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Kong Y, Cao L, He B, Zhou Z, Zhang M, Zhang Q, Wang Q, Wang W, Zhu H, Xiao J, Rominger A, Guan Y, Tan H, Ni R. Head-to-head comparison of [18F]florbetapir and [18F]FDG PET for the early detection of amyloidosis in systemic amyloidosis and plasma cell dyscrasias. Eur J Radiol 2025; 189:112188. [PMID: 40413864 DOI: 10.1016/j.ejrad.2025.112188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2025] [Revised: 04/26/2025] [Accepted: 05/21/2025] [Indexed: 05/27/2025]
Abstract
RATIONALE AND OBJECTIVES Systemic amyloidosis is underdiagnosed in light-chain amyloidosis (AL), as is plasma cell dyscrasias (PCD). Early detection and accurate evaluation of organ involvement in systemic amyloidosis remain critical challenges. We aimed to assess the utility of [18F]florbetapir (FBP) and [18F]fluorodeoxyglucose (FDG) positron emission tomography (PET) for the early detection and evaluation of organ involvement in systemic amyloidosis. MATERIALS AND METHODS We included 66 participants and performed biochemical assays in serum and urine and whole-body PET/computed tomography using [18F]FBP and [18F]FDG, followed by visual, maximum standardized uptake value (SUVmax), and target-to-background ratio (TBR) analyses. The clinical evaluation of organ involvement was based on the histological analysis of tissue biopsies obtained from suspected organs in AL and PCD cases. RESULTS [18F]FBP SUVmax and TBR analyses revealed comparable uptake in AL patients and significantly greater uptake than in PCD patients. Distinct regional distributions of [18F]FBP and [18F]FDG were observed between the PCD and AL groups. The [18F]FBP SUVmax and visual analysis provided comparable measures of organ involvement and demonstrated high sensitivity, outperforming [18F]FDG in detecting organ amyloidosis in both PCD and AL patients. More organ involvement was detected by [18F]FBP PET (SUVmax or visual) than by biopsies based evaluation. CONCLUSION [18F]FBP PET, through both visual and SUVmax analysis, is more sensitive than [18F]FDG PET and biopsy-based analysis for detecting organ amyloidosis in PCD and AL patients. It serves as a valuable noninvasive method for the early and accurate detection of systemic amyloidosis, with the potential to improve diagnostic precision and facilitate timely intervention in systemic amyloidosis patients.
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Affiliation(s)
- Yanyan Kong
- PET Center, Huashan Hospital, Fudan University, 200235 Shanghai, China
| | - Lei Cao
- Institute for Regenerative Medicine, University of Zurich 8952 Zurich, Switzerland
| | - Boyan He
- PET Center, Huashan Hospital, Fudan University, 200235 Shanghai, China
| | - Zhongwen Zhou
- Department of Pathology, Huashan Hospital, Fudan University, 200235 Shanghai, China
| | - Minmin Zhang
- Department of Nephrology, Huashan Hospital, Fudan University, 200235 Shanghai, China
| | - Qian Zhang
- Department of Nephrology, Huashan Hospital, Fudan University, 200235 Shanghai, China
| | - Qian Wang
- Department of Hematology, Huashan Hospital, Fudan University, 200235 Shanghai, China
| | - Wei Wang
- Department of Hematology, Huashan Hospital, Fudan University, 200235 Shanghai, China
| | - Haoxiang Zhu
- Department of Infectious Diseases, Huashan Hospital, Fudan University, 200235 Shanghai, China
| | - Jianfei Xiao
- PET Center, Huashan Hospital, Fudan University, 200235 Shanghai, China
| | - Axel Rominger
- Department of Nuclear Medicine, Inselspital, University of Bern, 3010 Bern, Switzerland
| | - Yihui Guan
- PET Center, Huashan Hospital, Fudan University, 200235 Shanghai, China.
| | - Haibo Tan
- PET Center, Huashan Hospital, Fudan University, 200235 Shanghai, China.
| | - Ruiqing Ni
- Institute for Regenerative Medicine, University of Zurich 8952 Zurich, Switzerland; Department of Nuclear Medicine, Inselspital, University of Bern, 3010 Bern, Switzerland; Institute for Biomedical Engineering, University of Zurich & ETH Zurich 8093 Zurich, Switzerland.
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Charokopos A, Baqir M, Roden AC, Ryu JH, Moua T. Multifaceted pulmonary manifestations of amyloidosis: state-of-the-art update. Expert Rev Respir Med 2025; 19:107-120. [PMID: 39840767 DOI: 10.1080/17476348.2025.2457374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2024] [Accepted: 01/20/2025] [Indexed: 01/23/2025]
Abstract
INTRODUCTION Amyloidosis, a polymeric deposition disease classified according to protein subtype, may have varied pulmonary manifestations. Its anatomic-radiologic phenotypes include nodular, cystic, alveolar-septal, and tracheobronchial forms. Clinical presentation may range from asymptomatic parenchymal nodules to respiratory failure from diffuse parenchymal infiltration or diaphragmatic deposition. AREAS COVERED In this review, we systematically describe the molecular subtypes of amyloidosis and their clinical and radiologic findings in the lungs as well as key extrapulmonary organ systems. We detail novel treatment approaches to systemic amyloidosis. We also discuss prognostic elements for each subtype. We identify key clinical scenarios where reaching a precise diagnosis can be complicated, and we offer insights on the varied presentations of pulmonary amyloidosis. EXPERT OPINION Pulmonary amyloidosis is often difficult to diagnose as it may mimic other conditions, including fibrotic interstitial lung diseases and neoplasms, or can co-exist with certain connective tissue diseases. Despite some early artificial intelligence screening tools, improved familiarity among clinicians can aid in the more accurate and timely diagnosis of this multidimensional clinical entity. We additionally believe that multidisciplinary clinical pathwaysto diagnose and/or treat pulmonary amyloidosis have the potential to improve awareness, decrease diagnostic delay, and further elucidate knowledge on this multifaceted disease.
