How do you approach management of a patient with Sjogren's disease and lung mass biopsy revealing amyloidosis?

A lung mass showing amyloid in SjD may reflect systemic amyloid or local/focal amyloid. Interdisciplinary assessment is recommended (Fraenkel et al., PMID 34101376). Organ systems involved will guide the expertise needed.

Immunohistochemistry and molecular studies are needed to define if there is an associated lymphoproliferative process, and the type of amyloid fibrils present (Egashira et al., PMID 24224588, Benson et al., PMID 34766859).

Lymphoproliferative disorders in SjD can be polyclonal, oligoclonal or monoclonal. B-cell-centric pathways predominate, but T-cell disorders also occur.

Management options will flow from determining the specifics in an individual case, and clinical status of the patient. If the nodule/lung mass has been exc...