title: Amyloidosis of the renal pelvis: a harbinger of mammary carcinoma?
abstract: We describe a rare case of light chain immunoglobulin amyloid (AL) accumulation in the central and lower pole renal calyces. Our patient, a woman aged 60, presented with several episodes of gross haematuria. Radiological imaging detected a filling defect in the left renal pelvis. Rigid ureteroscopy showed a corresponding mucosal abnormality resembling transitional cell carcinoma. A definitive preoperative tissue diagnosis could not be reached. Laparoscopic-assisted left nephroureterectomy was indicated. Histopathological examination excluded malignancy, revealing congophilic deposits of submucosal amyloid. A constellation of findings confirmed localised or primary amyloidosis with an AL immunophenotype but no evidence of clonal B-cell disease in the amyloid-associated lymphoplasmacytic cell infiltrate. Investigation for systemic plasma cell dyscrasia and echocardiography and scintigraphy for visceral amyloid deposits were negative for systemic disease. At a follow-up period of 30 months, there is no recurrence. However, our patient was diagnosed with breast cancer 21 months ago.
authors.affiliation: Department of Histopathology, Royal Cornwall Hospital, Truro, UK.
authors.forename: Thomas
authors.initials: T
authors.lastname: Grigor
authors.affiliation: Royal Cornwall Hospital, Truro, UK.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Munro
mesh_terms: D000686:Amyloidosis / Q000150:complications* / Q000175:diagnosis* / Q000276:immunology / Q000601:surgery; D001943:Breast Neoplasms / Q000150:complications*; D044584:Carcinoma, Ductal / Q000150:complications*; D003937:Diagnosis, Differential; D005260:Female; D005500:Follow-Up Studies; D006417:Hematuria / Q000209:etiology; D006801:Humans; D007147:Immunoglobulin Light Chains; D000075363:Immunoglobulin Light-chain Amyloidosis; D007674:Kidney Diseases / Q000150:complications* / Q000175:diagnosis* / Q000276:immunology / Q000601:surgery; D007682:Kidney Pelvis; D008875:Middle Aged; D009392:Nephrectomy
chemical_list: D007147:Immunoglobulin Light Chains