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Endo H, Obara N, Mizuno S, Nakamura Y. Systemic AA Amyloidosis Secondary to Metastatic Renal Cell Carcinoma in a Hemodialysis Patient with Intractable Diarrhea. Case Rep Gastroenterol 2023; 17:275-280. [PMID: 37928968 PMCID: PMC10624937 DOI: 10.1159/000531066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 05/05/2023] [Indexed: 11/07/2023] Open
Abstract
We describe an autopsied case of systemic AA amyloidosis secondary to metastatic renal cell carcinoma presenting intractable diarrhea. Severe diarrhea was the major symptom for the diagnosis of AA amyloidosis. No renal symptoms which are common in AA amyloidosis secondary to renal cell carcinoma were shown because hemodialysis following bilateral nephrectomy had already been started 9 years before. Treatment against metastatic tumors as a solution of AA amyloidosis could not be performed because of bad performance status and the patient died 5 months after the diagnosis. Autopsy findings revealed that AA amyloid deposition was seen in multi-organs including the intestine. The metastatic tumors were histologically compatible as metastasis of renal cell carcinoma. There was no other cause of chronic inflammation such as inflammatory arthritis. We concluded that chronic inflammation provoked by the metastatic tumors of renal cell carcinoma was a major cause of systemic AA amyloidosis. Intestinal AA amyloidosis with malabsorption was the cause of death. Clinicians should keep it in mind that solid organ malignancy can be a cause of AA amyloidosis and renal cell carcinoma is the most common carcinomatous cause. This case is particularly instructive in that progression of amyloidosis may be missed in hemodialysis patients with anuria and that gastrointestinal symptoms can be the primary indicators of systemic amyloidosis. Endoscopic examination including biopsy is important for the diagnosis and early treatment of amyloidosis.
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Affiliation(s)
- Hiroyuki Endo
- Department of Gastroenterology, Japan Community Health Care Organization Sendai Hospital, Sendai, Japan
| | - Noriyuki Obara
- Department of Gastroenterology, Japan Community Health Care Organization Sendai Hospital, Sendai, Japan
| | - Shinichi Mizuno
- Department of Nephrology, Japan Community Health Care Organization Sendai Hospital, Sendai, Japan
| | - Yasuhiro Nakamura
- Division of Pathology, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan
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Bharati J, Lahoud OB, Jhaveri KD, Izzedine H. AA Amyloidosis associated with cancers. Nephrol Dial Transplant 2022; 38:1366-1374. [PMID: 35867878 DOI: 10.1093/ndt/gfac217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Indexed: 11/12/2022] Open
Abstract
Systemic AA amyloidosis is associated with systemic inflammatory processes such as autoimmune disorders or chronic infections. In addition, AA amyloidosis can develop in a localized or systemic form in patients with malignant neoplastic disorders, and usually involves kidneys impacting renal function. Among solid tumors, renal cell carcinoma (RCC) appears to be responsible for one-quarter to half of all cancers associated with amyloidosis. Among other solid cancers, various clinical presentation and pathological types of lung cancer and basal cell carcinoma skin were reported with AA amyloidosis more often than isolated case reports on other cancers with AA amyloidosis. Symptoms from kidney involvement rather than from the tumor per se were the presenting manifestations in cases of RCC associated with AA amyloidosis. Among hematological malignancies, clonal B cell/plasma cell dyscrasias such as monoclonal gammopathy and lymphoma were noted to be associated with AA amyloidosis. In addition, AA amyloidosis was reported in a substantial number of cases treated with immune checkpoint inhibitors such as pembrolizumab and nivolumab. The mechanism of association of cancer and AA amyloidosis seems to be mediated by the immune response exacerbated from the tumor and its microenvironment or immune therapy. The mainstay of treatment consists of therapy directed against the underlying malignancy or careful withdrawal of the offending agent. This review will discuss this rare but highly morbid clinical condition.
