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Schuetz T, Schiller D, Klingel K, Gattermeier M, Poelzl G. Unicentric Castleman's disease associated with malignant cardiac Amyloid-A amyloidosis: a case report. Eur Heart J Case Rep 2023; 7:ytad451. [PMID: 37719003 PMCID: PMC10500416 DOI: 10.1093/ehjcr/ytad451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 08/07/2023] [Accepted: 09/06/2023] [Indexed: 09/19/2023]
Abstract
Background Unicentric Castleman's disease (UCD), a lymphoproliferative disorder characterized by enlargement of the lymph nodes, is a rare cause of Amyloid-A amyloidosis. While patients usually present with impaired kidney function and proteinuria, heart involvement is neither common nor the main cause of signs and symptoms. Case summary We present a patient who was admitted to the hospital for impaired exercise capacity. Diagnostic work-up revealed severe left ventricular hypertrophy suggestive of cardiac amyloidosis. Although Congo red staining of endomyocardial biopsies was initially negative, subsequent immunohistochemical staining against serum amyloid A finally confirmed the diagnosis of cardiac amyloidosis. 18F-fluorodeoxyglucose positron emission tomography/computed tomography revealed a tumour located in dorsal of the duodenum. Fine-needle aspiration biopsy of the tumour was suggestive but could not confirm the presence of UCD beyond reasonable doubt. Rapid worsening of heart failure symptoms warranted urgent surgical tumourectomy, which resulted in immediate post-operative lowering of serum amyloid protein. However, post-operative cardiogenic shock could not be stabilized even with veno-arterial extracorporeal membrane oxygenation, and the patient eventually died. The UCD of the hyaline vascular (HV) subtype was confirmed by pathologic work-up of the excised tumour. Discussion This case report presents for the first time a patient with malignant cardiac Amyloid-A amyloidosis caused by unicentric Castleman's disease of the HV subtype. Since the disease progresses swiftly, rapid diagnosis is essential for potential curative treatment.
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Affiliation(s)
- Thomas Schuetz
- Department of Internal Medicine III—Cardiology and Angiology, Medical University Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Dietmar Schiller
- Department of Internal Medicine IV, Elisabethinen Hospital, Seilerstätte 4, 4010 Linz, Austria
| | - Karin Klingel
- Cardiopathology Department, Institute for Pathology and Neuropathology, Tübingen University Hospital, Liebermeisterstr. 8, 72076 Tübingen, Germany
| | - Martin Gattermeier
- Department of Internal Medicine, Landesklinikum Waidhofen/Ybbs, Ybbsitzerstraße 112, 3340 Waidhofen an der Ybbs, Austria
| | - Gerhard Poelzl
- Department of Internal Medicine III—Cardiology and Angiology, Medical University Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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3
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Chandrasekhar G, Rajasekaran R. Investigating the pernicious effects of heparan sulfate in serum amyloid A1 protein aggregation: a structural bioinformatics approach. J Biomol Struct Dyn 2020; 40:1776-1790. [PMID: 33050843 DOI: 10.1080/07391102.2020.1833756] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Amyloid-A mediated (AA) amyloidosis is the pathogenic byproduct of body's prolonged exposure to inflammatory conditions. It is described by the aggregation of mutated/misfolded serum amyloid A1 (SAA1) protein in various tissues and organs. Genetic polymorphism G90D is suspected to cause AA amyloidosis, although the causal mechanism remains cryptic. Recent experimental findings insinuate that heparan sulphate (HS), a glycosaminoglycans, exhibits binding with SAA1 to promote its aggregation. To foster the enhanced binding of HS, we computationally determined the pernicious modifications in G90D mutant SAA1 protein. Also, we examined the influence of HS on the dynamic conformation of mutant SAA1 that could potentially succor amyloidosis. Accordingly, the protein-ligand binding studies indicate that upon SNP G90D, SAA1 protein exhibited an augmented association with HS. Further, the simulation of HS bound mutant SAA1 complex delineates an increase in RMSD, Rg, and RMSF. Also, both RMSD and Rg evinced a fluctuating trajectory. Further, the complex showed increase of beta turn in its secondary structural composition. Additionally, the free energy landscape of mutant SAA1-HS complex posits the occurrence of multiple global minima conformers as opposed to the presence of a single global energy minima conformation in native SAA1 protein. In conclusion, the aforementioned conformational ramifications induced by HS on SAA1 could potentially be the proteopathic incendiary behind AA amyloidosis; this incendiary will need to be considered in future studies for developing effective therapeutics against AA amyloidosis.Communicated by Ramaswamy H. Sarma.
