PMC7864688_01
(a) and (b): Contrast-enhanced whole-body CT scan revealing stabilisation of the right renal mass, new bilateral pleural effusion and new pericardial effusion with an increase in the size of the lung metastasis (6 cm). (c): Lower gastrointestinal endoscopy demonstrating a severe pancolitis. (d): Echocardiography showing cardiac amyloidosis pattern. Increase in the thickness of the interventricular septum and walls of the ventricles. (e): Surgically removed piece from nephrectomy showing renal tumour.
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figure1
Further work-up was performed with contrast-enhanced whole-body CT scan (Figure 1a-b) which revealed bilateral pleural effusion and pericardial effusion and increase in target lung metastasis size (6 cm). Also, lower gastrointestinal endoscopy was performed (Figure 1c). The immunohistochemistry study for amyloid AA showed strong and diffuse amyloid AA deposits (in almost all the glomerulus, around blood vessels and the perinephritic fat) (Figures 1e, 3c and d).
(a) and (b): First graph shows the timeline of the case. The second graph shows the progression of proteinuria over time.
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figure2
An improvement in diarrhoea (Grade 1) was observed, but the proteinuria worsened (Figure 2b). The patient was deceased within 4 days of surgery due to multiorgan failure (Figure 2a).
(a): Congo red stain of colon mucosa showing periglandular amyloid deposits. (b): Green birefringence of colon mucosa was observed by polarisation microscopy. (c): Immunohistochemistry study for amyloid AA showing strong and diffuse amyloid AA deposits in almost all the glomerulus and around blood vessels. (d): Congo red stain showed red deposition in almost all the glomerulus and around blood vessels.
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figure3
The immunohistochemistry study for amyloid AA showed strong and diffuse amyloid AA deposits (in almost all the glomerulus, around blood vessels and the perinephritic fat) (Figures 1e, 3c and d).