A case of amyloidosis of the tracheobronchial tree and inferior nasal concha

A 50-year-old man resented at a local medical clinic with nasal obstruction. He was treated but did not improve. He then consulted our institution. Chest X-ray disclosed infiltrative shadows in the basal region of the left lung. A computed tomography scan of the lung showed marked thickening of the airway walls extending from the trachea to both bronchial trees and obstructive changes in the left lower lobe of the lung. On bronchoscopic examination the bronchial mucosa was reddened and edematous with a pinhole bronchial obstruction in one region. Congo red staining of biopsy samples taken from the bronchial mucosa showed deposition of an amorphous substance. Tracheobronchial amyloidosis was diagnosed. The amyloid material was resistant to potassium permanganate and tested positive for lambda-chain of L immunoglobulin. Otorrhinolaryngological examination disclosed a tumor in the inferior nasal concha as the cause of his nasal obstruction. The nasal tumor was resected and AL lambda-type amyloidosis was diagnosed pathologically. Tracheobronchial and inferior nasal concha amyloidosis is an extremely rare pathological condition. The patient was followed for one year and remain asymptomatic without treatment.