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Case Reports
. 2015 Jan 16:2015:bcr2014207955.
doi: 10.1136/bcr-2014-207955.

Amyloidosis of the renal pelvis: a harbinger of mammary carcinoma?

Thomas Grigor  1 , Nicolas Munro  2
Affiliations
Case Reports

Amyloidosis of the renal pelvis: a harbinger of mammary carcinoma?

Thomas Grigor et al. BMJ Case Rep. .

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.

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Figures

Figure 1
Figure 1
Enhanced axial computer tomography urogram shows thickening of the mucosa in the left lower pole calyx (dashed red circle).
Figure 2
Figure 2
Video fluoroscopy showing abnormal mucosa in the lower pole calyces (dashed red circle).
Figure 3
Figure 3
Rigid ureteroscopy shows papillary excrescences resembling urothelial malignancy.
Figure 4
Figure 4
(A) Formalin-fixed nephroureterectomy specimen with granular haemorrhagic mucosa highlighted (dashed red ellipse). (B) Close up of highlighted region.
Figure 5
Figure 5
Tissue slice of abnormal pelvicalyceal mucosa.
Figure 6
Figure 6
Corresponding stained section of tissue slice from figure 5 (H&E ×2.5).
Figure 7
Figure 7
Photomicrograph showing massive submucosal amyloid deposits (H&E ×100).
Figure 8
Figure 8
Suburothelial amyloid (Congo red ×100).
Figure 9
Figure 9
Immunohistochemistry for light chain immunoglobulins (immunoperoxidase ×100).
Figure 10
Figure 10
Amyloid with numerous plasma cells and intermingled inflammatory infiltrate (CD138 ×100).
Figure 11
Figure 11
Polyclonal expression in bystander plasma cell population (A) κ, (B) λ (immunoperoxidase ×200).
See this image and copyright information in PMC

References

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