Cervical cancer of the uterus complicated by renal AA amyloidosis
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CASE REPORT
Cervical cancer of the uterus complicated by renal AA amyloidosis Hajime Fujisawa1 · Atsuki Ohashi1 · Jun Ohta1 · Naohiro Muraki1 · Yuta Nakano1 · Kouhei Sugita1 · Saori Ishihara1 · Jiro Kumagai2 · Toshiyuki Fukutomi3 · Kiyotaka Nagahama4 Received: 26 March 2020 / Accepted: 28 August 2020 © Japanese Society of Nephrology 2020
Abstract Cervical cancer of the uterus rarely develops systemic secondary amyloidosis. We present the case of a 66-year-old female patient who manifested systemic amyloid A (AA) amyloidosis in the kidney, digestive tract, and cervix of the uterus, secondary to cervical cancer. She exhibited nephrotic syndrome, intractable diarrhea, and mild fever 3 months after she underwent an extended hysterectomy with postoperative cisplatin-based chemotherapy and whole pelvic irradiation. Further examinations revealed AA amyloidosis of the kidney and colon and cytomegalovirus infection in the colon. AA amyloid deposition was positive in the resected tissues of uterine cancer. The patient was diagnosed with systemic AA amyloidosis consecutive to cervical cancer. Despite a decrease in urinary protein after antiviral therapy, it increased 14 months later with neither apparent symptoms nor an increase in tumor marker. A second renal biopsy revealed AA amyloidosis of the kidney. Subsequent investigations revealed the recurrence of cervical cancer in the lung, liver, and lymph nodes. This case report indicated that AA amyloidosis would complicate cervical cancer and recur even after resection of neoplasm owing to other stimulation. Moreover, urine protein could be a marker for cancer relapse in known cases of cancer-derived AA amyloidosis. Keywords AA amyloidosis · Renal amyloidosis · Cervical cancer
Introduction Amyloid A (AA) systemic amyloidosis is known to complicate neoplasms; however, it is not clear if cervical cancer would develop AA systemic amyloidosis. In a Japanese cohort, neoplasms comprised 7% of AA systemic amyloidosis [1]. Renal cell carcinoma (RCC) is the most commonly reported neoplasm to be associated with AA amyloidosis [2]. On the other hand, systemic amyloidosis caused by cervical cancer is rarely reported [3]. Evolved AA amyloidosis could attenuate or remit completely after the removal * Hajime Fujisawa h‑[email protected] 1
Department of Nephrology, Yokohama City Minato Red Cross Hospital, 3‑12‑1 Shinyamashita Nakaku, Yokohama, Kanagawa, Japan
2
Department of Pathology, Yokohama City Minato Red Cross Hospital, Yokohama, Kanagawa, Japan
3
Department of Pharmacology and Toxicology, Kyorin University School of Medicine, Mitaka, Tokyo, Japan
4
Department of Pathology, Kyorin University School of Medicine, Mitaka, Tokyo, Japan
of the carcinoma. Karsenty et al. [4] reported that systemic amyloidosis involving the kidney and gastrointestinal tracts complicated RCC; however, the removal of the carcinoma caused the regression of nephrotic syndrome and enteropathy in the following 3 years. Similar resolution of AA amyloidosis associated with therapeu
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