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Affiliation(s)
- Joyita Bharati
- Department of Nephrology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.,Glomerular Center at Northwell Health, Division of Kidney Diseases and Hypertension, Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Great Neck, NY, USA
| | - Oscar B Lahoud
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, NY, NY, USA
| | - Kenar D Jhaveri
- Glomerular Center at Northwell Health, Division of Kidney Diseases and Hypertension, Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Great Neck, NY, USA
| | - Hassan Izzedine
- Department of Nephrology, Peupliers Private Hospital, Ramsay Générale de Santé, Paris, France
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Algarra MA, Fita MJJ, Sandiego S, Aguilar HA, Álvarez P, Quispe M, Salvador A, Egido A, Lavernia J, Machado I, Rubio-Briones J, Climent MÁ. Advanced systemic amyloidosis secondary to metastatic renal cell carcinoma. Ecancermedicalscience 2020; 14:1156. [PMID: 33574901 PMCID: PMC7864688 DOI: 10.3332/ecancer.2020.1156] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Indexed: 01/05/2023] Open
Abstract
Secondary amyloidosis is a rare complex complication related to chronic inflammatory disease. This complication is sparsely associated to malignant neoplasms. Renal cell carcinoma (RCC) is the most common solid organ malignancy related with this paraneoplastic syndrome. Some case reports have described stabilisation or even remission of amyloidosis with cytoreductive nephrectomy. Majority of those reports were based on locally advanced RCC. We report the first case of early aggressive systemic secondary amyloidosis in high-volume metastatic RCC. The subject was diagnosed with metastatic RCC within 6 months of secondary amyloidosis; on month 5 of initiation of targeted therapy (pazopanib) developed nephrotic syndrome with a heavy proteinuria (>18 g/day), severe hypoalbuminaemia (1.53 g/dL), intense and progressive oedema, severe pancolitis and mild dyspnoea with hypotension. A colon biopsy and the immunohistochemistry confirmed the histological diagnosis of a secondary amyloidosis. The multidisciplinary tumour board decided to perform cytoreductive nephrectomy in order to reduce the pro-inflammatory status. Pathology report showed a complete resection of clear cell RCC plus renal amyloid deposits. The patient died within 4 days of surgery due to multiorgan failure.
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Affiliation(s)
- Maria Asunción Algarra
- Servicio de Oncología Médica, Fundación Instituto Valenciano de Oncología (IVO), Calle Profesor Beltrán Báguena, 8, 46009, Valencia, Spain.,https://orcid.org/0000-0003-2105-8597
| | - Maria José Juan Fita
- Servicio de Oncología Médica, Fundación Instituto Valenciano de Oncología (IVO), Calle Profesor Beltrán Báguena, 8, 46009, Valencia, Spain
| | - Sergio Sandiego
- Servicio de Oncología Médica, Fundación Instituto Valenciano de Oncología (IVO), Calle Profesor Beltrán Báguena, 8, 46009, Valencia, Spain
| | - Héctor Augusto Aguilar
- Servicio de Oncología Médica, Fundación Instituto Valenciano de Oncología (IVO), Calle Profesor Beltrán Báguena, 8, 46009, Valencia, Spain
| | - Pablo Álvarez
- Servicio de Oncología Médica, Fundación Instituto Valenciano de Oncología (IVO), Calle Profesor Beltrán Báguena, 8, 46009, Valencia, Spain
| | - Mateo Quispe
- Servicio de Oncología Médica, Fundación Instituto Valenciano de Oncología (IVO), Calle Profesor Beltrán Báguena, 8, 46009, Valencia, Spain
| | - Antonio Salvador
- Servicio de Cardiología, Fundación Instituto Valenciano de Oncología (IVO), Calle Profesor Beltrán Báguena, 8, 46009, Valencia, Spain
| | - Adoración Egido
- Servicio de Medicina Interna, Fundación Instituto Valenciano de Oncología (IVO), Calle Profesor Beltrán Báguena, 8, 46009, Valencia, Spain
| | - Javier Lavernia
- Servicio de Oncología Médica, Fundación Instituto Valenciano de Oncología (IVO), Calle Profesor Beltrán Báguena, 8, 46009, Valencia, Spain
| | - Isidro Machado
- Servicio de Anatomía Patológica, Fundación Instituto Valenciano de Oncología (IVO), Calle Profesor Beltrán Báguena, 8, 46009, Valencia, Spain
| | - José Rubio-Briones
- Servicio de Urología, Fundación Instituto Valenciano de Oncología (IVO), Calle Profesor Beltrán Báguena, 8, 46009, Valencia, Spain
| | - Miguel Ángel Climent
