68
CLINICAL RADIOLOGY
H E P A T I C AND S P L E N I C C A L C I F I C A T I O N DUE T O AMYLOIDOS1S
T H E VALUE O F NEGATIVE NEEDLE BIOPSY IN S U S P E C T E D O P E R A B L E LUNG CANCER
Sm We were interested to read the case report by K e n n a n and Evans (1991), describing hepatic and splenic calcification due tO primary amyloidosis. We noted similar findings in a 46-year-old w o m a n with primary amyloidosis confirmed on liver biopsy, who later developed endstage renal failure. A chest radiograph and an abdominal radiograph showed extensive hepatic and less conspicuous splenic calcification after 2 years of haemodialysis. Nine m o n t h s earlier a chest radiograph had shown no evidence of hepatic calcification. The patient's condition deteriorated through her 2 years on haemodialysis, with rapid decline and death a m o n t h after visceral calcification was first observed. Autopsy was not performed; her deterioration and death were attributed to cardiac amyloid. Our patient had never been treated by peritoneal dialysis. Serum inorganic phosphate was maintained below 2 mmol/litre. There was moderate hypercaleaemia (range 2,6 2.99 mmo!/litre ), an expected finding in a patient undergoing haemodialysis, and extensive soft tissue calcification would not be usual under these circumstances. It appears that prolonged survival due to renal replacement therapy allows the development of radiographic hepatic and splenic calcification in this progressive systemic condition.
SIR- I read with interest the article of Charig et al. (1991) stating that needle biopsy (NB) is of little value in the management of a pulmonary nodule with a high clinical probability of being malignant. We previously reached a similar conclusion when we reviewed the records of 102 patients at high risk of lung malignancy who underwent NB of a pulmonary mass. Only in three cases did NB diagnose a benign lesion and prevent unnecessary thoracotomy (Morcos et al., 1987). We have also pointed out the limitation of NB in diagnosing the benign pulmonary nodule and accurate cell typing of malignant tumours (Morcos, 1985, 1987). The technique, which is not without complications, is over-used. Hopefully these publications will result in a more rational approach to the use of NB of pulmonary masses.
J. M. GIBSON R. B A I L L O D A. D. PLATTS
The Royal Free Hampstead N H S Trust Pond Street Hampstead London NW3 20G
Reference
Kenna, NM & Evans, C (1991). Case Report: heaptic and splenic calcifications due to amyloid. Clinical Radiology, 44, 60 61.
S. K. M O R C O S
Northern General Hospital Herries Road Sheffield $5 7A U
References
Charig, M J, Stutley, JE, Padley, SPG & Hansell, D M (1991). The value of negative needle biopsy in suspected operable lung cancer. Clinical Radiology, 44, 147 149, Morcos, SK (1985). Lung biopsy. British Medical Journal 290, 561. Marcos, SK, Ward, P & Proctor, A (1987). The role of pereutaneous needle biopsy in the management of suspected lung malignancy. An evaluation of 102 patients. Egyptian Journal of Radiology and Nuclear Medicine 18, 157 165. Morcos, SK (1987). The Achilles heel of percutaneous needle biopsy of the lung. Radiology Now, 4, 63.
CLINICAL RADIOLOGY
H E P A T I C AND S P L E N I C C A L C I F I C A T I O N DUE T O AMYLOIDOS1S
T H E VALUE O F NEGATIVE NEEDLE BIOPSY IN S U S P E C T E D O P E R A B L E LUNG CANCER
Sm We were interested to read the case report by K e n n a n and Evans (1991), describing hepatic and splenic calcification due tO primary amyloidosis. We noted similar findings in a 46-year-old w o m a n with primary amyloidosis confirmed on liver biopsy, who later developed endstage renal failure. A chest radiograph and an abdominal radiograph showed extensive hepatic and less conspicuous splenic calcification after 2 years of haemodialysis. Nine m o n t h s earlier a chest radiograph had shown no evidence of hepatic calcification. The patient's condition deteriorated through her 2 years on haemodialysis, with rapid decline and death a m o n t h after visceral calcification was first observed. Autopsy was not performed; her deterioration and death were attributed to cardiac amyloid. Our patient had never been treated by peritoneal dialysis. Serum inorganic phosphate was maintained below 2 mmol/litre. There was moderate hypercaleaemia (range 2,6 2.99 mmo!/litre ), an expected finding in a patient undergoing haemodialysis, and extensive soft tissue calcification would not be usual under these circumstances. It appears that prolonged survival due to renal replacement therapy allows the development of radiographic hepatic and splenic calcification in this progressive systemic condition.
SIR- I read with interest the article of Charig et al. (1991) stating that needle biopsy (NB) is of little value in the management of a pulmonary nodule with a high clinical probability of being malignant. We previously reached a similar conclusion when we reviewed the records of 102 patients at high risk of lung malignancy who underwent NB of a pulmonary mass. Only in three cases did NB diagnose a benign lesion and prevent unnecessary thoracotomy (Morcos et al., 1987). We have also pointed out the limitation of NB in diagnosing the benign pulmonary nodule and accurate cell typing of malignant tumours (Morcos, 1985, 1987). The technique, which is not without complications, is over-used. Hopefully these publications will result in a more rational approach to the use of NB of pulmonary masses.
J. M. GIBSON R. B A I L L O D A. D. PLATTS
The Royal Free Hampstead N H S Trust Pond Street Hampstead London NW3 20G
Reference
Kenna, NM & Evans, C (1991). Case Report: heaptic and splenic calcifications due to amyloid. Clinical Radiology, 44, 60 61.
S. K. M O R C O S
Northern General Hospital Herries Road Sheffield $5 7A U
References
Charig, M J, Stutley, JE, Padley, SPG & Hansell, D M (1991). The value of negative needle biopsy in suspected operable lung cancer. Clinical Radiology, 44, 147 149, Morcos, SK (1985). Lung biopsy. British Medical Journal 290, 561. Marcos, SK, Ward, P & Proctor, A (1987). The role of pereutaneous needle biopsy in the management of suspected lung malignancy. An evaluation of 102 patients. Egyptian Journal of Radiology and Nuclear Medicine 18, 157 165. Morcos, SK (1987). The Achilles heel of percutaneous needle biopsy of the lung. Radiology Now, 4, 63.
