Localized nodular pulmonary amyloidosis mimicking primary lung cancer associated with cystic airspaces: A case report

Localized nodular pulmonary amyloidosis can form pulmonary nodules associated with cystic air spaces, but due to its rarity, it cannot be included in the differential diagnosis without appropriate knowledge. Among the differential diagnoses of nodules with cysts in the lungs is primary lung cancer, however, diagnosis based solely on imaging findings is challenging. A 59-year-old Japanese female was referred to our hospital for an abnormality noted on the chest radiograph of an annual health check. She had no history of smoking or medical issues. Chest computed tomography revealed a 1.2 cm pulmonary nodule with surrounding multilocular cystic air spaces in the superior lingular segment. We suspected it was a nodule of primary lung cancer arising in the pulmonary cyst and performed video-assisted thoracic surgery. As the intraoperative frozen examination after a wedge resection revealed fibrotic tissue without malignancy, we did not do any further resection. The histopathological examination of the permanent section revealed unstructured eosinophilic deposits positive for direct fast scarlet staining, which were consistent with amyloidosis. The surrounding pulmonary cysts contained the check valve made by amyloid deposition. Localized nodular pulmonary amyloidosis can give rise to pulmonary cysts and mimic primary lung cancer associated with cystic air spaces. It should be raised as a potential differential diagnosis for pulmonary nodules with cystic air space formation, particularly in patients without a smoking history.