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Affiliation(s)
- G Chandrasekhar
- Bioinformatics Lab, Department of Biotechnology, School of Bio Sciences and Technology, Vellore Institute of Technology (Deemed to be University), Vellore, Tamil Nadu, India
| | - R Rajasekaran
- Bioinformatics Lab, Department of Biotechnology, School of Bio Sciences and Technology, Vellore Institute of Technology (Deemed to be University), Vellore, Tamil Nadu, India
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4
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Bernabei L, Waxman A, Caponetti G, Fajgenbaum DC, Weiss BM. AA amyloidosis associated with Castleman disease: A case report and review of the literature. Medicine (Baltimore) 2020; 99:e18978. [PMID: 32028407 PMCID: PMC7015640 DOI: 10.1097/md.0000000000018978] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 11/27/2019] [Accepted: 12/30/2019] [Indexed: 12/01/2022] Open
Abstract
RATIONALE AA amyloidosis (AA) is caused by a wide variety of inflammatory states, but is infrequently associated with Castleman disease (CD). CD describes a heterogeneous group of hematologic disorders that share characteristic lymph node histopathology. CD can present with a solitary enlarged lymph node (unicentric CD, UCD) or with multicentric lymphadenopathy (MCD), constitutional symptoms, cytopenias, and multiple organ dysfunction due to an interleukin-6 driven cytokine storm. PATIENT CONCERNS We are reporting a case of a 26-year-old woman with no significant past medical history who presented with a 3-month history of fatigue and an unintentional 20-pound weight loss. DIAGNOSIS A CT-scan of the abdomen and pelvis revealed hepatosplenomegaly and a mesenteric mass. Congo Red staining from a liver biopsy showed apple-green birefringence and serum markers were suggestive of an inflammatory process. Post-excision examination of the resected mass revealed a reactive lymph node with follicular hyperplasia with kappa and lambda stains showing polyclonal plasmacytosis consistent with CD. INTERVENTIONS The patient underwent surgery to remove the affected lymph node. OUTCOMES IL-6, anemia, leukocytosis, and thrombocytosis resolved or normalized 2 weeks after resection; creatinine normalized 9 months postsurgery. Twenty two months post-surgery her IFN-γ normalized, her fatigue resolved, her proteinuria was reduced by >90% and she had returned to her baseline weight. LESSONS Our case and literature review suggest that patients presenting with UCD or MCD along with organ failure should prompt consideration of concurrent AA amyloidosis.
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Affiliation(s)
| | - Adam Waxman
- Penn Amyloidosis Program, Abramson Cancer Center
| | | | - David C. Fajgenbaum
- Division of Translational Medicine and Human Genetics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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Fayand A, Boutboul D, Galicier L, Kahn JE, Buob D, Boffa JJ, Cez A, Oksenhendler E, Grateau G, Ducharme-Bénard S, Georgin-Lavialle S. Epidemiology of Castleman disease associated with AA amyloidosis: description of 2 new cases and literature review. Amyloid 2019; 26:197-202. [PMID: 31364863 DOI: 10.1080/13506129.2019.1641078] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Introduction: HHV8-negative Castleman disease (CD) is classified as hyaline vascular (HV) type, or mixed or plasma cell (PC) types. It may present as multicentric CD (MCD) or unicentric CD (UCD). CD is a rare cause of AA amyloidosis (AAA). We aimed to report the main features of CD with secondary AAA through a description of new cases and a systematic literature review. Patients and methods: New cases were identified from the French National Reference Center for AAA. A systematic literature review was performed to identify HHV8-negative CD cases associated with AAA. Results: Thirty-seven patients were analysed, consisting of two new cases and 35 from literature. Twenty-three had UCD and 14 had MCD. PC was the main histologic subtype (n = 25; 68%) in both UCD and MCD patients. Surgical excision of UCD was performed in 21 patients (91%) with a favourable outcome, except for four patients (19%). Clinical and biologic remission was achieved in six patients with MCD (43%), all of whom were treated with anti-interleukin-6 (IL-6) therapy. Conclusions: AAA is a rare complication of CD, namely idiopathic MCD and UCD presenting with the PC histologic subtype. Surgical excision of UCD should be the first-line treatment whenever possible, while anti-IL-6 therapies seem effective for MCD.