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Affiliation(s)
- Antonios Charokopos
- Division of Pulmonary & Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
| | - Misbah Baqir
- Division of Pulmonary & Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
| | - Anja C Roden
- Division of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Jay H Ryu
- Division of Pulmonary & Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
| | - Teng Moua
- Division of Pulmonary & Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
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Demirkol B, Satici C, Eren R, Ugur Chousein EG, Senkal N, Turan D, Urer HN, Cetinkaya E. A descriptive analysis of 21 patients with pulmonary amyloidosis: An observational study. Medicine (Baltimore) 2024; 103:e40535. [PMID: 39533551 PMCID: PMC11556964 DOI: 10.1097/md.0000000000040535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Accepted: 10/25/2024] [Indexed: 11/16/2024] Open
Abstract
Pulmonary amyloidosis is an extremely rare disease, often detected incidentally because of its asymptomatic nature and potential to result in fatal outcomes. In this study, we aimed to present the clinical and radiological features of patients diagnosed with pulmonary amyloidosis by biopsy. This descriptive study included 21 patients with pathologically diagnosed pulmonary amyloidosis. Pulmonary amyloidosis was classified as diffuse alveolar-septal amyloidosis (DASA), cystic amyloidosis (CPA), tracheobronchial amyloidosis (TBA), nodular amyloidosis (NPA), and extraparenchymal pulmonary amyloidosis (pleural and mediastinal lymph node). Clinical, bronchoscopic, and radiological specific characteristics were presented in detail to be used for differential diagnosis. The median age of the patients was 63 (40-83) years, and 14 (66.7%) were male. Twenty patients (95.2%) presented with at least 1 comorbidity. All patients diagnosed with tracheobronchial amyloidosis were symptomatic at presentation, whereas those diagnosed with NPA/extraparenchymal amyloidosis were often asymptomatic. The patients included 1 case of DASA, 1 case of CPA, 10 cases of NPA, 6 cases of TBA, and 3 cases of extraparenchymal amyloidosis involving the mediastinal lymph node and pleura. Sixteen patients (76.2%) were classified as localized amyloidosis, while 5 patients (23.8%) were classified as systemic amyloidosis following the diagnosis of multiple myeloma, monoclonal gammopathy of undetermined significance, systemic lupus erythematosus, Sjogren's syndrome, and B-cell lymphoma. Bronchoscopic biopsies were sufficient for diagnosis, and notably, even transbronchial needle aspiration could be a useful diagnostic method. During the follow-up, we observed that the disease remained stable without progression. However, it is important to note that patients with concurrent malignancies experience fatal outcomes. In conclusion, it is crucial to distinguish pulmonary amyloidosis from other pulmonary diseases such as malignancies, infectious diseases, and interstitial lung diseases, which may have similar clinical and radiological findings. Bronchoscopic diagnostic methods are usually sufficient for the diagnosis. Although patients with pulmonary involvement mostly remain stable during long-term follow-up without progression, it is important to consider the risk of malignancy.
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Affiliation(s)
- Baris Demirkol
- Department of Chest Diseases, Basaksehir Cam and Sakura City Hospital, University of Health Sciences Turkey, Istanbul, Turkey
| | - Celal Satici
- Department of Chest Diseases, Yedikule Chest Diseases and Thoracic Surgery Education and Research Hospital, University of Health Sciences Turkey, Istanbul, Turkey
| | - Ramazan Eren
- Department of Chest Diseases, Yedikule Chest Diseases and Thoracic Surgery Education and Research Hospital, University of Health Sciences Turkey, Istanbul, Turkey
| | - Efsun Gonca Ugur Chousein
- Department of Chest Diseases, Yedikule Chest Diseases and Thoracic Surgery Education and Research Hospital, University of Health Sciences Turkey, Istanbul, Turkey
| | - Naci Senkal
- Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Demet Turan
- Department of Chest Diseases, Yedikule Chest Diseases and Thoracic Surgery Education and Research Hospital, University of Health Sciences Turkey, Istanbul, Turkey
| | - Halide Nur Urer
- Department of Pathology, Haseki Education and Research Hospital, University of Health Sciences Turkey, Istanbul, Turkey
| | - Erdogan Cetinkaya
- Department of Chest Diseases, Yedikule Chest Diseases and Thoracic Surgery Education and Research Hospital, University of Health Sciences Turkey, Istanbul, Turkey
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Gaffney B, Murphy DJ. Approach to Pulmonary Nodules in Connective Tissue Disease. Semin Respir Crit Care Med 2024; 45:316-328. [PMID: 38547916 DOI: 10.1055/s-0044-1782656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/24/2024]
Abstract
The assessment of pulmonary nodules is a common and often challenging clinical scenario. This evaluation becomes even more complex in patients with connective tissue diseases (CTDs), as a range of disease-related factors must also be taken into account. These diseases are characterized by immune-mediated chronic inflammation, leading to tissue damage, collagen deposition, and subsequent organ dysfunction. A thorough examination of nodule features in these patients is required, incorporating anatomic and functional information, along with patient demographics, clinical factors, and disease-specific knowledge. This integrated approach is vital for effective risk stratification and precise diagnosis. This review article addresses specific CTD-related factors that should be taken into account when evaluating pulmonary nodules in this patient group.
