Multinodular

Primary

Amyloidosis

of the Lung:

Downloaded from www.ajronline.org by 117.253.244.100 on 10/04/15 from IP address 117.253.244.100. Copyright ARRS. For personal use only; all rights reserved

JEAN-PAUL

To date

fewer

amyloidosis

than

cal literature biopsy

lung

[1-14].

[9].

lung

thirty

of the An

needle

cases have

Only

one

additional

biopsy

of multinodular

been

reported

was

case

diagnosed

i-

than

by needle

diagnosed

is reported

nodules

med

promptly

usually

diagnosis ulomas,

by

here.

have

occurring

A. K.

,

a 65-year-old

correction

of an

without soft

These

ranging contain

lung needle

biopsy

including

laboratory

some

on

including

had typical

was

another

marrow

material showed

biopsy

and

biopsy

a waxy

somewhat include

(fig.

1).

tory

sharply

trabeculae

consistency,

(fig. to

protein

based

shorten

and

of

the

elected

cancer

by

microscopic

search

for

patient. thyroid

an

of such lengthy,

an and

Usual scan,

tests excre-

series,

and

gastrointestinal it was

metastatic on

the

Investigation expensive,

from

the

to

lung

confirm

needle

appearance,

primary

the

biopsy

direct

and

carcinoma.

of amyloidosis

2B). rule

These

and,

upper

patient

metastases

for the liver scan,

Instead,

grancell no-

asymptomatic

carcinoma. have been

an

enema.

other

differential

periarteritis

to represent

uncomfortable sputum cytology,

diagnosis

outpatient

lymphoma,

suspected

urography,

barium

of one of the an

features

serum

were

preopmasses

and the mediastinum as

cause.

cm

and

undertaken

underlying

lung

1.5-5.5

uneventfully

bony

investigation

myeloma

from

calcification

performed

evaluation

A routine

and

The

includes metastases, entities such as alveolar

septic emboli. this otherwise

unknown primary occult entity might

surgical

healthy

bilateral

A percutaneous The

microscopic

lungs.

no hilan nodes

was

procedure.

in size any

for

otherwise

were

nodules

were

multiple

did

was normal.

24)

to the

showed

density

There

He was

referable

tissue

not

hospitalized

feature

patients.

hamartomas,

initially

were

was

hernia.

radiograph

masses

lung

male,

chest

circumscribed.

(fig.

inguinal

any symptoms

erative of

white

Biopsy

distinguishing

most prominently and less common

carcinoma,

Report

no

in asymptomatic

dosa, and multiple The nodules in Case

by Needle

BIERNY1

primary in the

Diagnosis

Additional

out

multiple

-

,.

.

investigations,

w

electnophoresis

.

.

..

normal.

-

#{149}C a

‘Im

._r.

“#{149}

-

I,

:

Discussion

Nodular as a single from

pulmonary amyloidosis mass or as multiple

a few

mm

calcifications,

to

bony

several

.a

is rare. It can nodules varying

cm,

tnabeculae

sometimes

[8],

or

present in size

4_%_

.

1

containing

cavitation.

-

The

4%

. ..

‘

,.

.

%

%,#{246}

. .‘-‘

e’p

#{149}

V

,

;

. ..

.5,’-4r .

.‘e;

.

‘,2.

.

.L

,..,

..‘

‘1,”.,

.

..

.

.

-‘ .‘

:‘

.,.

,

“

‘,

.5 . .,

.-.

.‘

.

;

.

-

:

.,

a.

.

‘1,

“I

B Fig. 1.-Chest various

sizes

radiography showing in both lung fields.

multiple

soft tissue

masses

I

Fig. plasma

2.-Histologic section. A, Amyloid cells are shown. All are characteristic material with bony tnabeculae (arrows).

of

material, lymphocytes, and of amyloidosis. B, Amyloid

Received December 16, 1977; accepted after revision August 8, 1978. , Radiology Ltd., 5410 East Pima Street, Tucson, Arizona 85712. Am J Roentgenol

© 1978 American

131 :1082-1083, December Roentgen Ray Society

1978

1082

0361

-803X/78/i

200-1

082

$00.00

Downloaded from www.ajronline.org by 117.253.244.100 on 10/04/15 from IP address 117.253.244.100. Copyright ARRS. For personal use only; all rights reserved

CASE

Lung needle biopsy was performed with a modified 18 gauge Fnanseen needle [15], which obtains a good core of tissue for histologic examination, rather than a smear of aspirated cells for cytologic study. The technique has been described by McCartney et al. [16], and includes a guiding Jelco sleeve, constant suction, and injection of a coagulated blood patch” through the sleeve as it is withdrawn at the end of the procedure. This technique is comfortable and safe enough to be performed routinely on an outpatient basis (W. Boyd, personal communica‘ ‘

tion)

as are

other

lung

needle

biopsy

techniques

major

diseases

associated

myeloma. The patient’s after the procedure.

year

with

amyloidosis,

condition

mainly

3. Weiss

mul-

is unchanged

6.

