays.

CASE PRESENTATION: A 71-year-old female with 75 pack year smoking history was referred for evaluation of a 12mm spiculated left lower lobe (LLL) nodule seen on a routine CXR. She had a 20lbs intentional weight loss. She denied anorexia, chest pain, dyspnea or hemoptysis. Pulmonary exam was normal. Laboratories were normal. A CAT scan of chest revealed a 12mm spiculated nodule with central punctate calcification (Image 1). A PET/CT scan showed no abnormal FDG accumulation in the nodule. A PFT showed moderate obstructive defect with air trapping and reduced diffusion capacity. She had a flexible bronchoscopy with EBUS, which revealed mild mucosal thickening of lingular bronchus. There was no pathologic enlargement of lymph nodes. Pathology from transbronchial biopsy was normal. Patient had a wedge resection of the LLL nodule, which was complicated by a pneumothorax requiring chest tube placement. Microscopically the nodule showed uniformly acellular eosinophilic staining material. Near the edge of the nodule, cuboidal metaplasia of the alveoli was associated with scattered multinucleate giant cells, which appeared to be engulfing the eosinophilic material. Similar eosinophilic material was present in the walls of the small muscular pulmonary arteries near the tumor. A Congo red stain showed apple-green birefringence in the deposits consistent with a Pulmonary Nodular Amyloidosis. Immunostain for Amyloid A was negative. Patient was discharged home after resolution of pneumothorax and removal of chest tube.

DISCUSSION: The respiratory system is involved in approximately 50% of patients diagnosed with amyloidosis. Although pulmonary nodular amyloidosis is a rare disease, it should be considered in the differential diagnosis of pulmonary nodules or masses, mainly with primary or metastatic neoplasms and granulomatous diseases. Unlike systemic amyloidosis, localized pulmonary amyloidosis usually follows a benign course.

CONCLUSIONS: Clinicians should be aware of this relative rarity of localized pulmonary amyloidosis, which grows slowly and usually remains asymptomatic

Reference #1: Reference: Hidekazu Suzuki et al. Three cases of nodular pulmonary amyloidosis, Volume 45(2006) No. 5 P283-286). Japan, Internal-Medicine

DISCLOSURE: The following authors have nothing to disclose: Augustine Andoh-Duku, Dhaval Raval, Samaan Rafeq, Hisushi Tsukada

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