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Affiliation(s)
- Brian Gaffney
- Department of Radiology, St Vincent's University Hospital, Dublin, Ireland
| | - David J Murphy
- Department of Radiology, St Vincent's University Hospital, Dublin, Ireland
- School of Medicine, University College, Dublin, Ireland
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5
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Ko Y, Tobino K, Hiramatsu Y, Sueyasu T, Nishizawa S, Yoshimatsu Y. Nodular pulmonary amyloidosis diagnosed by ultrasound-guided percutaneous needle biopsy. Respir Med Case Rep 2024; 50:102025. [PMID: 38745726 PMCID: PMC11091706 DOI: 10.1016/j.rmcr.2024.102025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 04/05/2024] [Accepted: 04/26/2024] [Indexed: 05/16/2024] Open
Abstract
Pulmonary amyloidosis is characterized by extracellular deposition of fibrous protein called amyloid in the lungs and has three subtypes: nodular, diffuse, and tracheobronchial amyloidosis. Pulmonary nodular amyloidosis can mimic other lung diseases including infectious diseases, metastatic lung tumors, sarcoidosis, and pulmonary hyalinizing granuloma. A biopsy of the lesion is essential for a definitive diagnosis. Herein, we report the case of a 66-year-old man who presented for shortness of breath on exertion and was diagnosed with nodular pulmonary amyloidosis on ultrasound-guided percutaneous needle biopsy. A chest X-ray and computed tomography (CT) revealed bilateral slowly growing multiple calcified pulmonary nodules and cavities. Malignancy was suspected based on 18F-fluoro-deoxyglucose (18F-FDG) positron emission tomography/CT (PET/CT) images. An ultrasound-guided percutaneous needle biopsy was performed, and histopathologic examination of the lesion confirmed nodular pulmonary amyloidosis. This case highlights the importance of considering nodular pulmonary amyloidosis in the differential diagnosis of pulmonary nodules with increased uptake of 18F-FDG on PET/CT and the utility of ultrasound-guided needle biopsy in the definitive diagnosis.
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Affiliation(s)
- Yuki Ko
- Department of Respiratory Medicine, Iizuka Hospital, 3-83 Yoshiomachi, Iizuka, Fukuoka, 820-8505, Japan
- Department of Respiratory Medicine, Juntendo University, School of Medicine, 2-1-1 Hongo, Bunkyo-Ku, Tokyo, 113-8421, Japan
| | - Kazunori Tobino
- Department of Respiratory Medicine, Iizuka Hospital, 3-83 Yoshiomachi, Iizuka, Fukuoka, 820-8505, Japan
- Department of Respiratory Medicine, Juntendo University, School of Medicine, 2-1-1 Hongo, Bunkyo-Ku, Tokyo, 113-8421, Japan
| | - Yuri Hiramatsu
- Department of Respiratory Medicine, Iizuka Hospital, 3-83 Yoshiomachi, Iizuka, Fukuoka, 820-8505, Japan
| | - Takuto Sueyasu
- Department of Respiratory Medicine, Iizuka Hospital, 3-83 Yoshiomachi, Iizuka, Fukuoka, 820-8505, Japan
- Department of Respiratory Medicine, Juntendo University, School of Medicine, 2-1-1 Hongo, Bunkyo-Ku, Tokyo, 113-8421, Japan
| | - Saori Nishizawa
- Department of Respiratory Medicine, Iizuka Hospital, 3-83 Yoshiomachi, Iizuka, Fukuoka, 820-8505, Japan
| | - Yuki Yoshimatsu
- Department of Respiratory Medicine, Iizuka Hospital, 3-83 Yoshiomachi, Iizuka, Fukuoka, 820-8505, Japan
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6
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Riehani A, Soubani AO. The spectrum of pulmonary amyloidosis. Respir Med 2023; 218:107407. [PMID: 37696313 DOI: 10.1016/j.rmed.2023.107407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 08/21/2023] [Accepted: 09/08/2023] [Indexed: 09/13/2023]
Abstract
Amyloidosis is a disease caused by misfolded proteins that deposit in the extracellular matrix as fibrils, resulting in the dysfunction of the involved organ. The lung is a common target of Amyloidosis, but pulmonary amyloidosis is uncommonly diagnosed since it is rarely symptomatic. Diagnosis of pulmonary amyloidosis is usually made in the setting of systemic amyloidosis, however in cases of localized pulmonary disease, surgical or transbronchial tissue biopsy might be indicated. Pulmonary amyloidosis can be present in a variety of discrete entities. Diffuse Alveolar septal amyloidosis is the most common type and is usually associated with systemic AL amyloidosis. Depending on the degree of the interstitial involvement, it may affect alveolar gas exchange and cause respiratory symptoms. Localized pulmonary Amyloidosis can present as Nodular, Cystic or Tracheobronchial Amyloidosis which may cause symptoms of airway obstruction and large airway stenosis. Pleural effusions, mediastinal lymphadenopathy and pulmonary hypertension has also been reported. Treatment of all types of pulmonary amyloidosis depends on the type of precursor protein, organ involvement and distribution of the disease. Most of the cases are asymptomatic and require only close monitoring. Diffuse alveolar septal amyloidosis treatment follows the treatment of underlying systemic amyloidosis. Tracheobronchial amyloidosis is usually treated with bronchoscopic interventions including debulking and stenting or with external beam radiation. Long-term prognosis of pulmonary amyloidosis usually depends on the type of lung involvement and other organ function.
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Affiliation(s)
- Anas Riehani
- Division of Pulmonary, Critical Care and Sleep Medicine, Wayne State University School of Medicine, Detroit, MI, USA
| | - Ayman O Soubani
- Division of Pulmonary, Critical Care and Sleep Medicine, Wayne State University School of Medicine, Detroit, MI, USA.
