A Case of Senile Systemic Amyloidosis That Presented as Progressive Massive Mediastinal Lymph Node Swelling

Abstract

Background. Progressive mediastinal lymph node swelling due to amyloidosis in a patient with senile systemic amyloidosis (SSA) has not been described previously. Case. An 81-year-old man was admitted to our hospital because of disturbance of consciousness. Chest computed tomography (CT) showed massive multiple lymph node swelling in the mediastinum and a right axillary lymph node. Histopathological and immunohistochemical examinations of CT-guided biopsy specimens from a right axillary lymph node and endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) specimens from mediastinal lymph nodes showed transthyretin (TTR)-positive amyloid deposition. The presence of wild-type TTR was confirmed by genetic analysis of TTR using a blood sample, and he was given a diagnosis of SSA. The comparison between previous and present CT images showed progressive massive mediastinal lymph nodes swelling. Conclusion. This report describes a rare case of SSA with mediastinal lymph node swelling diagnosed based on EBUS-TBNA.