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Affiliation(s)
- Antoine Fayand
- Sorbonne Université, AP-HP, Hôpital Tenon, Service de médecine interne, Centre de référence des maladies auto-inflammatoires et des amyloses d'origine inflammatoire (CEREMAIA) , Paris , France
| | - David Boutboul
- Clinical Immunology Department, National Reference Center for Castleman Disease and UMR 1149 CRI INSERM, Hôpital Saint Louis, Assistance Publique Hôpitaux de Paris (APHP) Université Paris Diderot , Paris , France
| | - Lionel Galicier
- Clinical Immunology Department, National Reference Center for Castleman Disease and UMR 1149 CRI INSERM, Hôpital Saint Louis, Assistance Publique Hôpitaux de Paris (APHP) Université Paris Diderot , Paris , France
| | - Jean-Emmanuel Kahn
- Service de médecine interne, Hôpital Ambroise Paré Boulogne Billancourt, Université Versailles Saint Quentin en Yvelines , Versailles , France
| | - David Buob
- Sorbonne Université, AP-HP, Hôpital Tenon, Service d'Anatomie Pathologique , Paris , France
| | - Jean-Jacques Boffa
- Service de néphrologie et dialyse, Hôpital Tenon (AP-HP) , Paris , France
| | - Alexandre Cez
- Service de néphrologie et dialyse, Hôpital Tenon (AP-HP) , Paris , France
| | - Eric Oksenhendler
- Service Immunopathologie clinique, Hôpital Saint-Louis (AP-HP) , Paris , France
| | - Gilles Grateau
- Sorbonne Université, AP-HP, Hôpital Tenon, Service de médecine interne, Centre de référence des maladies auto-inflammatoires et des amyloses d'origine inflammatoire (CEREMAIA) , Paris , France.,Inserm UMRS_933, hôpital Trousseau, AP-HP, Faculté de médecine - Sorbonne Université , Paris , France
| | | | - Sophie Georgin-Lavialle
- Sorbonne Université, AP-HP, Hôpital Tenon, Service de médecine interne, Centre de référence des maladies auto-inflammatoires et des amyloses d'origine inflammatoire (CEREMAIA) , Paris , France.,Inserm UMRS_933, hôpital Trousseau, AP-HP, Faculté de médecine - Sorbonne Université , Paris , France
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6
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De Vito C, Papathomas G T, Pedica F, Kane P, Amir A, Heaton N, Quaglia A. Synchronous Unicentric Castleman Disease and Inflammatory Hepatocellular Adenoma: a Case Report. Ann Hepatol 2019; 18:263-268. [PMID: 31113603 DOI: 10.5604/01.3001.0012.7936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 03/13/2018] [Indexed: 02/04/2023]
Abstract
Systemic symptoms such as fever and fatigue are non-specific manifestations spanning from inflammation to neoplasia. Here we report the case of a 34 year-old man who presented with systemic symptoms for four months. CT-scan and MRI revealed a 3.4 cm arterialized hepatic lesion and a 7 cm paraduodenal mass. Surgical resection of both lesions and histological examination revealed an inflammatory hepatocellular adenoma and a unicentric plasma cell type of Castleman disease. Moreover, a diffuse AA amyloid deposition in the liver was observed. Resection of both lesions was associated with an improvement of the symptoms. To our knowledge, this is the first report of a synchronous presentation of a unicentric plasma cell type of Castleman disease, inflammatory hepatocellular adenoma and AA amyloidosis.
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Affiliation(s)
- Claudio De Vito
- Institute of Liver Studies, King's College Hospital, London, UK; Division of Clinical Pathology, Geneva University Hospitals, Geneva, Switzerland; Equal Contribution.
