case_images: PMC3891392_01
case_images: Neck and PNS CT scans reveal that numerous enlarged lymph nodes had conglomerated in the right submental and submandibular areas, and that the right internal jugular vein was severely compressed by multiple enlarged lymph nodes.
case_images: kjim-20-183-g001.jpg
case_images: PMC3891392_01_kjim-20-183-g001.jpg
case_images: F1
case_images: The tonsil, salivary gland, paranasal sinus, and nasal cavity yielded no abnormal findings (Figure 1).
case_images: The cut surface of the masses were grayish white with focal hemorrhaging.
case_images: kjim-20-183-g002.jpg
case_images: PMC3891392_01_kjim-20-183-g002.jpg
case_images: F2
case_images: Upon sectioning of the lymph nodes, the cut surfaces were grayish-white with focal hemorrhaging (Figure 2).
case_images: Microscopic study revealed dense and diffuse infiltrations of atypical plasma cells, with a few residual atrophic lymphoid follicles (A, H&E, x100). Immunoglobulin (Lambda positive/Kappa negative) aggregates with extensive amyloid deposits in the stroma and blood vessel walls (B, C).
case_images: kjim-20-183-g003.jpg
case_images: PMC3891392_01_kjim-20-183-g003.jpg
case_images: F3
case_images: These secreted immunoglobulin (Lambda positive) aggregates with extensive amyloid deposits (Congo Red positive, Lambda positive/Kappa negative) in both the stroma and blood vessel walls (Figure 3A -3C).
case_images: Serum PEP revealed an M-spike in the gamma region (A). Serum IEP revealed abnormal arcs against anti-IgG and anti-Lambda antisera (B).
case_images: kjim-20-183-g004.jpg
case_images: PMC3891392_01_kjim-20-183-g004.jpg
case_images: F4
case_images: Serum PEP revealed an M-spike in the gamma region, and serum IEP revealed abnormal arcs against anti-IgG and anti-Lambda antisera (Figure 4A, 4B), but urine PEP was not performed due to the small amount of available protein, and urine IEP revealed no abnormal arcs.