Soft-tissue amyloidoma. A case report

Bilateral multifocal lower extremity localized soft tissue amyloidomas: case report with ultrasonographic characterization

Amyloidosis may be acquired or hereditary and consists of multiple disease processes characterized by the abnormal deposition of extracellular fibrillary protein aggregates. The presentation of amyloidosis is varied, ranging from an isolated, focal deposition to systemic disease. While systemic involvement is common, a rare entity known as amyloidoma or tumor amyloidosis may also occur. The 75-year-old female in this case presented with slowly growing multifocal bilateral lower extremity masses and was ultimately diagnosed with localized amyloidomas in the absence of chronic illness or systemic disease. This case report includes a description of the sonographic features of localized extremity amyloidoma that, to the best of our knowledge, have not yet been described in the literature. Awareness of the sonographic features, and this unique presentation of multifocal soft tissue extremity amyloidomas will allow for this rare diagnosis to be included in a limited differential diagnosis.

Calcified amyloid tumor of neck with exuberant giant cell reaction

Amyloidosis is a group of disorders characterized by an extracellular deposition of an abnormal amount of proteins in a variety of organs resulting from abnormal folding of protein. It typically presents as disseminated deposits. Tumor like localized presentation of amyloidosis in the absence of systemic amyloidosis is referred to as amyloidoma or amyloid tumor. Amyloidoma is the least common presentation of tissue amyloid deposition. Amyloidoma of soft tissue is again a very rare entity, especially in the neck region. Calcification and minimum giant cell reaction can occur in amyloidoma. However, extensive calcification and exuberant giant cell reaction in amyloidoma of soft tissue neck make it difficult to diagnose. In this report, we discuss such a rare case with its differential diagnoses.

Solitary amyloidoma related to THA

Amyloidoma of soft tissues is rare, and no previously published reports describe it in relation to hip prostheses. This article presents the case of a 78-year-old woman with a medical history of myelodysplasia and mild renal failure who underwent a right-sided metal-on-polyethylene total hip arthroplasty in 2003. She presented to the outpatient clinic with a 1-year history of right anterior thigh pain. On examination, a large proximal anteromedial lump was palpable and was nontender, nonpulsatile, and firm. She had a positive Trendelenburg test but good hip range of motion. Plain radiographs showed signs of osteolysis around the hip prosthesis. Serology showed mildly raised liver function and renal function but a normal erythrocyte sedimentation rate and white blood cell count. Magnetic resonance imaging revealed a large mixed-signal soft tissue mass directly opposing the anterior cortex of the right femur, related to the hip prosthesis, measuring 16×10×7 cm. Associated destruction of the underlying cortex existed. Histological staining of a biopsy of the mass confirmed that the mass contained AL-type amyloid seen in primary amyloidosis. Mean patient age at diagnosis for amyloid tumors of soft tissues is 66 years. By definition, they start as solitary lesions. The types are important: AA type is related to infection and AL type is a primary process. Patients with AL amyloidomas have a poorer prognosis because they have a higher chance of malignancies. Early diagnosis can prevent long-term serious consequences of this condition.

Multiple myeloma-associated iliopsoas muscular amyloidoma first presenting with bilateral femoral nerve entrapment

We report a 38-year-old man of multiple myeloma with bilateral femoral nerve entrapment caused by bilateral huge protruding masses in the inguinal areas. The masses were identified as iliopsoas muscular amyloidoma after the operation. He was diagnosed with multiple myeloma 1 year ago before he was admitted to our hospital. He complained of muscle weakness in the bilateral thigh and protruding lumps in the bilateral inguinal areas with tenderness for 6 month. The pelvic MRI revealed round masses in the iliopsoas muscles of bilateral inguinal areas. To implement the nerve decompression, the resection of the bilateral masses was done. The pathological result showed Congo red-positive substance with green birefringence to polarized light in a dense fibrous background. Before the operation, six cycles of chemotherapy with VAD (vincristine, adriamycin, dexamethasone) and two cycles of chemotherapy with PAD (bortezomib, adriamycin, dexamethasone) regimen were performed. One month after the operations, one cycle of chemotherapy with PADT (bortezomib, adriamycin, dexamethasone, thalidomide) regimen was used and the patient reached complete remission. The function of the bilateral femoral nerves restored to normal 7 months after the operation with a Karnofsky score of 100. Twenty-two months follow-up showed that there was no evidence of the recurrence of the iliopsoas muscular amyloidoma and no progression of multiple myeloma.

Primary amyloidoma of chest wall--a rare condition

Organ specific amyloidosis has been shown to be confined to various organs like liver, lung, spleen, urinary bladder and gastro-intestinal tract, but amyloidoma or tumoural amyloidosis of chest wall with no evidence of systemic amyloidosis is an extremely rare presentation and only two cases have been reported till now. The authors report a case of chest wall amyloidoma with review of literature.

