A case of the pulmonary nodular amyloidosis: Multiple calcified nodules exhibiting interval growth

Abstract

In a 71-year-old woman, 2 years and 10 months ago, several nodular shadows with calcification were pointed out in both lung fields on the chest X-ray (CXR). After 1 year and 3 months, abnormal shadows were increased in size on CXR, then, she visited our hospital for detailed examination and treatment. On computed tomography CT), several nodular shadows with partial calcification were observed in both lung fields. CT after 1 year and 1 month (6 months before), showed several circular to slightly lobulated mass ranging in diameter of 6-24 mm around the bronchovascular bundles of both lungs and the peri-lobular area such as subpleural peripheral zone and punctate to dendritic calcification also progressed compared to the previous CT. The thoracoscopic partial left lung resection revealed 2 relatively well-defined nodular lesions with a yellow to brown cut surface. Histologically, the deposition of amorphous eosinophilic substance was found around/in the bronchi and blood vessel's wall of the lesions with partial calcification and/or ossification. A diagnosis of AL-type amyloidosis was made by the immunohistochemical findings. Pulmonary amyloidosis is radiologically classified into (1) nodular, (2) tracheobronchial, and (3) lung parenchymal type (diffuse alveolar septal type) according to the deposition patterns. Dendrite irregular calcification, irregular contours, different sizes 0.5-5 cm mean diameter, are characteristic radiological finding of the pulmonary nodular amyloidosis, and it is important to know that it occasionally shows the significant growth simulating malignant diseases.