| | - Thomas Papathomas G
- Department of Histopathology, King's College Hospital, London, UK; Equal Contribution
| | - Federica Pedica
- Pathology Unit, San Raffaele Scientific Institute, Milano, Italy
| | - Pauline Kane
- Institute of Liver Studies, King's College Hospital, London, UK
| | - Ali Amir
- Institute of Liver Studies, King's College Hospital, London, UK
| | - Nigel Heaton
- Institute of Liver Studies, King's College Hospital, London, UK
| | - Alberto Quaglia
- Institute of Liver Studies, King's College Hospital, London, UK
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7
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Bziz A, Rouas L, Lamalmi N, Malihy A, Cherradi N, Ouzeddoun N, Bayahia R, Flayou K, Chala S, Bouclouze A, Benomar A, Abouqal R, Alhamany Z. [Pathological and clinical correlations in renal AA amyloidosis: A Moroccan series of 30 cases]. Nephrol Ther 2015; 11:543-50. [PMID: 26608566 DOI: 10.1016/j.nephro.2015.06.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Revised: 06/15/2015] [Accepted: 06/16/2015] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Study of histological and clinical correlations of 30 cases of renal amyloidosis AA diagnosed between November 2010 and December 2012. RESULTS The main causes associated with amyloidosis AA were represented by chronic infectious diseases (60%). Nephrotic syndrome and renal failure were observed in 94% and 73% respectively. The distribution of amyloid deposits: 90% of patients had a glomerular form and 10% had a vascular form. Inflammatory reaction associated with AA renal amyloidosis was present in 50% of cases. This inflammation was observed near amyloid deposits associated with a deposition of immunoglobulin chains and/or complement factors. CONCLUSION Our study confirms the predominance of AA amyloidosis complicating chronic infectious diseases, especially tuberculosis. Our data point out a relationship between the morphology of renal AA amyloidosis, its clinical presentation and prognosis.
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Affiliation(s)
- Asmae Bziz
- Laboratoire d'anatomie cytologie pathologiques, faculté de médecine et de pharmacie, université Mohamed V, hôpital d'enfants, Rabat, Maroc.
| | - Lamia Rouas
- Laboratoire d'anatomie cytologie pathologiques, faculté de médecine et de pharmacie, université Mohamed V, hôpital d'enfants, Rabat, Maroc
| | - Najat Lamalmi
- Laboratoire d'anatomie cytologie pathologiques, faculté de médecine et de pharmacie, université Mohamed V, hôpital d'enfants, Rabat, Maroc
| | - Abderrahmane Malihy
- Laboratoire d'anatomie cytologie pathologiques, faculté de médecine et de pharmacie, université Mohamed V, hôpital d'enfants, Rabat, Maroc
| | - Nadia Cherradi
- Laboratoire d'anatomie cytologie pathologiques, faculté de médecine et de pharmacie, université Mohamed V, hôpital d'enfants, Rabat, Maroc
| | - Naima Ouzeddoun
- Service de néphrologie, faculté de médecine et de pharmacie, université Mohamed V, hôpital Ibn Sina (Avicenne), Rabat, Maroc
| | - Rabia Bayahia
- Service de néphrologie, faculté de médecine et de pharmacie, université Mohamed V, hôpital Ibn Sina (Avicenne), Rabat, Maroc
| | - Kaoutar Flayou
- Service de néphrologie, faculté de médecine et de pharmacie, université Mohamed V, hôpital Ibn Sina (Avicenne), Rabat, Maroc
| | - Sanae Chala
- Laboratoire de biostatistique, recherche clinique et épidémiologie (LBRCE), faculté de médecine et de pharmacie, université Mohamed V, Rabat, Maroc
| | - Aziz Bouclouze
- Plateau technique de recherche, faculté de médecine et de pharmacie, université Mohamed V, Rabat, Maroc
| | - Ali Benomar
- Centre de recherche clinique, épidémiologique et essais thérapeutiques (CRECET), faculté de médecine et pharmacie, Rabat, Maroc
| | - Redouan Abouqal
- Laboratoire de biostatistique, recherche clinique et épidémiologie (LBRCE), faculté de médecine et de pharmacie, université Mohamed V, Rabat, Maroc
| | - Zaitouna Alhamany
- Laboratoire d'anatomie cytologie pathologiques, faculté de médecine et de pharmacie, université Mohamed V, hôpital d'enfants, Rabat, Maroc
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Abstract
Amyloidosis is a rare diverse condition caused by the pathologic extracellular deposition of abnormal insoluble proteins throughout the body. It may exist as a primary disease or, more commonly, may be secondary to a wide variety of pathologic processes ranging from chronic infection or inflammation to malignancy. Hereditary forms also exist. On the basis of the structure of the protein deposits, more than two dozen subtypes of amyloidosis have been described. A single organ or multiple organ systems may be affected. The radiologic manifestations of amyloidosis are varied and often nonspecific, making amyloidosis a diagnostic challenge for the radiologist. In the chest, the lungs, mediastinum, pleura, and heart may be involved. Lung involvement may manifest as diffuse reticulonodular interstitial thickening, consolidations, or solitary or multiple parenchymal nodules that may calcify, cavitate, and slowly enlarge. Pleural involvement most commonly manifests as pleural effusions. Tracheobronchial involvement may exhibit concentric airway thickening, mural and intraluminal nodules, submucosal calcification, and airway obstruction. Mediastinal and hilar lymph nodes may enlarge and frequently calcify. At cardiac magnetic resonance (MR) imaging, the left ventricular wall is typically thickened, with associated diastolic dysfunction. Delayed contrast material-enhanced cardiac MR imaging typically shows global transmural or subendocardial enhancement. The pathophysiology, classification, treatment, and prognosis of amyloidosis are reviewed, followed by case examples of the appearance of thoracic and cardiac amyloidosis on chest radiographs, computed tomographic (CT) images, and cardiac MR images.
