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Primary pulmonary amyloidosis misdiagnosed as malignancy on dual-time-point fluoro-deoxyglucose positron emission tomography/computed tomography: A case report and review of the literature.

Dong MJ, Zhao K, Liu ZF, Wang GL, Yang J - Oncol Lett (2014)

Bottom Line: A percutaneous CT-guided thoracoscopic biopsy was subsequently performed.Histological examination revealed that the specimens contained amorphous, homogeneous material with a number of polyclonal plasma cells, lymphocytes and giant cells.The patient remained in good clinical condition during follow-up.

View Article: PubMed Central - PubMed

Affiliation: Positron Emission Tomography Center, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310003, P.R. China.

ABSTRACT

Primary pulmonary amyloidosis is an uncommon manifestation, characterized by amyloid deposition in the lungs and other associated tissue. The clinical presentation of amyloidosis is variable, with non-specific symptoms. The current study reports the case of a 59-year-old female presenting with primary pulmonary amyloidosis, indistinguishable from lung malignancy based on 18F-fluoro-deoxyglucose (18F-FDG) accumulation on dual-time-point (DTP) FDG-positron emission tomography/computed tomography (PET/CT) imaging and the similarities in morphological changes. A percutaneous CT-guided thoracoscopic biopsy was subsequently performed. Histological examination revealed that the specimens contained amorphous, homogeneous material with a number of polyclonal plasma cells, lymphocytes and giant cells. A diagnosis of primary nodular parenchymal pulmonary amyloidosis was determined, and the patient was discharged without chemotherapy. The patient remained in good clinical condition during follow-up. The present case indicated that localized nodular amyloidosis with increased FDG uptake on DTP FDG PET must be considered in the differential diagnosis of growing lung nodules, and that a histological examination must be conducted to distinguish this condition from malignancies of the lung.

No MeSH data available.


Related in: MedlinePlus

Primary pulmonary amyloidosis on 18F-FDG PET/CT. The PET/CT images revealed a 1.83×1.40 cm lobulated nodule with burr-like margins in the left lower lung exhibiting increased FDG uptake. Continuous slice images are shown from left to right (CT and PET/CT fusion images of the mediastinal window and lung window are shown, respectively). Upper row, PET images (arrows indicate lesions with increased FDG uptake); middle row, CT images (arrows indicate lobulated nodules with burr-like margins); lower row, PET/CT fusion images (arrows indicate lesions with increased FDG uptake in the lobulated nodule). FDG, fluoro-deoxyglucose; PET/CT, positron emission tomography/computed tomography.
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f1-ol-09-02-0591: Primary pulmonary amyloidosis on 18F-FDG PET/CT. The PET/CT images revealed a 1.83×1.40 cm lobulated nodule with burr-like margins in the left lower lung exhibiting increased FDG uptake. Continuous slice images are shown from left to right (CT and PET/CT fusion images of the mediastinal window and lung window are shown, respectively). Upper row, PET images (arrows indicate lesions with increased FDG uptake); middle row, CT images (arrows indicate lobulated nodules with burr-like margins); lower row, PET/CT fusion images (arrows indicate lesions with increased FDG uptake in the lobulated nodule). FDG, fluoro-deoxyglucose; PET/CT, positron emission tomography/computed tomography.

Mentions: A dual phase FDG PET/CT scan was performed following six hours of fasting. FDG (5.5 MBq/kg) was injected intravenously through an antecubital vein while the patient remained at rest. Image acquisition was subsequently conducted using a Siemens Biograph 16 PET-CT scanner (Siemens Medical Solutions USA, Inc., Malvern, PA, USA). The PET/CT images revealed a 1.83×1.40 cm slightly lobulated nodule, with burr-like margins in the left lower lung, exhibiting moderately increased F-18 FDG uptake (maximum SUV of 2.6) in the initial images (1 h following the FDG injection), and more intense FDG uptake with an SUV of 3.5 (26.9% increase) in the delayed images (2 h following the injection) (Fig. 1). Based on the dual phase FDG PET/CT imaging findings, morphological features, contrast-enhanced chest CT imaging and medical history (progression of the nodule during the two-month follow-up period), lung malignancy was highly suspected. A percutaneous CT-guided thoracoscopic biopsy was subsequently performed. Histological examination revealed that the specimens contained amorphous, homogeneous material with a number of polyclonal plasma cells, lymphocytes and giant cells. Eosinophilic material exhibited apple-green birefringence under polarizing microscopy. Immunohistochemically, congo red staining was positive, and trichrome staining was negative, confirming the deposition of amyloid within the specimen (Fig. 2). Therefore, a diagnosis of primary nodular parenchymal pulmonary amyloidosis was determined, and the patient was discharged without chemotherapy and other treatment. After May 2011, the patient was followed up every 3 months and was in good clinical condition at the time of writing.


