Hourseau M, Virally J, Habib E, Juberthie B, Bienvenu L
Service d'Anatomie et Cytologie Pathologiques, Hôpital Robert Ballanger, Aulnay sous Bois, France.
Rev Mal Respir. 2008 Nov;25(9):1123-6. doi: 10.1016/s0761-8425(08)74983-0.
Pulmonary amyloïdoma is a nodular formation containing amyloid deposits, which can mimick a pulmonary carcinoma. Its etiologic diagnosis require the search of an underlying infectious disease, a connective tissue disorder or a lymphoma.
We report the case of a 73 year old woman, asymptomatic, presenting an incidental pulmonary opacity in the left upper lobe, associated with hilar lymphadenopathies, positive on PET scan. The patient underwent a left superior lobectomy with mediastinal lymphadenectomy. Histologically, the nodule was composed of amylodosis deposits. It was surrounded by a dense lymphoïd infiltrate. The phenotype (CD20+, CD5-, CD3-, CD23-) of the lymphoïd cells, like the demonstration of a lambda light chain restriction permited to pose the diagnostic of pulmonary Malt lymphoma and to characterize the AL lambda type of the amyloïdosis
Association of amyloïdoma and Malt lymphoma is a rare condition. The histologic diagnosis of lymphoma may be difficult in this case, the lymphomatous process being concealed by the volume of the amyloïd mass. Therefore it is necessary in case of amyloïdoma to search histological signs of Malt lymphoma and to confirm diagnosis by demonstrating a B clonality and a immunoglobulin light chains restriction.
肺淀粉样瘤是一种含有淀粉样沉积物的结节性病变，可酷似肺癌。其病因诊断需要寻找潜在的感染性疾病、结缔组织病或淋巴瘤。
我们报告一例73岁无症状女性病例，其左上叶偶然发现肺部阴影，伴有肺门淋巴结肿大，PET扫描呈阳性。患者接受了左上叶切除及纵隔淋巴结清扫术。组织学检查显示，结节由淀粉样变性沉积物组成，周围有密集的淋巴细胞浸润。淋巴细胞的表型（CD20 +、CD5 -、CD3 -、CD23 -）以及λ轻链限制的证实有助于诊断肺黏膜相关淋巴组织淋巴瘤，并确定淀粉样变性的AL λ型。
淀粉样瘤与黏膜相关淋巴组织淋巴瘤的关联较为罕见。在这种情况下，淋巴瘤的组织学诊断可能困难，淋巴瘤过程被淀粉样物质团块掩盖。因此，对于淀粉样瘤病例，有必要寻找黏膜相关淋巴组织淋巴瘤的组织学迹象，并通过证实B细胞克隆性和免疫球蛋白轻链限制来确诊。
