[Pseudotumoral pulmonary AL amyloidosis].
BACKGROUND
Thoracic involvement in amyloidosis is rare. An isolated pseudotumor without extra-thoracic disease suggests a malignant process. We present the case of a patient with pseudonodular AL amyloidosis, confirmed by lobar lung resection.


METHODS
A 57-year-old woman, with a 25-pack-year smoking history, presented with a nodular opacity on chest x-ray. Physical examination was normal. Thoracic CT-scan revealed an isolated spiculated nodule in the right upper lobe. A whole body positron emission tomography (PET) scan revealed high FDG activity in this nodule, without evidence of metastatic disease. Bronchoscopy was negative. Lobectomy revealed lambda L-chain amyloidosis. Investigation for systemic extension was negative. Follow up has been unremarkable.


CONCLUSIONS
A spiculated lung nodule on conventional imaging (radiography, scanner) is cancer until proven otherwise. The use of PET scan in this context is sensitive but not specific. Definitive diagnosis must be obtained by histological examination. Nodular lung amyloidosis must be included in the differential diagnosis of lung nodules and false-positive FDG PET.
Service d'oncologie thoracique, maladies de la plèvre, pneumologie interventionnelle, CHU Hôpital Nord, chemin des Bourrely, 13915 Marseille cedex 20, France.
M
M
Cappiello
Service d'oncologie thoracique, maladies de la plèvre, pneumologie interventionnelle, CHU Hôpital Nord, chemin des Bourrely, 13915 Marseille cedex 20, France.
E
E
Pagano
Service d'oncologie thoracique, maladies de la plèvre, pneumologie interventionnelle, CHU Hôpital Nord, chemin des Bourrely, 13915 Marseille cedex 20, France.
T
T
Vandemoortele
Service d'oncologie thoracique, maladies de la plèvre, pneumologie interventionnelle, CHU Hôpital Nord, chemin des Bourrely, 13915 Marseille cedex 20, France; Aix-Marseille université, 13284 Marseille, France.
S
S
Laroumagne
Service d'anatomopathologie, CHU Hôpital Nord, 13915 Marseille, France.
S
S
Giusiano
Service d'oncologie thoracique, maladies de la plèvre, pneumologie interventionnelle, CHU Hôpital Nord, chemin des Bourrely, 13915 Marseille cedex 20, France.
H
H
Dutau
Service d'oncologie thoracique, maladies de la plèvre, pneumologie interventionnelle, CHU Hôpital Nord, chemin des Bourrely, 13915 Marseille cedex 20, France; Aix-Marseille université, 13284 Marseille, France. Electronic address: pastoul@ap-hm.fr.
P
P
Astoul
D000686:Amyloidosis / Q000175:diagnosis*; D001999:Bronchoscopy; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D000075363:Immunoglobulin Light-chain Amyloidosis; D008168:Lung / Q000473:pathology; D008175:Lung Neoplasms / Q000175:diagnosis*; D008875:Middle Aged; D013902:Radiography, Thoracic; D014057:Tomography, X-Ray Computed
Amylose pulmonaire; F-18 FDG PET; F-18 FDG TEP; Lung nodule; Nodule pulmonaire; PET-scanner; Pulmonary amyloidosis; TEP scanner