Introduction:
Light-chain deposition disease (LCDD) is a multisystem disorder characterized by overproduction of nonamyloid immunoglobulin light chains that can deposit in any organ. Renal involvement almost invariably occurs as free light chains are predominantly filtered by the kidneys. Less common extrarenal manifestations involve the liver, heart, and lungs. The underlying cause of LCDD is unknown, but it is often associated with myeloma or other lymphoplasmacytic disorders Ciléin Kearns, Artibiotics, Copyright © 2022
https://doi.org/10.1148/rg.220123
LCDD in a 69-year-old man with plasmacytoma and multiple myeloma. (A) Axial postcontrast chest CT image shows an enhancing soft-tissue mass occupying the right-sided vertebral elements at the level of T4 (arrow). (B) Sagittal postcontrast CT image of the spine (bone window) reveals patchy lytic disease throughout the thoracolumbar spine (arrowheads). (C) Axial T2-weighted MR image of the thoracic spine better characterizes the medullary-based lesion, which is T2-hyperintense to muscle, with epidural invasion causing severe canal stenosis (arrow). Percutaneous biopsy of the T4 soft-tissue mass was performed. (D) High-power photomicrograph (hematoxylin-eosin stain) used for histologic correlation reveals diffuse sheets of plasma cells. Results of λ light-chain in situ hybridization (not shown) showed that the plasma cells were λ restricted (κ to λ ratio of 1:100), which was positive in virtually all of the cells.
Sweet, David E., et al. "Pulmonary Light-Chain Deposition Disease." Radiographics, 22 July 2022, pubs.rsna.org/doi/10.1148/rg.220123.
Pulmonary LCDD:
Axial (A) and coronal (B) postcontrast chest CT images (lung window) in a 69-year-old man with plasmacytoma and multiple myeloma (same patient as above) demonstrate numerous thin-walled pulmonary cysts bilaterally, with vessels coursing along several of the cyst walls (arrows). Kidney biopsy was performed, as the patient also had nephropathy, and the results confirmed LCDD.
Sweet, David E., et al. "Pulmonary Light-Chain Deposition Disease." Radiographics, 22 July 2022, pubs.rsna.org/doi/10.1148/rg.220123.