Korean J Nephrol.
1999 Sep;18(5):808-814.
An Unusual Case of AA Type Amyloidosis in Lymphoma
- Affiliations
-
- 1Department of Internal Medicine, Catholic University School of Medicine, Korea.
- 2Department of Clincal Pathology, Catholic University School of Medicine, Korea.
- 3Department of Pathology, Chung Nam National University School of Medicine, Korea.
- 4Department of Pathology, Keimyng University School of Medicine, Korea.
Abstract
- Amyloidosis is a rare complication of nonhodgikin's lymphoma. In review of the literature, almost all amyloidosis in lymphoma are the AL type and they are resulted frorn monoclonal light chains synthesized by the lymphoma cells. But we want to describe the AA type in patient with small lymphocytic lymphoma. A 60-year-old male patient admitted due to generalized edema and asthenia. He complained anorexia and dizziness at standing. Initial laboratory test revealed nephrotic range proteinuria and hypoalbuminemia. Combined pituitary stimulation test confirmed a decreased pituitary function and the adrenal function was also regarded hypofunctioning status in view of decreased cortisol response. Serum protein electrophoresis revealed monoclonal peak in gamma globulin area. This protein was composed by IgG and Lambda. We found the monotonous cellular infiltration in bone marrow specimen. These cells were lamMa positive in immunohistochemical stain- ing and only CD 20 positive in immunophenotype study. We made a diagnosis of small lymphocytic lymphoma with bone marrow involvement. Kidney biopsy revealed amyloidosis and the electrornicroscopy showed definite randomly arranged amyloid fibril, but immunohistochemical staining was positive with AA amyloid, unexpectedly. We suggest that all amyloidosis in lymphoma patient should be explored the origin of the amyloid fibrile, that is AA type or AL type.
MeSH Terms
-
Amyloid
Amyloidosis*
Anorexia
Asthenia
Biopsy
Bone Marrow
Diagnosis
Dizziness
Edema
Electrophoresis
gamma-Globulins
Humans
Hydrocortisone
Hypoalbuminemia
Immunoglobulin G
Kidney
Leukemia, Lymphocytic, Chronic, B-Cell
Lymphoma*
Male
Middle Aged
Nephrotic Syndrome
Proteinuria
Amyloid
Hydrocortisone
Immunoglobulin G
gamma-Globulins
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