A 65-year-old woman with abdominal distension consulted our hospital. Abdominal contrast-enhanced computed tomography revealed remarkable hepatomegaly with heterogeneous parenchymal enhancement (Picture1, 2). Hepatic amyloidosis was suspected because of extraordinary hepatomegaly and hyperglobulinemia of 5.2 g/dL (normal range: 2.0-3.2 g/dL). Monoclonal immunoglobulin in blood and urine was not detected by protein electrophoresis. Serum free light chain concentrations revealed kappa chain values of 1,290.0 (3.3-19.4) mg/L and lambda chain values of 86.0 (5.7-26.3) mg/L with a kappa/lambda ratio of 15.0 (0.26-1.65). A pathological examination of the liver biopsy showed diffuse, lamellar, amorphous substances (amyloid deposits) stained with Congo red in the hepatic parenchyma (Picture 3). A histological examination of the bone marrow biopsy specimen revealed 10.4% plasmacytosis and amyloid deposition stained with Congo red. Based on the above findings, the patient was diagnosed with hepatic amyloidosis (AL type) associated with nonsecretory multiple myeloma (1). Hepatic amyloidosis should be considered as a differential diagnosis of hepatomegaly.
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Picture 3.
The author states that he has no Conflict of Interest (COI).
References
- 1. Gertz MA. Immunoglobulin light chain amyloidosis: 2022 update on diagnosis, prognosis, and treatment. Am J Hematol 97: 818-829, 2022. [DOI] [PubMed] [Google Scholar]