Monoclonality of infiltrating plasma cells in primary pulmonary nodular amyloidosis: detection with polymerase chain reaction

Aims-To investigate the relation between localised amyloidosis and immunocy tic dyscrasia. Methods-Open lung biopsy specimens from a 72 year old man with multiple nod ules in the right middle and lower lung. were stained with haematoxylin-eos in, Congo red, and antibodies against IgG, IgA, IgM, and kappa and lambda l ight chains. Semi-nested PCR amplification for the immunoglobulin heavy cha in (IgH) gene was performed using consensus primers for the VDJ region of t he IgH gene, FR3A, LJH, and VLJH. Results-The biopsy specimens contained eosinophilic amorphous material stai ned with Congo red and anti-re light chain, and surrounded by inflammatory cells intermingled with plasma cells. Plasma cells in the adjacent amorphou s material showed cytoplasmic staining with anti-re. Polymerase chain react ion revealed a discrete amplified band of apparently uniform size with back ground smear. Conclusions-Primary AL type localised amyloidosis involves local accumulati on of monoclonal plasma cells and their secreted products, as in nodular cu taneous amyloidosis. Localised AL type nodular amyloidosis is a separate en tity in amyloidosis.