Nodular Amyloidosis

Radiology

Figures 1-4 are from the same patient.

nodule1

Figure 1. Radiograph

Nodular parenchymal amyloidosis presents as single or multiple nodules (up to about 10), which occasionally show calcification on CT.

Adjacent cystic changes may be present. The lesions are often situated peripherally.

Find the nodule.

nodule2

Figure 2. Lateral View

In the lateral radiograph, the nodule overlies the vertebrae.

Outline the nodule.

Figure 3. HRCT, Lung Window

The nodule has a slightly lobulated margin.

 

Figure 4. HRCT, Soft Tissue Window

The nodule shows central irregular calcification.

The differential diagnosis includes malignant and benign, primary or metastatic neoplasms, infectious granulomas, and non-infectious inflammation including rheumatoid nodules and Wegener's granulomatosis.


Pathology

Figure 5. Histology

This nodule from another patient shows a large deposit of homogeneous, extracellular material.

Figure 6. Diagnostic Stain

The left panel shows amyloid stained orangish with Congo red. The right panel shows the same section viewed with polarized light. The green birefringence is diagnostic of amyloid.

For a discussion of nodular amyloidosis, click here. For an example of nodular light chain deposition disease, click here.

Diagnosis is usually made by thoracoscopic or open biopsy. Although needle biopsies can make the diagnosis, amyloid can be an integral part of malignant neoplasms, and the neoplasm might be missed by a small biopsy.

References:

1. Matsumoto K, Ueno M, Matsuo Y, Kudo S, Horita K, Sakao Y. Primary solitary amyloidoma of the lung: findings on CT and MRI. Eur Radiol 1997; 7:586-588. Abstract

2. Tamura K, Nakajima N, Makino S, Maruyama R, Kohno T, Koga Y. Primary pulmonary amyloidosis with multiple nodules. Eur J Radiol 1988; 8:128-130. Abstract

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