Jackson

JW:

Brown

Localized

malignant

J:

Primary

W,

Berhardt

amyloid

neoplasm.

amyloidosis.

tumors

Thorax

C/in

of

the

19:97-103,

Radiol

15:358-367,

1964 7.

Hayes

Cancer 8.

H:

24:20-25,

Teixidor

HS,

Solitary

Bachman

genographic 10.

Dyle

AL: Multiple 1 1 1 : 525-529,

mass

of

the

lung.

JF,

tumors

G, Turner

of pulmonary

23 : 269-272,

Denary

amyloid 1971

EN, Jacobson

manifestations Radio/

PC,

amyloid

1969

lung. Am J Roentgeno/ 9. Gordonson JS, Sargent

of

the

AF: Roent-

amyloidosis.

J

1972

Delavan

JW,

Rasmussen

RA:

Pulmo-

nary amyloidoma. Am J C/in Pathol 61 :301-305, 1974 1 1 . Keiler A, Staffen A, Syre G: Zur Problematik den isolierten tumorformige Amyloidose den Lunge. Thoraxchirurgie 22:86-93,

1974

12. Siong CL, Johnson HA: Multiple nodular dosis. Thorax 30:178-185, 1975 13.

1

Rabin

IJ,

Hilser

CL,

pseudotumor

Scheinnan

of the lung.

HZ,

Mt Sinai

pulmonary

McKenna

J Med

amyloi-

PJ:

Amyloid

NY 33:168-173,

1976 Ganiepy lame

of the

Its roentgen

15.

lower

respiratory 16.

note:

Phaneus du

Arnston

T,

Boyd

effective

needle.

D, Charbonneau

Union

poumon.

A: Amyloidose

Med

Can

nodu-

105:1227-1230,

McCartney

I,

W:

Percutaneous

Tait

biopsy

using

D, Stilson

N, Seidel

GS:

Lalli

A,

McCormack

Aspiration

L,

biopsies

safe,

A technique

of pneumothorax in pulmonary Am J Roentgenol 120 :872-875, 1974

biopsy. 17.

a

127 :265, 1978

Radiology

the prevention

L: Isolated

The feature of this case report that attracted my attention is the directness with which a very uncommon situation was precisely identified and with minimal inconvenience to the patient. Such directness is the purpose for constructing algorithms for diagnostic workup of various common clinical problems. It provides a solid basis for effective cost containment, an objective that commands attention from all of us in medicine. Where radiologic methods are involved, such directness can only be achieved when the radiologist actively participates in

J, multiple

1976

man-

multiple nodular pulmonary amyloidosis. Am J C/in Pathol 33 : 31 8-329, 1960 4. Schuller H, Bollin H, Linden E, Stenran U: Tumor-forming amyloidosis of the lower respiratory system. Chest 42:5867, 1962

Editor’s

RE,

lung simulating 1964

14.

Wang CC, Robbins LL: Amyloid disease. ifestations. Radiology 66 :489-500, 1956

2. Barrington Prowse C: Amyloidosis tract. Thorax 13:308-320, 1958

Cotton

Can Assoc

REFERENCES 1.

5.

[17].

The pathologist identified amyloidosis on the specimen without difficulty, and the diagnosis was unequivocal enough to assume the other lung nodules represented the same process. The diagnosis singularly expedited the patient’s wonkup, eliminating further search for a primary carcinoma and limiting testing to exclude tiple

1083

REPORTS

Zelch

of chest

M,

Reich

lesions.

N,

for

aspiration Belovich

D:

127:35-40,

Radiology

1978

the

selection

tices today.

of

procedures.

However,

This

is not

the radiologist

the

technical ability. He must be a clinician, yield and costs of alternative procedures peutic

potential

of

the

entities

with

case

in many

prac-

must have more than just

which

knowledgeable

of the

as well as the therahe

may

be

dealing.

As the reader, would you take exception to the expeditious workup described here? If so, please respond through the Letters section. MMF