Division of Nephrology and Rheumatology, Department of Internal Medicine, Aichi Medical University School of Medicine, Nagakute, Japan.
Amyloid. 2012 Dec;19(4):197-200. doi: 10.3109/13506129.2012.712926. Epub 2012 Aug 28.
AA amyloidosis occurs in patients with high levels of serum amyloid A protein (SAA), which is produced by liver cells in response to signals from several pro-inflammatory cytokines. Chronic inflammatory disease is a major cause of AA amyloidosis; however, malignant neoplasms are rarely reported to be associated with AA amyloidosis. We report herein a case of a solitary lung metastasis of renal cell carcinoma associated with systemic AA amyloidosis. Pathological specimens of the resected lung tumor demonstrated renal cell carcinoma, and the presence of IL-1β, IL-6, and TNF-α in the lymphocytes and plasma cells surrounding the tumor cells, and AA amyloid in the vascular area, but not in metastatic clear cells. Four weeks after surgery, serum IL-6, SAA, and CRP levels normalized. Although this case is very rare, it is full of interesting suggestions about the pathogenesis of malignancy-related systemic amyloidosis.
AA 淀粉样变性发生于血清淀粉样 A 蛋白（SAA）水平升高的患者中，该蛋白由肝细胞在几种促炎细胞因子的信号刺激下产生。慢性炎症性疾病是 AA 淀粉样变性的主要病因；然而，恶性肿瘤与 AA 淀粉样变性相关的报道很少。本文报告了一例肾细胞癌孤立性肺转移伴全身 AA 淀粉样变性的病例。切除的肺肿瘤的病理标本显示为肾细胞癌，肿瘤细胞周围的淋巴细胞和浆细胞中存在 IL-1β、IL-6 和 TNF-α，血管区域存在 AA 淀粉样物质，但转移的透明细胞中不存在。手术后 4 周，血清 IL-6、SAA 和 CRP 水平恢复正常。尽管该病例非常罕见，但它为恶性肿瘤相关系统性淀粉样变性的发病机制提供了有趣的启示。