- Servicio de Oncología Médica, Fundación Instituto Valenciano de Oncología (IVO), Calle Profesor Beltrán Báguena, 8, 46009, Valencia, Spain
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Fujisawa H, Ohashi A, Ohta J, Muraki N, Nakano Y, Sugita K, Ishihara S, Kumagai J, Fukutomi T, Nagahama K. Cervical cancer of the uterus complicated by renal AA amyloidosis. CEN Case Rep 2020; 10:115-120. [PMID: 32910374 DOI: 10.1007/s13730-020-00530-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 08/28/2020] [Indexed: 11/29/2022] Open
Abstract
Cervical cancer of the uterus rarely develops systemic secondary amyloidosis. We present the case of a 66-year-old female patient who manifested systemic amyloid A (AA) amyloidosis in the kidney, digestive tract, and cervix of the uterus, secondary to cervical cancer. She exhibited nephrotic syndrome, intractable diarrhea, and mild fever 3 months after she underwent an extended hysterectomy with postoperative cisplatin-based chemotherapy and whole pelvic irradiation. Further examinations revealed AA amyloidosis of the kidney and colon and cytomegalovirus infection in the colon. AA amyloid deposition was positive in the resected tissues of uterine cancer. The patient was diagnosed with systemic AA amyloidosis consecutive to cervical cancer. Despite a decrease in urinary protein after antiviral therapy, it increased 14 months later with neither apparent symptoms nor an increase in tumor marker. A second renal biopsy revealed AA amyloidosis of the kidney. Subsequent investigations revealed the recurrence of cervical cancer in the lung, liver, and lymph nodes. This case report indicated that AA amyloidosis would complicate cervical cancer and recur even after resection of neoplasm owing to other stimulation. Moreover, urine protein could be a marker for cancer relapse in known cases of cancer-derived AA amyloidosis.
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Affiliation(s)
- Hajime Fujisawa
- Department of Nephrology, Yokohama City Minato Red Cross Hospital, 3-12-1 Shinyamashita Nakaku, Yokohama, Kanagawa, Japan.
| | - Atsuki Ohashi
- Department of Nephrology, Yokohama City Minato Red Cross Hospital, 3-12-1 Shinyamashita Nakaku, Yokohama, Kanagawa, Japan
| | - Jun Ohta
- Department of Nephrology, Yokohama City Minato Red Cross Hospital, 3-12-1 Shinyamashita Nakaku, Yokohama, Kanagawa, Japan
| | - Naohiro Muraki
- Department of Nephrology, Yokohama City Minato Red Cross Hospital, 3-12-1 Shinyamashita Nakaku, Yokohama, Kanagawa, Japan
| | - Yuta Nakano
- Department of Nephrology, Yokohama City Minato Red Cross Hospital, 3-12-1 Shinyamashita Nakaku, Yokohama, Kanagawa, Japan
| | - Kouhei Sugita
- Department of Nephrology, Yokohama City Minato Red Cross Hospital, 3-12-1 Shinyamashita Nakaku, Yokohama, Kanagawa, Japan
| | - Saori Ishihara
- Department of Nephrology, Yokohama City Minato Red Cross Hospital, 3-12-1 Shinyamashita Nakaku, Yokohama, Kanagawa, Japan
| | - Jiro Kumagai
- Department of Pathology, Yokohama City Minato Red Cross Hospital, Yokohama, Kanagawa, Japan
| | - Toshiyuki Fukutomi
- Department of Pharmacology and Toxicology, Kyorin University School of Medicine, Mitaka, Tokyo, Japan
| | - Kiyotaka Nagahama
- Department of Pathology, Kyorin University School of Medicine, Mitaka, Tokyo, Japan
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Bessa F, Gaspar P, Antunes Meireles P, Parreira MI, Serrazina Pedro J, Teixeira da Silva M, Meneses J, Victorino R, Mota C. Malabsorption Syndrome due to Intestinal Amyloidosis as Presentation of Renal Cell Carcinoma. Case Rep Gastrointest Med 2020; 2020:8854620. [PMID: 32963846 PMCID: PMC7492959 DOI: 10.1155/2020/8854620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 08/19/2020] [Accepted: 08/20/2020] [Indexed: 11/23/2022] Open
Abstract
Renal cell carcinoma accounts for approximately 3% of adult malignancies. Designated in the literature as "the great masquerader," the great diversity of clinical manifestations is associated with the several paraneoplastic syndromes that potentially accompany it. Paraneoplastic amyloidosis is described in about 3-8% of cases, only exceptionally as an initial manifestation, with uncommon gastrointestinal involvement. A rare case of malabsorption by intestinal amyloidosis is presented as initial manifestation of renal cell carcinoma, emphasizing the need for early recognition of these paraneoplastic conditions.