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7
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Cavallasca JA, Guidi J, Monzón J, Garcilazo EN. Hypermetabolic pulmonary nodule in a patient with Sjögren's syndrome. Int J Rheum Dis 2023; 26:1630-1632. [PMID: 36880654 DOI: 10.1111/1756-185x.14655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 01/18/2023] [Accepted: 02/23/2023] [Indexed: 03/08/2023]
Affiliation(s)
| | - Jorge Guidi
- Section of Pulmonary Medicine, Hospital Gumersindo Sayago, Santa Fe, Argentina
| | - Juan Monzón
- Section of Thoracic Surgery, Hospital JB Iturraspe, Santa Fe, Argentina
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8
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Lee ME, Wong VCK, Bui C, Mansberg R. FDG avid pulmonary amyloid nodule in a patient with metastatic renal cell cancer on 18F-FDG PET/CT. Radiol Case Rep 2021; 17:439-441. [PMID: 34917224 PMCID: PMC8666447 DOI: 10.1016/j.radcr.2021.11.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 11/12/2021] [Indexed: 11/12/2022] Open
Abstract
A 60-year-old man with a background of resected clear cell renal cancer and resected colorectal adenocarcinoma presented with a pulmonary mass lesion in the left upper lobe which was avid on 18-F FDG PET/CT. Needle biopsy confirmed metastatic renal cell cancer, which was surgically excised with wedge resection. Follow-up imaging 6 months later demonstrated a second slowly enlarging subcentimeter nodule in the contralateral lung with increasing FDG avidity, suspicious of further small volume oligometastatic disease. Following surgical resection of the second pulmonary lesion, histopathological examination demonstrated nodular pulmonary amyloidosis and no evidence of malignancy.
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Affiliation(s)
- Marco Enoch Lee
- Department of Nuclear Medicine and PET, Nepean Hospital, Derby St, Kingswood, NSW, 2747.,Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia, 2052
| | - Veronica Chi Ken Wong
- Department of Nuclear Medicine and PET, Nepean Hospital, Derby St, Kingswood, NSW, 2747.,Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia, 2006
| | - Chuong Bui
- Department of Nuclear Medicine and PET, Nepean Hospital, Derby St, Kingswood, NSW, 2747.,Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia, 2006
| | - Robert Mansberg
- Department of Nuclear Medicine and PET, Nepean Hospital, Derby St, Kingswood, NSW, 2747.,Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia, 2006
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Avdeev SN, Merzhoeva ZM, Samsonova MV, Makarova MA, Cherniaev AL. A 61-Year-Old Woman With Insidious Dyspnea and Diffuse Cystic Lung Disease. Chest 2021; 160:e199-e203. [PMID: 34366045 DOI: 10.1016/j.chest.2021.02.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 02/03/2021] [Accepted: 02/22/2021] [Indexed: 11/18/2022] Open
Abstract
A 61-year-old woman, an ex-smoker with a 10 pack year smoking history, was referred to our clinic for the evaluation of insidious dyspnea and diffuse, bilateral infiltrates on a chest radiograph. She reported that she had been experiencing dyspnea on exertion and dry cough for the past 1.5 years. She denied fevers, chills, hemoptysis, or weight loss. Aside from a smoking history, there were no comorbidities or environmental exposures. She had no family history of lung diseases or other disorders. She worked as a school teacher and had no occupational exposures. There were no pets in the home and no prior occupational exposures.
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Affiliation(s)
- Sergey N Avdeev
- Department of Pulmonology, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia; Pulmonology Scientific Research Institute, Federal Medical and Biological Agency of Russian Federation, Moscow, Russia.
| | - Zamira M Merzhoeva
- Department of Pulmonology, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Maria V Samsonova
- Pulmonology Scientific Research Institute, Federal Medical and Biological Agency of Russian Federation, Moscow, Russia
| | - Marina A Makarova
- Pulmonology Scientific Research Institute, Federal Medical and Biological Agency of Russian Federation, Moscow, Russia
| | - Andrey L Cherniaev
- Pulmonology Scientific Research Institute, Federal Medical and Biological Agency of Russian Federation, Moscow, Russia
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10
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Lin XY, Pan D, Sang LX, Chang B. Primary localized gastric amyloidosis: A scoping review of the literature from clinical presentations to prognosis. World J Gastroenterol 2021; 27:1132-1148. [PMID: 33828390 PMCID: PMC8006099 DOI: 10.3748/wjg.v27.i12.1132] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 01/10/2021] [Accepted: 02/24/2021] [Indexed: 02/06/2023] Open
Abstract
Localized gastric amyloidosis (LGA) is a rare disease characterized by abnormal extracellular deposition of amyloid protein restricted to the stomach and it is confirmed by positive results of Congo red staining. Over decades, only a few cases have been reported and studies or research focusing on it are few. Although LGA has a low incidence, patients may suffer a lot from it and require proper diagnosis and management. However, the pathology of LGA remains unknown and no overall review of LGA from its presentations to its prognosis has been published. Patients with LGA are often asymptomatic or manifest atypical symptoms, making it difficult to differentiate from other gastrointestinal diseases. Here, we report the case of a 70-year-old woman with LGA and provide an overview of case reports of LGA available to us. Based on that, we conclude current concepts of clinical manifestations, diagnosis, treatment, and prognosis of LGA, aiming at providing a detailed diagnostic procedure for clinicians and promoting the guidelines of LGA. In addition, a few advanced technologies applied in amyloidosis are also discussed in this review, aiming at providing clinicians with a reference of diagnostic process. With this review, we hope to raise awareness of LGA among the public and clinicians.
