PMC6288450_01
CT chest showing multiple cystic lesions and right lower lobe nodule.
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A CT of the chest performed demonstrated multiple pulmonary nodules bilaterally, including a solitary non-calcified multilobulated opacity in the right lower lobe (RLL) measuring 28 x 17 mm with slight speculation (Fig. 1). The CT scan also demonstrated multiple bilateral pulmonary cysts. (Fig. 1).
PET-CT scan showing positive uptake in the right lower lobe.
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She underwent a PET scan which showed positive uptake in the right lower lobe lesion with an SUV of 4.2, suspicious for malignancy and included in the differential of possible inflammatory process (Fig. 2).
Low power image showing normal lung vs amyloid.
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Surprisingly, the biopsy showed evidence of amorphous material and demonstrated apple-green birefringence under polarised light after staining with Congo-Red in keeping with pulmonary AL amyloidosis (Fig. 3, Fig. 4, Fig. 5). In-situ hybridisation with kappa and lambda stains showed preferential kappa staining (Fig. 3, Fig. 4, Fig. 5).
Biopsy showing evidence of birefringence under polarised light after staining with Congo-Red.
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Surprisingly, the biopsy showed evidence of amorphous material and demonstrated apple-green birefringence under polarised light after staining with Congo-Red in keeping with pulmonary AL amyloidosis (Fig. 3, Fig. 4, Fig. 5). In-situ hybridisation with kappa and lambda stains showed preferential kappa staining (Fig. 3, Fig. 4, Fig. 5).