PMC9881482_01
Chest X-ray showed extensive pulmonary nodulo- reticular shadowing at the peripheries signifying extensive fibrotic changes with scattered nodules.
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F1
CT chest showed several nodules bilaterally: a calcified nodule (1.4 cm) in the apical segment of the left lower lobe and a 2-cm calcified nodule along the posterior mediastinal pleural surface of the left lung (blue arrow), above the level of the aortic knob. CT: computed tomography.
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F2
Subsequently, a CT chest performed in March 2022 (Fig. 2) showed several nodules bilaterally, demonstrating an interval increase in size compared to the prior study.
(a) Low magnification H&E stain. (b) High magnification H&E stain showing homogenous acellular amorphous material (amyloid) with plasma cells. (c) High magnification H&E stain showing homogenous acellular amorphous material (amyloid) with plasma cells. H&E: hematoxylin and eosin.
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F3
Pathology showed homogenous acellular amorphous material with an entrapped plasma cell infiltrate on microscopy (Fig. 3a-c).
(a) Unpolarized Congo red stain. (b) Polarized Congo red stain showing apple-green birefringence.
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F4
Congo red stain using polarizing microscopy confirmed the presence of apple-green birefringence (Fig. 4a, b).
Immunohistochemistry showing kappa light chains.
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F5
Immunohistochemistry showed a mixture of kappa-positive (Fig. 5) and lambda-positive (Fig. 6) cells but the predominance of kappa-positive cells.