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Affiliation(s)
- Xin-Yu Lin
- Department of Neurology, The First Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
| | - Dan Pan
- Department of Geriatrics, The First Affiliated Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
| | - Li-Xuan Sang
- Department of Geriatrics, The First Affiliated Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
| | - Bing Chang
- Department of Gastroenterology, The First Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
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12
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Casal Moura M, Navin PJ, Johnson GB, Hartman TE, Baqir M, Yi ES, Ryu JH. Pulmonary nodules in patients with primary Sjögren's syndrome: Causes, clinico-radiologic features, and outcomes. Respir Med 2020; 174:106200. [PMID: 33147563 DOI: 10.1016/j.rmed.2020.106200] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 10/19/2020] [Accepted: 10/19/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Primary Sjögren's Syndrome (pSS) is characterized by an immune-mediated lymphoplasmacytic infiltration of the salivary and lacrimal glands. Pulmonary nodules are not uncommonly encountered in these patients. METHODS We conducted a retrospective computer-assisted search for patients with pSS who were encountered at our institution between 1999 and 2018 and had histologically characterized pulmonary nodule(s)/mass (es) (PNs). RESULTS Of 41 patients with pSS and PNs, median age was 67 years (IQR, 56-74), 94% were women, and 39% had a smoking history. The PNs proved to be non-Hodgkin lymphoma (NHL) in 16 patients (39%), lung carcinoma in 11 patients (27%), other malignancies in 2 patients (5%), and benign diseases in remaining 12 patients (29%), including 7 with amyloidomas. Patients with NHL were younger (p = 0.006) while smoking exposure was more prevalent in patients with lung carcinoma (p = 0.022). Patients with NHL had a higher number of PNs and more often manifested random distribution, cysts, ground-glass changes and consolidations. Upper and/or mid-lung location, spiculated borders, solitary nodule, increasing size, and higher SUVmean on FDG-PET scan were associated with lung carcinoma. At the end of follow-up (median 5.9 years), 8 patients (20%) had died and included 5 patients with lung carcinoma; no deaths were observed in the NHL group. CONCLUSIONS The majority of biopsied PNs in patients with pSS were malignant, most commonly lymphomas. Smoking exposure, solitary nodule, and high FDG avidity were more frequently associated with lung carcinoma. The clinical context, CT and 18FDG-PET are complementary in the evaluation and management of PNs in patients with pSS.
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Affiliation(s)
- M Casal Moura
- Division of Pulmonary and Critical Care, Department of Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Patrick J Navin
- Division of Nuclear Medicine, Department of Radiology, and Department of Immunology Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Geoffrey B Johnson
- Division of Nuclear Medicine, Department of Radiology, and Department of Immunology Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Thomas E Hartman
- Department of Radiology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Misbah Baqir
- Division of Pulmonary and Critical Care, Department of Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Eunhee S Yi
- Dvision of Anatomic Pathology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Jay H Ryu
- Division of Pulmonary and Critical Care, Department of Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN, USA.
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Mangla L, Vadala R, Kadli SK, Prajapat D, Talwar D. Tracheobronchial amyloidosis: an uncommon disease with a common presentation. Respirol Case Rep 2020; 8:e00630. [PMID: 32765884 PMCID: PMC7396321 DOI: 10.1002/rcr2.630] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 06/19/2020] [Accepted: 07/05/2020] [Indexed: 11/06/2022] Open
Abstract
Amyloidosis is an uncommon heterogeneous and multi-systemic disease characterized by extracellular amyloid deposition. The size of proteins varies and forms a part of local disease or systemic process. Light chain amyloidosis (AL) is the most prevalent form of systemic amyloidosis which may also be seen in localized disease. Isolated tracheobronchial amyloidosis (TBA) is rather unusual with local amyloid deposition which may pose a diagnostic dilemma with subsequent therapeutic challenge. Awareness of such a presentation is crucial in the diagnosis of this rare disease. We describe three cases who presented with haemoptysis, which on further evaluation were diagnosed as isolated TBA, and a review of literature.
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Affiliation(s)
- Loveleen Mangla
- Metro Centre for Respiratory Diseases (MCRD)Metro Multispeciality HospitalNoidaIndia
| | - Rohit Vadala
- Metro Centre for Respiratory Diseases (MCRD)Metro Multispeciality HospitalNoidaIndia
| | - Shirish Kumar Kadli
- Metro Centre for Respiratory Diseases (MCRD)Metro Multispeciality HospitalNoidaIndia
| | - Deepak Prajapat
- Metro Centre for Respiratory Diseases (MCRD)Metro Multispeciality HospitalNoidaIndia
| | - Deepak Talwar
- Metro Centre for Respiratory Diseases (MCRD)Metro Multispeciality HospitalNoidaIndia
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14
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Khor YM, Cuddy S, Falk RH, Dorbala S. Multimodality Imaging in the Evaluation and Management of Cardiac Amyloidosis. Semin Nucl Med 2020; 50:295-310. [PMID: 32540027 PMCID: PMC9440475 DOI: 10.1053/j.semnuclmed.2020.01.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Systemic amyloidosis is a heterogeneous group of disorders where misfolded proteins deposit in the various organs as nonbranching fibrils with a β-pleated-sheet structure called amyloid. Extensive extracellular deposition of these amyloid fibrils eventually leads to organ dysfunction. Involvement of the heart, termed as cardiac amyloidosis, leads to heart failure if left untreated and carries high morbidity and mortality. Current interest in cardiac amyloidosis is growing rapidly thanks to the recent development of effective targeted treatment options, driving the need for better and earlier detection of the condition, which is largely underdiagnosed and far commoner than recognized. Timely diagnosis of cardiac amyloidosis is challenging, but is poised to improve with emergence of newer noninvasive imaging techniques, potentially obviating the need for endomyocardial biopsy in some patients and providing prognostic information. With recent advances in the therapeutic options for cardiac amyloidosis, an area of immense interest is the adoption of imaging as biomarkers for longitudinal assessment of disease progression and treatment response. In this article, we provide an overview of cardiac amyloidosis, discuss the role of imaging modalities in cardiac amyloidosis, and explore future directions for imaging in cardiac amyloidosis.
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Affiliation(s)
- Yiu Ming Khor
- Department of Nuclear Medicine and Molecular Imaging, Singapore General Hospital, Singapore, Singapore
| | - Sarah Cuddy
- CV imaging program, Cardiovascular Division, Brigham and Women's Hospital, Boston, MA
| | - Rodney H Falk
- Cardiac Amyloidosis Program, Division of Cardiology, Department of Medicine, Brigham and Women's Hospital, Boston, MA
| | - Sharmila Dorbala
- Cardiac Amyloidosis Program, Division of Cardiology, Department of Medicine, Brigham and Women's Hospital, Boston, MA; Cardiac Amyloidosis Program, Division of Cardiology, Department of Medicine, Brigham and Women's Hospital, Boston, MA; Division of Nuclear Medicine, Department of Radiology, Brigham and Women's Hospital, Boston, MA.
