Amyloidosis

[PPG1212]

Amyloidosis

Is it likely that a tumor on the right lung, which is thought to be amyloidosis, to in fact be amyloidosis in a situaltion where there is a tumor on the left lung which has been diagnosed as squamous cell carcinoma?  Has anyone heard of a similar situation?  

[HeinrikMD]

Hi,
The diagnosis of cancer on the left lung would mandate a thorough evaluation of the opposite lung in order to plan the appropriate therapy.
Amyloidosis presents more often with diffuse involvement of the lung and with disease elsewhere in the body (as the amyloid may also deposit along the heart, the kidneys, etc.).Based on your description, this is not likely the case. The other type of amyloidosis would present as a localized area, and may indeed be mistaken for lung cancer. These would generally have a benign course, but since these are much rarer, the actual behavior would not be very predictable.
The diagnosis of lung cancer would likely mandate a biopsy of the opposite lung, to ascertain if it is also cancer or not.  

[PPG1212]

Hello again,

Before performing the lobectomy on Mom's left lung, a physcian/radiologist twice biopsied the lesion on the right lung, which did not yeild a specific pathology.  The physcian who performed the biopsy reported the lesion/tumor was approximately 2 cm with a very hard surface, making it difficult to obtain an adequate sample.  The forcep could only scrape a small specimen to test.  She experienced pneumothorax in her right lung in one instance.  The left lesion, was sized at approximately 3 cm and was easier to biopsy.  Its specific pathology was squamous cell carcinoma.  Her surgeon and primary physician reasoned that her best shot at survival was to perform the lobectomy on her left lower lobe (a known malignant tumor) and then watch the lesion on the right lung.  Should we be concerned with the inconclusive nature of the biopsy results?  Should our mom request a third biopsy? Is her chemotherapy plan dependent on whether the right lesion is cancerous or benign amyloidosis?

Many thanks for your kind replies.

[PPG1212]

Hi:

Please forgive me for adding this information.  I just located the two biopsy reports for mom's right lung biopsy.  

The first report stated "Final Diagnosisamorphos eosinophilic and portion of pulmonary alveolar.  Parenchyma with no specific pathologic change.  Comment:  The histologic finding raise the possibility of nodular amyloidosis versus stromal reacion reaction/scar.  Cong red stain was equivocal.  If malignancy is suspected, the biopsy material may not be representative of the lesion.  Clinicla correlation and additional studies may be requred for a specific diagnosis.  

The second report stated "Final Diagnosis:  amorphous eosinophilic material with scattered giant cells and lymphoplasmacytic inflamation.  Comment:  The histologic features are similar to the previous biopsy material and is most consistent with nodular amyloidosis.  No malignant infiltrates are identified."

I thought this may be helpful to you in responding to my earlier post.  Thanks again.

[HeinrikMD]

Hi,

Getting biopsies on the lung isn’t easy, and after 2 biopsies, a third may not really help unless the entire segment would be removed. If suspicion is indeed high, then that would be the case.
If this is amyloidosis indeed, this would tend to have a slow, indolent course unlike the amyloidosis which is diffuse, involving more areas of the lung. Observation for its behavior over time is indeed an option. However, action must be taken for the left lung.
The chemotherapy after surgery would be adjunctive to the surgery done on the left lower lobe. It is not meant to eliminate cancer in the right lobe if it exists. While it is theoretically sound that a cancer on the right lung can be eliminated- such an approach has not been proven. Put another way, chemotherapy alone has not been able to provide cures by itself in the absence of surgery for lung cancer. So the best outcome would be that the right lung contains no cancer.