PMC8554224_01
(A) Computed tomography scan revealed uneven thickening of the walls of the trachea and bronchi at different levels with luminal narrowing. (B) Computed tomography scan showed obliteration in the right intermediate bronchus, but pulmonary parenchyma were normal. (C) Bronchoscopy revealed roughness of mucosa in trachea and multiple nodular in airway lumen. (D) Serum protein electrophoresis showing an M-peak in the gamma fraction. (E) Serum immunofixation electrophoresis. It shows biclonal gammopathy of IgG kappa type and IgA kappa type. (F) Amyloidosis was confifirmed by tissue biopsy, which showed Congo red dye staining of lesion was positive (Hematoxylin and Eosin, x 200).
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F1
Chest computed tomography (CT) revealed that the tracheal walls and bronchi were extensively uneven to different degrees and exhibited luminal stenosis (Figures 1A,B). Electronic bronchoscopy revealed completely irregular and thickened bronchial mucosal surface with prominent nodes accompanied by a small amount of white secretion (Figure 1C). The lumen of the right middle bronchus exhibited extreme narrowing, and pathological examination of the tracheal mucosal biopsy specimen at the site of narrowing revealed mucosal calcification and fibrous hyperplasia with deposition of kappa light chain, as well as the following: PAS stain (-), acid-fast staining (-), and Congo red stain (+) (Figure 1F). Serum electrophoresis showed a monoclonal spike, although immunofixation electrophoresis (IFE) revealed a double monoclonal component: IgA kappa and IgG kappa (Figures 1D,E).