case_images: PMC9881482_01
case_images: Chest X-ray showed extensive pulmonary nodulo- reticular shadowing at the peripheries signifying extensive fibrotic changes with scattered nodules.
case_images: jmc-14-036-g001.jpg
case_images: PMC9881482_01_jmc-14-036-g001.jpg
case_images: F1
case_images: CT chest showed several nodules bilaterally: a calcified nodule (1.4 cm) in the apical segment of the left lower lobe and a 2-cm calcified nodule along the posterior mediastinal pleural surface of the left lung (blue arrow), above the level of the aortic knob. CT: computed tomography.
case_images: jmc-14-036-g002.jpg
case_images: PMC9881482_01_jmc-14-036-g002.jpg
case_images: F2
case_images: Subsequently, a CT chest performed in March 2022 (Fig. 2) showed several nodules bilaterally, demonstrating an interval increase in size compared to the prior study.
case_images: (a) Low magnification H&E stain. (b) High magnification H&E stain showing homogenous acellular amorphous material (amyloid) with plasma cells. (c) High magnification H&E stain showing homogenous acellular amorphous material (amyloid) with plasma cells. H&E: hematoxylin and eosin.
case_images: jmc-14-036-g003.jpg
case_images: PMC9881482_01_jmc-14-036-g003.jpg
case_images: F3
case_images: Pathology showed homogenous acellular amorphous material with an entrapped plasma cell infiltrate on microscopy (Fig. 3a-c).
case_images: (a) Unpolarized Congo red stain. (b) Polarized Congo red stain showing apple-green birefringence.
case_images: jmc-14-036-g004.jpg
case_images: PMC9881482_01_jmc-14-036-g004.jpg
case_images: F4
case_images: Congo red stain using polarizing microscopy confirmed the presence of apple-green birefringence (Fig. 4a, b).
case_images: Immunohistochemistry showing kappa light chains.
case_images: jmc-14-036-g005.jpg
case_images: PMC9881482_01_jmc-14-036-g005.jpg
case_images: F5
case_images: Immunohistochemistry showed a mixture of kappa-positive (Fig. 5) and lambda-positive (Fig. 6) cells but the predominance of kappa-positive cells.