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A case report of pulmonary amyloidosis recognized by detection of AA amyloid exclusively in alveolar macrophages

医学 淀粉样变性 嗜酸性 病理 淀粉样蛋白(真菌学) 淀粉样变性 胸腔积液 血清淀粉样蛋白A 薄壁组织 淀粉样疾病 淀粉样变性 血清淀粉样蛋白A 支气管肺泡灌洗 肺泡蛋白沉积症 淀粉样纤维 疾病 外科 内科学 淀粉样β
作者
Thiyaphat Laohawetwanit,Kei Tanaka,Yoshiaki Zaizen,Kazuhiro Tabata,Kouji Ando,Hiroshi Ishimoto,Hiroshi Mukae,Yasushi Miyazaki,Andrey Bychkov,Junya Fukuoka
出处
期刊:Respiratory medicine case reports [Elsevier]
卷期号:30: 101046-101046
标识
DOI:10.1016/j.rmcr.2020.101046
摘要

Amyloidosis is a rare condition in which tissue deposits of inert fibrillar protein result in organ damage and dysfunction. There are several types of amyloid fibrils. Some of the most common forms are AL (amyloid light chain) protein and AA (amyloid-associated) type of amyloid fibril protein. Pulmonary amyloidosis is relatively common but is usually asymptomatic. Thus, the diagnosis may be easily overlooked. A 78-year-old male with a history of multiple myeloma followed by systemic amyloidosis presented with abnormal chest CT showing diffuse interlobular thickening in the whole lung field with bilateral pleural effusion. Bronchoalveolar lavage and transbronchial biopsy were performed. Due to the patient's poor condition and hemorrhage, only one fragment was available from forceps biopsy. Histologically, there was no amyloid deposition in the lung parenchyma; however, some histiocytes showed eosinophilic granular contents which prompted us to perform additional staining. The cytoplasmic material turned to be positive with direct fast scarlet (DFS) staining and AA amyloid immunostaining. Similar macrophages with AA amyloid were also found in the bronchoalveolar fluid. We experienced a case with AA amyloidosis affecting the lung diagnosed by the presence of intracytoplasmic amyloid in alveolar macrophages. The microscopic changes were so subtle that they may be overlooked. Recognition of amyloid deposition in alveolar macrophages may be an important clue to diagnose pulmonary amyloidosis. Such finding is of particular significance in the small-sized specimens, such as biopsies and cytologic smears.
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