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15
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Khor YM, Cuddy S, Harms HJ, Kijewski MF, Park MA, Robertson M, Hyun H, Di Carli MF, Bianchi G, Landau H, Yee A, Sanchorawala V, Ruberg FL, Liao R, Berk J, Falk RH, Dorbala S. Quantitative [ 18F]florbetapir PET/CT may identify lung involvement in patients with systemic AL amyloidosis. Eur J Nucl Med Mol Imaging 2020; 47:1998-2009. [PMID: 31807884 PMCID: PMC8202062 DOI: 10.1007/s00259-019-04627-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 11/18/2019] [Indexed: 12/28/2022]
Abstract
PURPOSE The clinical diagnosis of pulmonary involvement in individuals with systemic AL amyloidosis remains challenging. [18F]florbetapir imaging has previously identified AL amyloid deposits in the heart and extra-cardiac organs. The aim of this study is to determine quantitative [18F]florbetapir pulmonary kinetics to identify pulmonary involvement in individuals with systemic AL amyloidosis. METHODS We prospectively enrolled 58 subjects with biopsy-proven AL amyloidosis and 9 control subjects (5 without amyloidosis and 4 with ATTR cardiac amyloidosis). Pulmonary [18F]florbetapir uptake was evaluated visually and quantified as distribution volume of specific binding (Vs) derived from compartmental analysis and simpler semiquantitative metrics of maximum standardized uptake values (SUVmax), retention index (RI), and target-to-blood ratio (TBR). RESULTS On visual analysis, pulmonary tracer uptake was absent in most AL subjects (40/58, 69%); 12% (7/58) of AL subjects demonstrated intense bilateral homogeneous tracer uptake. In this group, compared to the control group, Vs (median Vs 30-fold higher, 9.79 vs. 0.26, p < 0.001), TBR (median TBR 12.0 vs. 1.71, p < 0.001), and RI (median RI 0.310 vs. 0.033, p < 0.001) were substantially higher. Notably, the AL group without visually apparent pulmonary [18F]florbetapir uptake also demonstrated a > 3-fold higher Vs compared to the control group (median 0.99 vs. 0.26, p < 0.001). Vs was independently related to left ventricular SUVmax, a marker of cardiac AL deposition, but not to ejection fraction, a marker of cardiac dysfunction. Also, intense [18F]florbetapir lung uptake was not related to [11C]acetate lung uptake, suggesting that intense [18F]florbetapir lung uptake represents AL amyloidosis rather than heart failure. CONCLUSIONS [18F]florbetapir PET/CT offers the potential to noninvasively identify pulmonary AL amyloidosis, and its clinical relevance warrants further study.
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Affiliation(s)
- Yiu Ming Khor
- Division of Nuclear Medicine, Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA
| | - Sarah Cuddy
- Cardiac Amyloidosis Program, Division of Cardiology, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Hendrik J Harms
- Division of Nuclear Medicine, Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA
| | - Marie F Kijewski
- Division of Nuclear Medicine, Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA
| | - Mi-Ae Park
- Division of Nuclear Medicine, Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA
| | - Matthew Robertson
- Division of Nuclear Medicine, Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA
| | - Hyewon Hyun
- Division of Nuclear Medicine, Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA
| | - Marcelo F Di Carli
- Division of Nuclear Medicine, Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA
| | - Giada Bianchi
- Division of Medical Oncology, Dana Farber Cancer Institute, Boston, MA, USA
| | - Heather Landau
- Division of Medical Oncology, Memorial Sloan Kettering Medical Center, New York, NY, USA
| | - Andrew Yee
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | | | - Frederick L Ruberg
- Amyloidosis Center, Boston University School of Medicine, Boston, MA, USA
| | - Ronglih Liao
- Stanford University Cardiovascular Institute and Cardiovascular Medicine, Stanford Amyloid Center, Stanford, CA, USA
| | - John Berk
- Amyloidosis Center, Boston University School of Medicine, Boston, MA, USA
| | - Rodney H Falk
- Cardiac Amyloidosis Program, Division of Cardiology, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Sharmila Dorbala
- Division of Nuclear Medicine, Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA.
- Cardiac Amyloidosis Program, Division of Cardiology, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.
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Baqir M, Moua T, White D, Yi ES, Ryu JH. Pulmonary nodular and cystic light chain deposition disease: A retrospective review of 10 cases. Respir Med 2020; 164:105896. [PMID: 32217287 DOI: 10.1016/j.rmed.2020.105896] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 02/03/2020] [Accepted: 02/05/2020] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Light chain deposition disease (LCDD) rarely involves the lungs. We report clinical and radiologic findings of pulmonary LCDD. METHODS We retrospectively identified patients with biopsy-proven pulmonary LCDD seen at Mayo Clinic (Rochester, Minnesota) from January 1997 through December 2018. Demographic, clinical, and imaging features were analyzed. RESULTS We identified 10 patients with pulmonary LCDD (median age at diagnosis, 55 years; range, 39-77 years). Eight patients were women and 7 were never-smokers. Dyspnea (n = 3) and chest pain (n = 3) were the most common respiratory symptoms. Associated conditions included Sjögren syndrome (n = 6), sarcoidosis (n = 1), and limited scleroderma (n = 1). Eight patients had mucosa-associated lymphoid tissue (MALT) lymphoma. Among the 9 patients with chest computed tomography (CT) images, 8 (89%) had cysts. Cysts were predominantly distributed in the lower lung and were round or oval. All patients had multiple cysts (5 patients had 1-5 cysts, 3 had >20 cysts). The median diameter of the largest cyst was 18 mm (range, 5-68 mm). All 9 patients had solid nodules (3 had >10 nodules). Five patients had subsolid nodules. The median diameter of the largest solid nodules was 13 mm (range, 6-26 mm). Positron emission tomography-CT images were available for 8 patients. The median maximum standardized uptake value of the most avid pulmonary nodule was 2.2 (range, 1.9-6.0). Two patients died during a median follow-up of 2.3 years (range, 0.5-9.9 years). CONCLUSIONS Pulmonary LCDD is characterized by cysts and nodules. The disease is associated with MALT lymphoma, especially in the setting of Sjögren syndrome.
