Division of Nephrology, Marmara University Hospital, Altunizade, Istanbul, Turkey Email: serhantuglular{at}yahoo.com
Sir,
Garthwaite et al. report a rare case of squamous cell carcinoma of the bronchus associated with AA (secondary) amyloidosis. In our series of 287 cases with secondary amyloidosis [1], we did not have a single case of documented malignancy. The aetiologic distribution of the 14 cases classified as miscellaneous corresponding to 4% of the whole series was: Behçet's disease (4), Castleman disease (3), Still's disease (1) and valvular heart disease (1). All the cases reported in this article, including the 7% with unknown aetiology, are currently on follow-up and without documented underlying malignancy.
Furthermore, as emphasized in our report, these cases are all from nephrology clinics, which may be a bias in the aetiologic distribution.
It is tempting to speculate that since 30% of patients with non-small cell lung cancer have concurrent long-standing chronic obstructive airway disease [2] with possible presence of bronchiectasias, the association may be with this underlying chronic inflammatory situation rather than the bronchogenic cancer itself. However, the previously reported association of secondary amyloidosis with other malignancies suggests that this may also be the case with lung cancer.
As is true for all rare disease associations, it is only through meticulous communications that we can gather this information which may finally enable us to conclude if this is really an association or merely a coincidence.
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