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Affiliation(s)
- Ferenc Czeyda-Pommersheim
- From the Department of Medical Imaging, University of Arizona, 1501 N Campbell Ave, Tucson, AZ 85724 (F.C.P.); Departments of Radiology (M.H., S.S.C., C.F.) and Cardiothoracic Surgery (D.S.), University of Pittsburgh, Pittsburgh, Pa; and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (S.B.)
| | - Misun Hwang
- From the Department of Medical Imaging, University of Arizona, 1501 N Campbell Ave, Tucson, AZ 85724 (F.C.P.); Departments of Radiology (M.H., S.S.C., C.F.) and Cardiothoracic Surgery (D.S.), University of Pittsburgh, Pittsburgh, Pa; and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (S.B.)
| | - Sue Si Chen
- From the Department of Medical Imaging, University of Arizona, 1501 N Campbell Ave, Tucson, AZ 85724 (F.C.P.); Departments of Radiology (M.H., S.S.C., C.F.) and Cardiothoracic Surgery (D.S.), University of Pittsburgh, Pittsburgh, Pa; and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (S.B.)
| | - Diane Strollo
- From the Department of Medical Imaging, University of Arizona, 1501 N Campbell Ave, Tucson, AZ 85724 (F.C.P.); Departments of Radiology (M.H., S.S.C., C.F.) and Cardiothoracic Surgery (D.S.), University of Pittsburgh, Pittsburgh, Pa; and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (S.B.)
| | - Carl Fuhrman
- From the Department of Medical Imaging, University of Arizona, 1501 N Campbell Ave, Tucson, AZ 85724 (F.C.P.); Departments of Radiology (M.H., S.S.C., C.F.) and Cardiothoracic Surgery (D.S.), University of Pittsburgh, Pittsburgh, Pa; and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (S.B.)
| | - Sanjeev Bhalla
- From the Department of Medical Imaging, University of Arizona, 1501 N Campbell Ave, Tucson, AZ 85724 (F.C.P.); Departments of Radiology (M.H., S.S.C., C.F.) and Cardiothoracic Surgery (D.S.), University of Pittsburgh, Pittsburgh, Pa; and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (S.B.)
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Katoh N, Matsushima A, Kurozumi M, Matsuda M, Ikeda SI. Marked and rapid regression of hepatic amyloid deposition in a patient with systemic light chain (AL) amyloidosis after high-dose melphalan therapy with stem cell transplantation. Intern Med 2014; 53:1991-5. [PMID: 25175136 DOI: 10.2169/internalmedicine.53.2065] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 52-year-old woman with a high serum alkaline phosphatase (ALP) level underwent a liver biopsy, which showed diffuse heavy deposition of Aκ amyloid, and was diagnosed as having immunoglobulin light chain (AL) amyloidosis. Although she received high-dose melphalan with stem cell transplantation and achieved a hematologic complete response (CR), her ALP level began to increase one year after treatment. Further examinations revealed that she was still in a CR state with dominant bone-type ALP, and re-biopsied liver specimens demonstrated marked regression of amyliod deposition, providing important evidence that the turnover of hepatic amyloid proteins can actually occur more rapidly than previously thought.