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Affiliation(s)
- Misbah Baqir
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA.
| | - Teng Moua
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
| | - Darin White
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Eunhee S Yi
- Division of Anatomic Pathology, Mayo Clinic, Rochester, MN, USA
| | - Jay H Ryu
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
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Lee J, Kim K, Choi JO, Kim SJ, Jeon ES, Choi JY. 99mTc-DPD scintigraphy and SPECT/CT in patients with AL and ATTR type amyloidosis: Potential clinical implications. Medicine (Baltimore) 2020; 99:e18905. [PMID: 31977903 PMCID: PMC7004596 DOI: 10.1097/md.0000000000018905] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Although pathological confirmation is the gold standard for diagnosis of amyloidosis, there is a need for a relevant imaging modality to identify involved organs and evaluate disease extent. Thus, we prospectively investigated imaging findings of Tc-DPD scintigraphy in AL and ATTR amyloidosis.A total of 21 subjects with pathologically confirmed AL or ATTR amyloidosis were included. Pretreatment whole body Tc-DPD planar scanning and regional SPECT/CT were performed in all subjects. For allegedly involved organs, Tc-DPD uptake was visually and semi-quantitatively evaluated on a 4-point scale (grade 0: no uptake, 1: uptake less than spine, 2: uptake similar to spine, and 3: uptake greater than spine).There were 29 organs involved in AL and 12 in ATTR. Significant Tc-DPD uptake was found in 24 organs (sensitivity = 82.8%) in AL and 9 organs (sensitivity = 75.0%) in ATTR. Additional SPECT/CT was helpful to ensure abnormal DPD uptake in the involved organs, which was uncertain by attenuation in planar imaging. Degree of Tc-DPD uptake was significantly higher in ATTR compared with AL amyloidosis (P = .017). Diffuse soft tissue uptake with photon defects in the liver area was found only in ATTR amyloidosis.This study showed that Tc-DPD scintigraphy might have capacity to differentiate between AL and ATTR subtypes with good sensitivity in various organs involving primary systemic AL and ATTR amyloidosis. Additional SPECT/CT significantly improved the diagnostic efficacy of Tc-DPD scintigraphy.
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Affiliation(s)
| | - Kihyun Kim
- Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jin-Oh Choi
- Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Seok Jin Kim
- Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Eun-Seok Jeon
- Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Core JM, Alsaad AA, Jiang L, Patel NM. Nodular pulmonary amyloidosis: a complex disease with malignancy association. BMJ Case Rep 2017; 2017:bcr-2017-220428. [PMID: 29038189 DOI: 10.1136/bcr-2017-220428] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Pulmonary amyloidosis is a rare disease that incorporates deposition of amyloid microfibril material in the lung parenchyma. The condition generally presents as an indolent subacute-to-chronic pulmonary disease and requires tissue biopsy to establish the diagnosis. Nodular pulmonary amyloidosis, a subtype of pulmonary amyloidosis, is characterised by special radiographic and pathological features. While the disease can be associated with inflammatory conditions; its association with mucosal-associated lymphoid tissue (MALT lymphoma) is unusual and carries management challenges. Herein, we illustrate a case study of nodular pulmonary amyloidosis associated with underlying MALT lymphoma in a patient with known systemic lupus erythematosus. The aim of this article is to share the management experience of this complex condition with the medical community and to conduct an up-to-date literature review on nodular pulmonary amyloidosis.
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Affiliation(s)
- Jacob M Core
- Internal Medicine, Mayo Clinic Hospital Jacksonville, Jacksonville, Florida, USA
| | - Ali A Alsaad
- Internal Medicine, Mayo Clinic Florida, Jacksonville, Florida, USA
| | - Liuyan Jiang
- Pathology and Laboratory Medicine, Mayo Clinic Florida, Jacksonville, Florida, USA
| | - Neal M Patel
- Pulmonary and Critical Care, Mayo Clinic Florida, Jacksonville, Florida, USA
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Narechania S, Valent J, Farver C, Tonelli AR. A 70-Year-Old Man With Large Cervical and Mediastinal Lymphadenopathies. Chest 2015; 148:e8-e13. [PMID: 26149568 DOI: 10.1378/chest.14-3124] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
We present a case of a 70-year-old man with enlarged mediastinal and cervical lymph nodes that provided interesting radiologic and pathologic observations. The 70-year-old black man was found to have enlarged mediastinal lymph nodes. He had symptoms of atypical chest pain and generalized weakness for 2 weeks prior to the diagnosis. He denied shortness of breath, fever, chills, or night sweats. He was treated for hypertension and onychomycosis. Basic laboratory findings were within normal limits. Pulmonary function tests at the time of presentation showed FEV1, FVC, and FEV1/FVC ratio of 123% predicted, 133% predicted, and 0.7, respectively. Meanwhile, total lung capacity and carbon monoxide diffusing capacity were 103% and 107% predicted, respectively. Two weeks before he presented to our institution, the patient underwent bronchoscopy with transbronchial biopsies of the right lower lobe and endobronchial ultrasound-guided transbronchial needle aspiration of the right hilar lymph nodes.
