**Author Listing - Lead/ Submitting Author (we will be communicating with this individual): Name, Institution, City and State where the work was done. Co-authors will be added in a separate section.**
Ellen Lewis, Tom Baker Cancer Center, Calgary, Alberta, Canada

**Main Body of the Abstract**
Background: AIns is a rare iatrogenic amyloidosis. Compared to more common types of amyloidosis it is unknown if AIns is associated with cancer development. We present a case of concomitant AIns and lymphoma.
Case Report: 70-year-old female with a 20-year history of DMII presented with abdominal pain, increasing insulin requirements, and an A1c of 10.2%. CT showed small-bowel mesenteric mass, subcutaneous fat density, and multiple mediastinal nodes. Core biopsy of the fat mass showed amyloid (Fig. 1) and mass spectrometry showed AIns. PET/CT showed multiple FDG-avid nodes in the chest and inguinal fossa. Later biopsy of an inguinal node showed grade 1-2/3 follicular lymphoma. A watch-and-wait approach was adopted, and insulin was rotated to thigh injection. Three-months post diagnosis, her A1c had improved, and insulin requirements decreased by 50%.
One-year post she reported acute-onset back pain with CT scan showing a paravertebral mass. Core biopsy demonstrated DLBCL. She underwent standard R-CHOP chemotherapy, with final restaging PET scan showing CMR.
Discussion and Summary: To our knowledge, this is the first case describing AIns and concurrent widespread nodal lymphoma. Certain types of amyloidosis, particularly AL, are associated with other cancers. The frequency of co-occurring AIns and malignancy is unknown. A case series of iatrogenic amyloid noted serum amyloid P-component (SAP) in most patients studied. SAP is associated with underlying autoimmune and inflammatory conditions and possible predisposition to cancer formation. SAP activation within AIns tissue may contribute to cancer pathogenesis and malignancy formation. Further research is needed to understand this possible association.



**Author Listing - Lead/ Submitting Author (we will be communicating with this individual): Name, Institution, City and State where the work was done. Co-authors will be added in a separate section.**
Ellen Lewis, Tom Baker Cancer Center, Calgary, Alberta, Canada

**Main Body of the Abstract**
**Background:** AIns is a rare iatrogenic amyloidosis. Compared to more common types of amyloidosis it is unknown if AIns is associated with cancer development. We present a case of concomitant AIns and lymphoma.
**Case Report:** 70-year-old female with a 20-year history of DMII presented with abdominal pain, increasing insulin requirements, and an A1c of 10.2%. CT showed small-bowel mesenteric mass, subcutaneous fat density, and multiple mediastinal nodes. Core biopsy of the fat mass showed amyloid (Fig. 1) and mass spectrometry showed AIns. PET/CT showed multiple FDG-avid nodes in the chest and inguinal fossa. Later biopsy of an inguinal node showed grade 1-2/3 follicular lymphoma. A watch-and-wait approach was adopted, and insulin was rotated to thigh injection. Three-months post diagnosis, her A1c had improved, and insulin requirements decreased by 50%.
One-year post she reported acute-onset back pain with CT scan showing a paravertebral mass. Core biopsy demonstrated DLBCL. She underwent standard R-CHOP chemotherapy, with final restaging PET scan showing CMR.
**Discussion and Summary:** To our knowledge, this is the first case describing AIns and concurrent widespread nodal lymphoma. Certain types of amyloidosis, particularly AL, are associated with other cancers. The frequency of co-occurring AIns and malignancy is unknown. A_ _case series of iatrogenic amyloid noted serum amyloid P-component (SAP) in most patients studied. SAP is associated with underlying autoimmune and inflammatory conditions and possible predisposition to cancer formation. SAP activation within AIns tissue may contribute to cancer pathogenesis and malignancy formation. Further research is needed to understand this possible association.



Concomitant Diagnosis of Insulin Derived Amyloidosis (AIns) and Lymphoma: A Case Report PC21 (#426)

We invite you to attend the XIX International Symposium on Amyloidosis to be held in Rochester, MN.

This symposium is organized as a hybrid meeting (with the focus on in-person) held from Sunday, May 26 through Thursday, May 30, 2024.

Together with the ISA Board and members of Mayo Clinic, a very attractive scientific hybrid program is being planned. The program will cover a variety of types of systemic amyloidosis: ATTR (hereditary and wild-type), AL (light-chain), AA and less frequent forms. There will be key lectures, specific symposia including those company sponsored, oral presentations and poster sessions of accepted abstracts.

COURSE DESCRIPTION
This program will provide a comprehensive review of state-of-the-art education in systemic amyloidosis: basic science, pathophysiology, diagnosis, current and emerging treatments. Scientific presentations will include competitive oral and poster abstracts. The rapid evolution of scientific discovery and expanding treatment options has created tremendous interest in the field and this meeting will fill and important gap in educating scientists and clinicians.