Pleural amyloidosis mimicking mesothelioma: a clinicopathologic study of two cases

Our plain-English summary of Pleural amyloidosis mimicking mesothelioma: a clinicopathologic study of two cases, by A.L. Adams, C.Y. Castro, S.P. Singh, et al (Annals of Diagnostic Pathology, 2001).

The study

• Authors: A.L. Adams, C.Y. Castro, S.P. Singh, C.A. Moran
• Journal: Annals of Diagnostic Pathology
• Published: 2001;5(4):229-32
• Type of article: Case report, Review
• Cited by: 6 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Two cases of pleural amyloidosis are presented. The patients are two men, 70 and 72 years of age respectively. Neither patient had evidence of systemic amyloidosis. Each presented clinically with symptoms of chest pain and dyspnea. Radiologically, both patients showed diffuse pleural thickening similar to that observed in malignant mesothelioma. In both patients, surgical decortication of the pleura was performed. Histologically, the lesions were characterized by the presence of an amorphous eosinophilic material with focal collections of a lymphoplasmacytic infiltrate. Focal clusters of giant cells were admixed with the lymphoplasmacytic infiltrate. Histochemical stains for Congo red showed strong positive apple-green birefringency. Immunohistochemical studies using kappa and lambda light chains showed polyclonality. The cases discussed herein represent an unusual presentation of amyloid and one that needs to be considered in the differential diagnosis of malignant mesothelioma.

In plain English

This article is a report of two cases, not a study of a larger group. It described two men, aged 70 and 72, who had deposits of a material called amyloid in the pleura, the lining around the lungs. Neither man had evidence of amyloidosis elsewhere in the body, and neither had been diagnosed with it before. One man had chest pain and shortness of breath. The other had shortness of breath lasting several weeks. On imaging, one man had irregular nodules over the pleura, with areas of calcification, and the other had diffuse pleural thickening. Both underwent surgical decortication of the pleura. Under the microscope, the tissue showed features characteristic of amyloid, and a Congo red stain gave the apple-green appearance typical of amyloid. In one case, tissue was examined during surgery while mesothelioma was suspected. The article did not discuss asbestos exposure. The authors concluded that pleural amyloid mimicked pleural mesothelioma clinically and on imaging, and that it should be considered when diagnosing malignant mesothelioma.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Case report of two cases (clinicopathologic and radiologic description)
• Who was studied: Two men, aged 70 and 72; neither had evidence of systemic amyloidosis. The article does not state where or when the patients were seen.
• Exposure: Not reported. The article does not mention asbestos or any occupational exposure.
• Main results:
  • The 72-year-old man presented with chest pain and shortness of breath. The 70-year-old man presented with shortness of breath of several weeks' duration. Neither had a previous diagnosis of amyloidosis.
  • In one patient, imaging showed irregular pleural nodules involving the costal and mediastinal pleura, with areas of calcification, and emphysema. In the other patient, radiographs showed diffuse pleural thickening.
  • Both patients underwent surgical decortication of the pleura.
  • In both cases, Congo red staining showed apple-green birefringence characteristic of amyloid, and kappa and lambda light chain studies showed polyclonality.
  • In one case, tissue was sent for frozen section (examination during surgery) with a clinical history indicating suspicion of mesothelioma.
• The authors' conclusion: The authors concluded that in these two cases pleural amyloid mimicked pleural mesothelioma clinically and radiologically, and that it needs to be considered in the differential diagnosis of malignant mesothelioma.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Mesothelioma, Pleural plaques and thickening.

Medical terms in this study, explained in our Lexicon: Mesothelioma, Dyspnea, Diffuse Pleural Thickening, Malignant Mesothelioma, Pleura, Eosinophilic, Differential Diagnosis.

Related studies

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• Nodular pulmonary amyloidosis associated with asbestos exposure — K. Hiroshima, H. Ohwada, et al. (1996)
• Asymptomatic localized pleural amyloidosis mimicking malignant pleural mesothelioma: report of a case — T. Nakano, S. Endo, et al. (2016)
• Florid mesothelial hyperplasia of the tunica vaginalis mimicking malignant mesothelioma: a clinicopathologic study of 12 cases — S. Lee, P.B. Illei, et al. (2014)
• Thoracic Hyper-IgG4-Related Disease Mimicking Malignant Pleural Mesothelioma — F. Lococo, T. Di Stefano, et al. (2019)
• Interlobar pleural plaque mimicking a lung nodule in a patient with asbestos exposure — W.R. Webb, C. Cooper, et al. (1983)

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