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Affiliation(s)
- Nagaaki Katoh
- Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine, Japan
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10
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Abstract
We report this case of secondary amyloidosis associated with Castleman's disease. A 51-year-old man presented with systemic symptoms of generalized weakness, fatigue, unintended weight loss, anorexia and progressively worsening abdominal distension. On examination he was found to have an indurated right-sided submandibular mass and tense ascites. He was found to have multiorgan dysfunction with deranged liver function tests and renal failure. Ascitic fluid analysis revealed evidence of spontaneous bacterial peritonitis. Biopsy of the submandibular mass revealed angiofollicular lymph node hyperplasia consistent with a diagnosis of Castleman's disease. A subsequent liver biopsy showed extensive deposition of amyloid protein. Bone marrow biopsy also showed the presence of amyloid and increased kappa light chain-restricted plasma cells. The patient was not considered a candidate for chemotherapy or solid organ transplantation in view of active sepsis and poor physical condition. Secondary systemic amyloidosis complicating Castleman's disease is very rare. Untreated secondary systemic amyloidosis often has a rapidly fatal course, such as seen in our patient.
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Affiliation(s)
- Vinaya Gaduputi
- Department of Medicine, Bronx Lebanon Hospital Center, New York, N.Y., USA
| | - Hassan Tariq
- Department of Medicine, Bronx Lebanon Hospital Center, New York, N.Y., USA
| | - Kanthi Badipatla
- Department of Medicine, Bronx Lebanon Hospital Center, New York, N.Y., USA
| | - Ariyo Ihimoyan
- Department of Medicine, Bronx Lebanon Hospital Center, New York, N.Y., USA
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11
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Abstract
We report this case of secondary amyloidosis associated with Castleman's disease. A 51-year-old man presented with systemic symptoms of generalized weakness, fatigue, unintended weight loss, anorexia and progressively worsening abdominal distension. On examination he was found to have an indurated right-sided submandibular mass and tense ascites. He was found to have multiorgan dysfunction with deranged liver function tests and renal failure. Ascitic fluid analysis revealed evidence of spontaneous bacterial peritonitis. Biopsy of the submandibular mass revealed angiofollicular lymph node hyperplasia consistent with a diagnosis of Castleman's disease. A subsequent liver biopsy showed extensive deposition of amyloid protein. Bone marrow biopsy also showed the presence of amyloid and increased kappa light chain-restricted plasma cells. The patient was not considered a candidate for chemotherapy or solid organ transplantation in view of active sepsis and poor physical condition. Secondary systemic amyloidosis complicating Castleman's disease is very rare. Untreated secondary systemic amyloidosis often has a rapidly fatal course, such as seen in our patient.
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Affiliation(s)
- Vinaya Gaduputi
- Department of Medicine, Bronx Lebanon Hospital Center, New York, N.Y., USA
| | - Hassan Tariq
- Department of Medicine, Bronx Lebanon Hospital Center, New York, N.Y., USA
| | - Kanthi Badipatla
- Department of Medicine, Bronx Lebanon Hospital Center, New York, N.Y., USA
| | - Ariyo Ihimoyan
- Department of Medicine, Bronx Lebanon Hospital Center, New York, N.Y., USA
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12
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Babu A, Lachmann H, Pickett T, Boddana P, Ludeman L. Renal cell carcinoma presenting as AA amyloidosis: a case report and review of the literature. CEN Case Rep 2013; 3:68-74. [PMID: 28509249 DOI: 10.1007/s13730-013-0088-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Accepted: 06/28/2013] [Indexed: 01/09/2023] Open
Abstract
A 47-year-old Caucasian man developed mild diarrhoea associated with more than 10 kg weight loss, severe fatigue and anaemia. Endoscopy demonstrated deposits of AA amyloid within the gastrointestinal tract. He had heavy proteinuria with a serum albumin of 15 g/L consistent with systemic AA amyloidosis. He had no symptoms to suggest an underlying chronic inflammatory condition but had CRP 130 mg/L and SAA 474 mg/L. In an attempt to identify the source of his inflammatory response, he underwent a contrast-enhanced whole-body computed tomography scan, which revealed a necrotising mass lesion in the right kidney consistent with a renal cell carcinoma. It also showed non-mechanical obstruction of the small bowel and, immediately post-imaging, the patient developed intractable vomiting followed by oliguric renal failure requiring haemodialysis. Despite his renal and gut failure, he underwent right radical nephrectomy without further complications. Histology showed complete resection of a clear cell renal cell carcinoma and renal amyloid deposits. Post-surgery, his acute-phase response decreased to normal, consistent with the renal cell carcinoma acting as the inflammatory stimulus. Although he remains dialysis dependent, his gut function improved and he has regained both normal weight and serum albumin. Our case demonstrates partial resolution of AA amyloidosis with removal of the inflammatory source.
