[Isolated amyloidosis of hilar lymph nodes]

Pseudotumoral mediastinal and pulmonary amyloidosis occur infrequently and may be confused with other tumors that are found more commonly in this region. Enlargement of hilar lymph nodes in the absence of pulmonary involvement is extremely rare. We report a case of nodular amyloidosis of the hilar lymph nodes that was studied using different diagnostic and radiologic methods. A previously healthy 79-year-old man presented with a large right hilar mass detected on routine chest roentgenography. The extensive mass behaved like a solid tumor and mimicked a bronchogenic carcinoma. At thoracotomy, frozen sections revealed the tumor to consist of kappa-light-chain amyloid. In light of the irresectibility of the tumor, thoracotomy was ended as open biopsy. Immunoelectrophoretic analyses of the plasma and urine showed no evidence of a paraprotein immunoglobulin or light chains. The patient was discharged without symptoms of disease. Different diagnostic procedures before and after surgery are discussed.