Hemodialysis‐associated soft tissue amyloidomas of the chest and abdominal wall

Abstract

Amyloidoma is a highly unusual presentation of amyloidosis in tumoral or nodular form. Isolated soft tissue amyloidomas in individuals with end‐stage renal disease on chronic hemodialysis is exceedingly rare, particularly in the era of advanced dialysis technologies. We report the case of a 55‐year‐old male with end‐stage renal disease due to autosomal‐dominant polycystic kidney disease, on HD for over 30\u2009years, who was found to have soft‐tissue, dialysis‐related (β2‐microglobulin) amyloidomas (DRA). He presented with painful, palpable masses within the thoracic and abdominal walls. Serum β2‐microglobulin level was only mildly elevated at 24.9\u2009mg/L. Biopsy confirmed amyloidosis with positivity for Congo Red staining and apple‐green birefringence under polarized light. Amyloid subtyping with immunohistochemistry showed positive β2‐microglobulin staining within the deposits. Conservative therapy involving pain management and close monitoring resulted in eventual improvement in symptoms and thus proved to be a viable option for treatment.