A solitary amyloid nodule in the lung.

Solitary primary amyloid nodule of the lung is rare. Only eight cases have been reported. Our patient was a 66-year-old retired furnaceman Who had an asymptomatic, smooth, round shadow in the right lower lobe, discovered accidentally on routine chest radiography. Right lower lobectomy was performed and a firm round nodule was found in the lateral basal segment. Its cut surface had a yellow-grey tinge and stained mahogany brown with Lugol's iodine. Micro-soopically the nodule consisted of uniformly eosinophilic-staining material with scattered multi-nucleate giant cells and groups of lymphocytes, plasma cells, and mononuclear cells at the edge. As the material stained with Congo red and gave typical greenish 'birefringence under polarized light it was evidently amyloid. Primary amyloid lesions may occur in the lung parenchyma or in the br,onchi. The rarest form of amyloid disease of the lung is primary isolated nodular amyloidosis of the parenchyma. The first case was reported by Lesser in 1877 and from then up to 1966 only seven solitary amyloid 'tumours' and 22 cases of multiple nodules were reported. They were reviewed by Firestone and Joison (1966). Hayes and Bernhardt (1969) reported the eighth case of solitary amyloid nodule of t;he lung. They kept the patient, a 59-year-old negro man, under constant observation for six years after removing the lesion, and during this time no evidence of any chronic respiratory disease, dysproteinaemia, malignancy or sysitemic amyloidosis emerged. The condition was therefore regarded as primary. Because of its extreme rarity, we are reporting this case of solitary amyloid nodule in the lung. The case was unusual ifor its association with asbestos bodies though no asbestosis was found in the portion of lung removed. a 66-year-old retired furnaceman, who had smoked five cigarettes a day for well over 20 years, was referred for investigation of a shadow in the right lower lobe (Fig. 1) which had been found on routine chest radiography two months after a total cystectomy. In June 1965 the patient complained of haematuria and cystoscopic biopsy revealed a papillary carcinoma of low-grade malignancy. The tumour was treated initially by local diathermy and subsequently by deep x-ray therapy. The haematuria recurred and it was considered to be due to irradiation cystitis. In May 1969 an ileal loop bladder was formed and in Sep-tember 1969 total cystectomy was carried out. Histo-logical examination showed chronic destructive cystitis with radionecrosis but no evidence of malignancy. On examination his general …