Tuberc Respir Dis.  2008 Dec;65(6):532-536.

A Case of Primary Localized Laryngo-tracheobronchial Amyloidosis

Affiliations
  • 1Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea. sjyong@yonsei.ac.kr
  • 2Department of Pathology, Yonsei University Wonju College of Medicine, Wonju, Korea.
  • 3Department of Radiology, Yonsei University Wonju College of Medicine, Wonju, Korea.

Abstract

We report on a case of a patient with laryngo-tracheobronchial amyloidosis who complained of cough, sputum, and hoarseness. A chest X-ray showed consolidation in the right middle lobe. A chest CT scan showed diffuse, irregular narrowing of the tracheobronchial tree and atelectasis of the right middle lobe, with calcification of bronchial wall. Bronchoscopic findings were multinodular submucosal thickening of the right vocal cord, and yellowish multinodular submucosal thickening from the lower trachea through both main bronchi, as well as the lingular division of the left upper lobe, the right middle lobe, and the right lower lobe. The right middle lobe bronchus was nearly obstructed. The diagnosis of amyloidosis was made by multiple bronchoscopic biopsies on the right vocal cord and both bronchi. Pathologic findings were characteristic apple-green birefringence under polarized microscopy with Congo-red stain. The patient had no evidence of systemic amyloidosis. The patient is under conservative symptomatic treatment.

Keyword

Tracheobronchial amyloidosis; Laryngeal amyloidosis; Right middle lobe syndrome; Hoarseness

MeSH Terms

Amyloidosis
Biopsy
Birefringence
Bronchi
Cough
Hoarseness
Humans
Microscopy
Pulmonary Atelectasis
Sputum
Thorax
Trachea
Vocal Cords

Figure

  • Figure 1 Chest X-rays. Consolidation was revealed in the right middle lobe. Trachea was diffusely and irregularly narrowed (arrow).

  • Figure 2 Chest CT. Tracheobronchial tree was diffusely and irregularly narrowed. Atelectasis of the right middle lobe and calcification of bronchial wall were revealed.

  • Figure 3 Bronchoscopy. (A) Multinodular submucosal thickening revealed in the right false and true vocal cord. (B) Yellowish multinodular submucosal thickening was revealed from lower trachea to both main bronchi. (C) The right middle lobe bronchus was nearly obstructed.

  • Figure 4 Pathologic findings. (A) Light microscopic finding was diffuse deposition of eosinophilic amorphous material in the submucosa (H&E stain, ×200). (B) The Congo-red stain for amyloid revealed characteristic apple green-colored birefringency under the polarized microscope (×200).


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