An Unusual Case of AA Type Amyloidosis in Lymphoma.
- Author:
Suk Young KIM
1
;
Byung Kee BANG
;
Cheol Whee PARK
;
Ki Won KIM
;
Sung Ro YUN
;
Chung Min HAN
;
Yong Hyun PARK
;
Suk Ju AHN
;
Suk Young PARK
;
Hee Jung KIM
;
Kwang Sun SUH
;
Kwan Kyu PARK
Author Information
1. Department of Internal Medicine, Catholic University School of Medicine, Korea.
- Publication Type:Case Report
- Keywords:
AA amyloidosis;
Nephrotic syndrome;
Enocrine dysfunction;
Small lymphocytic lymphoma
- MeSH:
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
- From:Korean Journal of Nephrology
1999;18(5):808-814
- CountryRepublic of Korea
- Language:Korean
-
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.