Primary pulmonary amyloidosis misdiagnosed as malignancy on dual-time-point fluoro-deoxyglucose positron emission tomography/computed tomography: A case report and review of the literature.

Dong MJ, Zhao K, Liu ZF, Wang GL, Yang J - Oncol Lett (2014)

Primary pulmonary amyloidosis on 18F-FDG PET/CT. The PET/CT images revealed a 1.83×1.40 cm lobulated nodule with burr-like margins in the left lower lung exhibiting increased FDG uptake. Continuous slice images are shown from left to right (CT and PET/CT fusion images of the mediastinal window and lung window are shown, respectively). Upper row, PET images (arrows indicate lesions with increased FDG uptake); middle row, CT images (arrows indicate lobulated nodules with burr-like margins); lower row, PET/CT fusion images (arrows indicate lesions with increased FDG uptake in the lobulated nodule). FDG, fluoro-deoxyglucose; PET/CT, positron emission tomography/computed tomography.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4301551&req=5

f1-ol-09-02-0591: Primary pulmonary amyloidosis on 18F-FDG PET/CT. The PET/CT images revealed a 1.83×1.40 cm lobulated nodule with burr-like margins in the left lower lung exhibiting increased FDG uptake. Continuous slice images are shown from left to right (CT and PET/CT fusion images of the mediastinal window and lung window are shown, respectively). Upper row, PET images (arrows indicate lesions with increased FDG uptake); middle row, CT images (arrows indicate lobulated nodules with burr-like margins); lower row, PET/CT fusion images (arrows indicate lesions with increased FDG uptake in the lobulated nodule). FDG, fluoro-deoxyglucose; PET/CT, positron emission tomography/computed tomography.
Mentions: A dual phase FDG PET/CT scan was performed following six hours of fasting. FDG (5.5 MBq/kg) was injected intravenously through an antecubital vein while the patient remained at rest. Image acquisition was subsequently conducted using a Siemens Biograph 16 PET-CT scanner (Siemens Medical Solutions USA, Inc., Malvern, PA, USA). The PET/CT images revealed a 1.83×1.40 cm slightly lobulated nodule, with burr-like margins in the left lower lung, exhibiting moderately increased F-18 FDG uptake (maximum SUV of 2.6) in the initial images (1 h following the FDG injection), and more intense FDG uptake with an SUV of 3.5 (26.9% increase) in the delayed images (2 h following the injection) (Fig. 1). Based on the dual phase FDG PET/CT imaging findings, morphological features, contrast-enhanced chest CT imaging and medical history (progression of the nodule during the two-month follow-up period), lung malignancy was highly suspected. A percutaneous CT-guided thoracoscopic biopsy was subsequently performed. Histological examination revealed that the specimens contained amorphous, homogeneous material with a number of polyclonal plasma cells, lymphocytes and giant cells. Eosinophilic material exhibited apple-green birefringence under polarizing microscopy. Immunohistochemically, congo red staining was positive, and trichrome staining was negative, confirming the deposition of amyloid within the specimen (Fig. 2). Therefore, a diagnosis of primary nodular parenchymal pulmonary amyloidosis was determined, and the patient was discharged without chemotherapy and other treatment. After May 2011, the patient was followed up every 3 months and was in good clinical condition at the time of writing.

Bottom Line: A percutaneous CT-guided thoracoscopic biopsy was subsequently performed.Histological examination revealed that the specimens contained amorphous, homogeneous material with a number of polyclonal plasma cells, lymphocytes and giant cells.The patient remained in good clinical condition during follow-up.

View Article: PubMed Central - PubMed

Affiliation: Positron Emission Tomography Center, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310003, P.R. China.

ABSTRACT

Primary pulmonary amyloidosis is an uncommon manifestation, characterized by amyloid deposition in the lungs and other associated tissue. The clinical presentation of amyloidosis is variable, with non-specific symptoms. The current study reports the case of a 59-year-old female presenting with primary pulmonary amyloidosis, indistinguishable from lung malignancy based on 18F-fluoro-deoxyglucose (18F-FDG) accumulation on dual-time-point (DTP) FDG-positron emission tomography/computed tomography (PET/CT) imaging and the similarities in morphological changes. A percutaneous CT-guided thoracoscopic biopsy was subsequently performed. Histological examination revealed that the specimens contained amorphous, homogeneous material with a number of polyclonal plasma cells, lymphocytes and giant cells. A diagnosis of primary nodular parenchymal pulmonary amyloidosis was determined, and the patient was discharged without chemotherapy. The patient remained in good clinical condition during follow-up. The present case indicated that localized nodular amyloidosis with increased FDG uptake on DTP FDG PET must be considered in the differential diagnosis of growing lung nodules, and that a histological examination must be conducted to distinguish this condition from malignancies of the lung.

No MeSH data available.


Related in: MedlinePlus