Gastric amyloidoma in patient after remission of Non-Hodgkin’s Lymphoma

Amyloidosis is commonly systemic, occasionally organ-limited, and rarely a solitary localized mass. The latter, commonly referred to as tumoral amyloidosis, is described as occurring in nearly every organ/tissue. Only a few reports of gastric amyloidosis exist today. We describe a 72 year-old black male from Barbados presenting with 3 d of diffuse abdominal pain. His medical history included Non-Hodgkin’s Lymphoma diagnosed five years ago, status-post six rounds of cyclophosphamide, adriamycin, vincristine, prednisone chemotherapy, and currently was in remission. On computed tomography scan of the abdomen, thickening and calcification of the gastric wall was noted along with pneumatosis. On esophagogastroduodenoscopy, a large circumferential friable mass was seen from the gastroesophageal junction to the body. A large non-bleeding 3 cm polyp was also seen in post bulbar area of duodenum. Biopsies were stained with Congo red and gave green birefringence under polarized light, consistent with tumoral amyloidosis. Positron emission tomography scan revealed diffuse gastric mucosa uptake compatible with gastric malignancy without metastatic foci. Treatment for gastric amyloidomas has presently been one of observation or, at most, resection of the amyloid mass. It is not known if our patient required the same approach or if this warranted the re-institution of chemotherapy for Non-Hodgkin’s Lymphoma. Until more reports of tumoral amyloidosis are made known, treatment as well as prognosis remain uncertain.

Soft-tissue amyloidoma of the extremities: a case report and review of literature

Amyloidosis is a heterogeneous group of disorders characterized by extracellular deposition of unique protein fibrils. Amyloidosis may be hereditary or acquired, and the deposits may be focal, localized, or systemic in distribution. The least common presentation of an amyloid deposition is as a discrete mass called amyloidoma or amyloid tumor. Although described at various body sites, soft-tissue amyloidoma in an extremity is exceedingly rare. We report such a case of a large amyloidoma in the thigh, which simulated a soft-tissue sarcoma. In spite of attaining a very large size over a course of more than 20 years, the clinical course and the histology of this lesion were benign. Awareness of this entity will allow this rare diagnosis to be considered, prevent confusion with malignant disease, and allow appropriate management and patient reassurance. A review of literature on soft-tissue amyloidomas of extremities is also being presented.

Amyloidoma: A Rare Cause of Soft Tissue Swelling in the Thigh

Soft tissue amyloidoma of the extremities is extremely rare and there are only 12 reported cases in the English literature to date. We present a case of soft tissue amyloidoma of the thigh in a 74-year-old lady.

Genital β2-Microglobulin Amyloidoma in a Long-Term Dialysis Patient

We present the case of a 58-year-old Japanese woman with a huge amyloid tumor in the genital region. Hemodialysis therapy was started for renal failure secondary to polycystic kidney disease in 1974. From 1989 to 1991, carpal tunnel decompression was performed surgically, and beta(2)-microglobulin (beta2MG)-amyloid deposition was found in the wrists. She was hospitalized at our institute for evaluation of lower-abdominal fullness and lower-extremity edema in March 2003. Magnetic resonance imaging showed a huge mass measuring 9.0 x 6.0 x 5.0 cm sandwiched between the vagina and rectum. The mass was hypointense compared with adjacent muscle on T2-weighted images. Computed tomography showed soft-tissue density accompanied by diffuse calcification. A biopsy specimen of the mass obtained by using a transvaginal approach showed material that was positive for beta2MG-amyloid immunohistologically. When patients on long-term dialysis therapy develop a genital mass with low-signal intensity on T2-weighted images by magnetic resonance imaging and diffuse calcification by computed tomography, beta2MG-amyloidoma should be considered as a differential diagnosis.

The spectrum of localized amyloidosis: a case series of 20 patients and review of the literature

Localized deposition of amyloid may occur in individual organs, in the absence of systemic involvement. The reason for localized deposition is unknown, but it is hypothesized that deposits result from local synthesis of amyloid protein, rather than the deposition of light chains produced elsewhere. We identified 20 cases of localized amyloidosis at our institution between 1993 and 2003. There were 11 males and nine females in the group. The mean age at the time of diagnosis was 65.5 years. Organs involved included skin, soft tissues, oropharynx, larynx, lung, bladder, colon, conjunctiva, and lymph node. In six of nine patients typed, the amyloid light chain was lambda. In those patients where follow-up was available (mean 7.6 years), none developed systemic disease. Localized amyloidosis occurs in a variety of organ systems. Evolution into systemic amyloidosis was not seen in our series of patients, supporting the hypothesis of local production of amyloid protein in these cases.

A case report of dystrophic localized amyloidosis that developed in the left thigh

We report on a 50-year-old man with dystrophic localized amyloidosis who noticed a soft tumor in his left thigh about 20 years ago, after which the tumor has gradually enlarged. The multicystic tumor showed hemorrhage, hematoma, necrosis, fibrosis, and tiny nodules and various polymorphous granulomas were observed. One was rich in eosinophilic amorphous materials and cholesterol crystals, and was poor in cell reaction. Another was formed by granuloma consisting of multinucleated giant cells, foamy cells, and macrophages. Transitional granulomas between the two were also observed. The materials showed eosinophilia and red staining and apple-green birefringence in polarized light by alkaline Congo-red stain, and they were also resistant to potassium permanganate pretreatment. They were also positive for amyloid P component and consistently negative for amyloid A, kappa- and lambda-light chains, beta2-microglobulin, and transthyretin. Therefore, it was suggested that this might be an amyloid derived from the hematoma, which has not been reported to date.