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Affiliation(s)
- Adarsh Babu
- Department of Renal Medicine, Southmead Hospital, North Bristol NHS Trust, Bristol, BS10 5NB, UK.
| | - Helen Lachmann
- National Amyloidosis Centre, UCL School of Medicine, London, UK
| | - Tom Pickett
- Department of Renal Medicine, Gloucestershire Royal Hospital, Gloucester, UK
| | - Preetham Boddana
- Department of Renal Medicine, Gloucestershire Royal Hospital, Gloucester, UK
| | - Linmarie Ludeman
- Department of Pathology, Gloucester Royal Hospital, Gloucester, GL1 3NN, UK
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Matsuda M, Katoh N, Tazawa KI, Shimojima Y, Mishima Y, Sano K, Ikeda SI. Surgical removal of amyloid-laden lymph nodes: a possible therapeutic approach in a primary systemic AL amyloidosis patient with focal lymphadenopathy. Amyloid 2011; 18:79-82. [PMID: 21401322 DOI: 10.3109/13506129.2011.560216] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
We report a patient with primary systemic AL amyloidosis who suffered from remarkable bilateral cervical lymphadenopathy. Intensive chemotherapies, including two cycles of high-dose melphalan with autologous peripheral blood stem cell transplantation, were insufficiently effective for both the lymphadenopathy and amyloidogenic IgGλ-type M-protein in serum, but the patient showed complete haematological remission after extensive surgical removal of enlarged lymph nodes that had massive depositions of λ-type immunoglobulin light chain-derived amyloid. Lymphadenectomy may be a possible therapeutic approach with regard to both cosmetic and haematological aspects in primary systemic AL amyloidosis patients with focal lymphadenopathy.
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Affiliation(s)
- Masayuki Matsuda
- Department of Medicine, Shinshu University School of Medicine, Matsumoto, Japan.
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Tazawa KI, Katoh N, Shimojima Y, Matsuda M, Ikeda SI. Marked shrinkage of amyloid lymphadenopathy after an intensive chemotherapy in a patient with IgM-associated AL amyloidosis. Amyloid 2009; 16:243-5. [PMID: 19922338 DOI: 10.3109/13506120903090924] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
A male patient with primary AL amyloidosis who had been suffering from systemic lymphadenopathy with IgMkappa-type M-proteinemia received two courses of VAD and high-dose melphalan with in vivo elimination of CD20(+) cells using rituximab followed by autologous peripheral blood stem cell transplantation. Four years after complete hematological remission he showed marked reduction in size of the amyloid-laden lymph nodes. Deposits of AL amyloid may regress from the tissue if the chemotherapy succeeds in persistent inhibition of the production of an amyloidogenic immunoglobulin light chain.
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Tsuchiya A, Yazaki M, Kametani F, Takei YI, Ikeda SI. Marked regression of abdominal fat amyloid in patients with familial amyloid polyneuropathy during long-term follow-up after liver transplantation. Liver Transpl 2008; 14:563-70. [PMID: 18383093 DOI: 10.1002/lt.21395] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
To elucidate whether the amount of tissue-deposited amyloid in familial amyloid polyneuropathy (FAP) patients decreases or increases over the long-term course after liver transplantation (LT), we examined changes in histopathological and biochemical characteristics of abdominal fat amyloid in the transplanted patients with a postoperative history of more than 10 years. Using a series of aspirated abdominal fat tissues from 6 FAP patients with transthyretin (TTR) Val30Met variant, the severity of amyloid deposits was examined and the composition ratio of wild type-to-variant TTR in fat amyloid was assayed by liquid chromatography-ion trap mass spectrometry (LC-MS/MS). Histopathological examination of abdominal fat tissues demonstrated a significant decrease or disappearance of amyloid deposits in all 6 patients. On LC-MS/MS analysis, the contribution of wild-type TTR to the composition ratio in amyloid fibrils was markedly increased in all patients after LT. This is the first report showing pathological evidence that deposited amyloid in FAP patients with long posttransplantation courses can gradually regress or disappear.