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Affiliation(s)
- Filipe Bessa
- Clínica Universitária de Medicina II, CHLN-Hospital de Santa Maria, Lisbon, Portugal
| | - Pedro Gaspar
- Clínica Universitária de Medicina II, CHLN-Hospital de Santa Maria, Lisbon, Portugal
| | | | - Maria Inês Parreira
- Clínica Universitária de Medicina II, CHLN-Hospital de Santa Maria, Lisbon, Portugal
| | | | | | - João Meneses
- Clínica Universitária de Medicina II, CHLN-Hospital de Santa Maria, Lisbon, Portugal
| | - Rui Victorino
- Clínica Universitária de Medicina II, CHLN-Hospital de Santa Maria, Lisbon, Portugal
| | - Catarina Mota
- Clínica Universitária de Medicina II, CHLN-Hospital de Santa Maria, Lisbon, Portugal
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Yamagata A, Uchida T, Yamada Y, Nakanishi T, Nagai K, Imakiire T, Oshima N, Kumagai H. Rapid clinical improvement of amyloid A amyloidosis following treatment with tocilizumab despite persisting amyloid deposition: a case report. BMC Nephrol 2017; 18:377. [PMID: 29287589 PMCID: PMC5747944 DOI: 10.1186/s12882-017-0799-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 12/18/2017] [Indexed: 01/11/2023] Open
Abstract
Background Amyloid A amyloidosis is one of the most common forms of amyloidosis. It is secondary to rheumatoid arthritis, which is difficult to manage and has a poor prognosis. We present a patient with rheumatoid arthritis and amyloid A amyloidosis who was treated with tocilizumab, a humanized monoclonal antibody against interleukin 6 receptor, resulting in improvement in both proteinuria and gastrointestinal symptoms; however, amyloid deposition remained. Case presentation A 67-year-old woman who had previously been treated for rheumatoid arthritis presented with abdominal pain and diarrhea. Right renal cell carcinoma was found, and amyloid A amyloidosis was diagnosed concomitantly based on colon biopsy. The renal cell carcinoma was resected, and the non-cancerous part of the renal tissue also showed amyloid A deposition. Following surgery, protein levels in the urine increased to the nephrotic range, and administration of tocilizumab was initiated, which resulted in resolution of the proteinuria. The patient’s gastrointestinal symptoms were also alleviated. However, repeat colon biopsy showed amyloid deposition. Conclusions This case of amyloid A amyloidosis suggests that amyloid deposition indicates only structural change of the affected tissue, and that it is not amyloid deposition per se that causes the clinical symptoms of amyloidosis.
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Affiliation(s)
- Akira Yamagata
- Department of Nephrology and Endocrinology, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama, 359-8513, Japan.
| | - Takahiro Uchida
- Department of Nephrology and Endocrinology, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama, 359-8513, Japan
| | - Yuji Yamada
- Department of Nephrology and Endocrinology, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama, 359-8513, Japan
| | - Takashi Nakanishi
- Department of Rheumatology, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Kazue Nagai
- Department of Nephrology and Endocrinology, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama, 359-8513, Japan
| | - Toshihiko Imakiire
- Department of Nephrology and Endocrinology, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama, 359-8513, Japan
| | - Naoki Oshima
- Department of Nephrology and Endocrinology, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama, 359-8513, Japan
| | - Hiroo Kumagai
- Department of Nephrology and Endocrinology, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama, 359-8513, Japan
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