A 59-year-old Chinese female was referred to the chest clinic of the First Affiliated Hospital, College of Medicine, Zhejiang University (Hangzhou, China) in April 2011 due to a two-month history of cough, hemoptysis and general fatigue. A CT scan of the chest revealed a nodule in the left lower lung with mild enhancement in the lesion. The nodule progressed during the two-month follow-up period under treatment with anti-infection drugs. No other significant history was noted. The patient’s physical examination was unremarkable, and hematological and biochemical parameters were within normal limits.\nA dual phase FDG PET/CT scan was performed following six hours of fasting. FDG (5.5 MBq/kg) was injected intravenously through an antecubital vein while the patient remained at rest. Image acquisition was subsequently conducted using a Siemens Biograph 16 PET-CT scanner (Siemens Medical Solutions USA, Inc., Malvern, PA, USA). The PET/CT images revealed a 1.83×1.40 cm slightly lobulated nodule, with burr-like margins in the left lower lung, exhibiting moderately increased F-18 FDG uptake (maximum SUV of 2.6) in the initial images (1 h following the FDG injection), and more intense FDG uptake with an SUV of 3.5 (26.9% increase) in the delayed images (2 h following the injection) (). Based on the dual phase FDG PET/CT imaging findings, morphological features, contrast-enhanced chest CT imaging and medical history (progression of the nodule during the two-month follow-up period), lung malignancy was highly suspected. A percutaneous CT-guided thoracoscopic biopsy was subsequently performed. Histological examination revealed that the specimens contained amorphous, homogeneous material with a number of polyclonal plasma cells, lymphocytes and giant cells. Eosinophilic material exhibited apple-green birefringence under polarizing microscopy. Immunohistochemically, congo red staining was positive, and trichrome staining was negative, confirming the deposition of amyloid within the specimen (). Therefore, a diagnosis of primary nodular parenchymal pulmonary amyloidosis was determined, and the patient was discharged without chemotherapy and other treatment. After May 2011, the patient was followed up every 3 months and was in good clinical condition at the time of writing.
A 70-year-old Caucasian male was diagnosed with iris deposits and elevated IOP LE. On examination, VA was 20/25 RE and 20/30 LE. IOP was 10 mm Hg RE and 16 mm Hg LE, on topical anti-glaucoma medication LE. Gonioscopy revealed ~200 translucent spherules of 200–400 microns diameter in the angle LE [Fig. and ]. Glaucomatous optic disc cupping with superior and inferior arcuate field defects were noted LE. Fine needle aspiration biopsy revealed amorphous material with mild Congo red staining, consistent with amyloid []. Systemic evaluation was normal. Medication compliance was poor with eventual glaucoma progression and refusal of surgical intervention. At 10-year follow-up, phthisis bulbi with no light perception was noted. The RE examination was normal all throughout.