Cystic Lung Disease from Protein Deposition: Pathogenesis and Associated Conditions
Purpose of Review: We explicate the development of cystic lung disease from the deposition of protein in the lung. The protein may be in the form of amyloid or non-amyloid (typically immunoglobulin-associated light chains) and is usually seen in the context of three entities: idiopathic light-chain deposition disease, Sjogren’s syndrome, and clonal lymphoplasmacytic proliferative disorders. A commonly observed and distinctive feature of the circumscribed cystic spaces is the presence of internal tissue septations. Recent Findings: The traditional causal association of lung cysts and the pathologic entity of lymphocytic interstitial pneumonitis is untenable. Instead, the development of cysts as a consequence of the degradation of lung extracellular matrix by metalloproteinases, the process initiated with the accumulation of macrophages around deposited protein, is a compelling alternative explanation. Summary: Lung cysts may be a consequence of parenchymal protein deposition. When internal septations are present, this particular pathogenesis should explicitly be considered, and the presence of associated clinical disorders further pursued.