PMC8024703_01
Oral finding of the patient. Multiple nodules and indentation of the tongue, suggesting tongue amyloidosis.
gr1.jpg
PMC8024703_01_gr1.jpg
fig1
Multiple nodules and tooth indentation were noted on the tongue (Fig. 1).
Radiological findings of the patient. (A) A chest X-ray image on admission. (B) Chest CT images on admission showing diffuse ground-glass opacities (GGO) with mosaic attenuation, consolidation in the left lingular lobe (arrow), and subpleural, wedge-shaped nodules in the bilateral lower lobes (arrowhead).
gr2.jpg
PMC8024703_01_gr2.jpg
fig2
High-resolution CT of the chest revealed diffuse ground-glass opacities (GGO) with mosaic attenuation, consolidation in the left lingular lobe, and subpleural, wedge-shaped nodules in the bilateral lower lobes (Fig. 2).
Bronchoscopic images of the patient. Enlarged, tortuous submucosal vessels were observed at the main carina (A, B) and the left main bronchus (C). No nodules nor masses were found in the patient.
gr3.jpg
PMC8024703_01_gr3.jpg
fig3
Bronchoscopy revealed enlarged tortuous submucosal vessels at the main carina and left main bronchus (Fig. 3), suggesting tracheal amyloidosis.
Pulmonary amyloidosis confirmed by trans-bronchial lung biopsy. (A) Haematoxylin and eosin staining. (B) Congo-red staining with bright field microscopy. (C) Congo-red staining showing positive signals under polarized light. (D) Immunohistochemistry of amyloid P. Magnificationx400. . (For interpretation of the references to colour in this figure legend, the reader is referred to the Web version of this article.)
gr4.jpg
PMC8024703_01_gr4.jpg
fig4
Microscopic examination of the TBLB showed deposition of amorphous eosinophilic amyloid at the smooth muscle layer of the bronchial tissue (Fig. 4A). Congo red staining displayed a positive signal in polarized light (Fig. 4B and C). Immunohistochemical staining for amyloid P was positive (Fig. 4D).
Hemosiderin-laden macrophages present in bronchoalveolar lavage fluid. (A) Brownish-yellow bronchoalveolar lavage fluid. (B) Numerous hemosiderin-laden macrophages were detected by Berlin blue staining. . (For interpretation of the references to colour in this figure legend, the reader is referred to the Web version of this article.)
gr5.jpg
PMC8024703_01_gr5.jpg
fig5
Bronchoalveolar lavage fluid from left B3 was brownish-yellow and numerous hemosiderin-laden macrophages were detected with Berlin blue staining (Fig. 5), indicating chronic alveolar hemorrhage, resulting in pulmonary hemosiderosis.