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Affiliation(s)
- Ayako Tsuchiya
- Department of Medicine (Neurology), Shinshu University School of Medicine, Matsumoto, Japan
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Verine J, Mourad N, Desseaux K, Vanhille P, Noël LH, Beaufils H, Grateau G, Janin A, Droz D. Clinical and histological characteristics of renal AA amyloidosis: a retrospective study of 68 cases with a special interest to amyloid-associated inflammatory response. Hum Pathol 2007; 38:1798-809. [PMID: 17714761 DOI: 10.1016/j.humpath.2007.04.013] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2006] [Revised: 04/13/2007] [Accepted: 04/20/2007] [Indexed: 11/20/2022]
Abstract
We retrospectively reviewed the clinicopathological features of a series of 68 renal AA amyloidosis observations collected between 1990 and 2005. The amyloidogenic disease was a chronic infection (40.8%), a chronic inflammation (38%), a tumor (9.9%), a hereditary disease (9.9%), or was undetermined in 1.4% of cases. Nephrotic syndrome and renal insufficiency were noted in 63.1% and 75% of patients, respectively. The distribution pattern of glomerular amyloid deposits was mesangial segmental (14.7%), mesangial nodular (26.5%), mesangiocapillary (32.3%), and hilar (26.5%). Glomerular form was observed in 80.9% of cases and vascular form in 19.1%. AA amyloidosis-related inflammation was noted in 30 patients (44.1%) and appeared as a multinucleated giant cell reaction (27.9%) or a glomerular inflammatory infiltrate (25%), including glomerular crescents (17.6%). At the end of follow-up, 26 patients (38.2%) showed end-stage renal disease. The clinical presentation of glomerular and vascular forms was distinct with a clear predominance of proteinuria in glomerular form. Inflammatory reaction was preferentially observed in biopsies with a codeposition of immunoglobulin chains and/or complement factors in AA amyloid deposits. The distribution pattern of glomerular amyloid deposits and glomerular inflammatory reaction were independent factors influencing proteinuria level. Tubular atrophy, abundance, and distribution pattern of glomerular amyloid deposits at the time of biopsy were independent predictors of renal outcome. In conclusion, the glomerular involvement appeared as the determining histological factor for clinical manifestations and outcome of renal AA amyloidosis. AA amyloidosis-related inflammation could partly result from an immune response directed against AA fibrils and could induce amyloid resolution and crescents.
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Affiliation(s)
- Jérôme Verine
- AP-HP, Hôpital Saint-Louis, Service d'Anatomie Pathologique, F-75010 Paris, France.
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Abstract
BACKGROUND Deposition of amyloid fibrils derived from circulating acute-phase reactant serum amyloid A protein (SAA) causes systemic AA amyloidosis, a serious complication of many chronic inflammatory disorders. Little is known about the natural history of AA amyloidosis or its response to treatment. METHODS We evaluated clinical features, organ function, and survival among 374 patients with AA amyloidosis who were followed for a median of 86 months. The SAA concentration was measured serially, and the amyloid burden was estimated with the use of whole-body serum amyloid P component scintigraphy. Therapy for inflammatory diseases was administered to suppress the production of SAA. RESULTS Median survival after diagnosis was 133 months; renal dysfunction was the predominant disease manifestation. Mortality, amyloid burden, and renal prognosis all significantly correlated with the SAA concentration during follow-up. The risk of death was 17.7 times as high among patients with SAA concentrations in the highest eighth, or octile, (>or=155 mg per liter) as among those with concentrations in the lowest octile (<4 mg per liter); and the risk of death was four times as high in the next-to-lowest octile (4 to 9 mg per liter). The median SAA concentration during follow-up was 6 mg per liter in patients in whom renal function improved and 28 mg per liter in those in whom it deteriorated (P<0.001). Amyloid deposits regressed in 60% of patients who had a median SAA concentration of less than 10 mg per liter, and survival among these patients was superior to survival among those in whom amyloid deposits did not regress (P=0.04). CONCLUSIONS The effects of renal dysfunction dominate the course of AA amyloidosis, which is associated with a relatively favorable outcome in patients with SAA concentrations that remain in the low-normal range (<4 mg per liter).
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Affiliation(s)
- Helen J Lachmann
- National Amyloidosis Centre and Centre for Amyloidosis and Acute Phase Proteins, Department of Medicine, Royal Free and University College Medical School, London
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