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Affiliation(s)
| | - Jason Valent
- Department of Hematology and Oncology, Cleveland Clinic, Cleveland, OH
| | - Carol Farver
- Department of Anatomic Pathology, Cleveland Clinic, Cleveland, OH
| | - Adriano R Tonelli
- Department of Pulmonary, Allergy and Critical Care Medicine, Cleveland Clinic, Cleveland, OH; Respiratory Institute, Cleveland Clinic, Cleveland, OH.
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20
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Imaging Findings and Literature Review of (18)F-FDG PET/CT in Primary Systemic AL Amyloidosis. Nucl Med Mol Imaging 2015; 49:182-90. [PMID: 26279691 DOI: 10.1007/s13139-015-0338-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Revised: 04/09/2015] [Accepted: 04/12/2015] [Indexed: 12/22/2022] Open
Abstract
PURPOSE Although several case reports and case series have described (18)F-FDG PET/CT in amyloidosis, the value of (18)F-FDG PET/CT for diagnosing amyloidosis has not been clarified. We investigated the imaging findings of (18)F-FDG PET/CT in patients with primary systemic AL amyloidosis. METHODS Subjects were 15 patients (M:F = 12:3; age, 61.5 ± 7.4 years) with histologically confirmed primary systemic AL amyloidosis who underwent pretreatment (18)F-FDG PET/CT to rule out the possibility of malignancy or for initial workup of alleged cancer. For involved organs, visual and semiquantitative analyses were performed on (18)F-FDG PET/CT images. In total, 22 organs (10 hearts, 5 kidneys, 2 stomachs, 2 colons, 1 ileum, 1 pancreas, and 1 liver) were histologically confirmed to have primary systemic AL amyloidosis. RESULTS F-FDG uptake was significantly increased in 15 of the 22 organs (68.2 %; 10 hearts, 2 kidneys, 1 colon, 1 ileum, and 1 liver; SUVmax = 7.0 ± 3.2, range 2.1-14.1). However, in 11 of 15 PET-positive organs (78.6 %; 10 hearts and the ileum), it was difficult to differentiate pathological uptake from physiological uptake. Definitely abnormal (18)F-FDG uptake was found in only 4 of the 22 organs (18.2 %; 2 kidneys, 1 colon, and the liver). (18)F-FDG uptake was negative for pancreas and gastric lesions. CONCLUSIONS Although (18)F-FDG PET/CT showed high uptake in two-thirds of the organs involving primary systemic AL amyloidosis, its sensitivity appeared to be low to make differentiation of pathological uptake from physiological uptake. However, due to the small number of cases, further study for the role of (18)F-FDG PET/CT in amyloidosis will be warranted.
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21
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Quan XQ, Yin TJ, Zhang CT, Liu J, Qiao LF, Ke CS. (18)F-FDG PET/CT in Patients with Nodular Pulmonary Amyloidosis: Case Report and Literature Review. Case Rep Oncol 2014; 7:789-98. [PMID: 25566054 PMCID: PMC4280457 DOI: 10.1159/000369112] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
A 62-year-old woman was found to have multiple bilateral pulmonary nodules showing different 18F-fluorodeoxyglucose (FDG) uptakes on positron-emission tomography/computed tomography (PET/CT). Only the largest nodule in the left lower lobe showed an increased 18F-FDG uptake on PET/CT. Three nodules were surgically resected from different lobes of the left lung. Two lobes were benign and showed amyloid deposition. The largest nodule in the left lower lobe showed adenocarcinoma and a heavy amyloid deposition. Pulmonary amyloidosis should be added to the differential diagnosis for cases with multiple pulmonary nodules that show different 18F-FDG uptakes on PET/CT. To the best of our knowledge, this is the second reported case of a lung nodule consisting of adenocarcinoma and amyloid deposition.
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Affiliation(s)
- Xiao-Qing Quan
- Department of Geriatrics, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Tie-Jun Yin
- Department of Geriatrics, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Cun-Tai Zhang
- Department of Geriatrics, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jian Liu
- Department of Geriatrics, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Li-Fen Qiao
- Department of Geriatrics, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chang-Shu Ke
- Department of Pathology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Kashino G, Hayashi K, Douhara K, Kobashigawa S, Mori H. Comparison of the biological effects of (18)F at different intracellular levels. Biochem Biophys Res Commun 2014; 454:7-11. [PMID: 25301551 DOI: 10.1016/j.bbrc.2014.09.136] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Accepted: 09/30/2014] [Indexed: 12/27/2022]
Abstract
We herein examined the biological effects of cells treated with (18)F labeled drugs for positron emission tomography (PET). The relationship between the intracellular distribution of (18)F and levels of damaged DNA has yet to be clarified in detail. We used culture cells (Chinese Hamster Ovary cells) treated with two types of (18)F labeled drugs, fluorodeoxyglucose (FDG) and fluorine ion (HF). FDG efficiently accumulated in cells, whereas HF did not. To examine the induction of DNA double strand breaks (DSB), we measured the number of foci for 53BP1 that formed at the site of DNA DSB. The results revealed that although radioactivity levels were the same, the induction of 53BP1 foci was stronger in cells treated with (18)F-FDG than in those treated with (18)F-HF. The clonogenic survival of cells was significantly lower with (18)F-FDG than with (18)F-HF. We concluded that the efficient accumulation of (18)F in cells led to stronger biological effects due to more severe cellular lethality via the induction of DNA DSB.
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Affiliation(s)
- Genro Kashino
- Advanced Molecular Imaging Center, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama-machi, Yufu City, Oita 879-5593, Japan.
| | - Kazutaka Hayashi
- Advanced Molecular Imaging Center, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama-machi, Yufu City, Oita 879-5593, Japan
| | - Kazumasa Douhara
- Advanced Molecular Imaging Center, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama-machi, Yufu City, Oita 879-5593, Japan
| | - Shinko Kobashigawa
- Department of Radiology, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama-machi, Yufu City, Oita 879-5593, Japan
| | - Hiromu Mori
- Department of Radiology, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama-machi, Yufu City, Oita 879-5593, Japan
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