Metabolic storage diseases: amyloidosis

Abnormal serum carbohydrate antigen 19-9 levels in a patient with splenic retiform haemangioendothelioma concomitant with hepatic amyloidosis: A case report

BACKGROUND

Carbohydrate antigen 19-9 (CA 19-9) is a glycoprotein that is used as a reliable tool for monitoring pancreatic cancer. Serum CA 19-9 levels are increased in patients suffering from liver, lung, and other non-malignant diseases. Haemangioendothelioma is a vascular neoplasm with a borderline biological behaviour. However, no case of haemangioendothelioma has yet been reported to be associated with CA 19-9.

CASE SUMMARY

A 54-year-old Chinese man was referred to our hospital for discontinuous fatigue and unintentional weight loss for over one year. Laboratory investigations revealed an elevated serum CA 19-9 concentration of 39 IU/mL (reference interval, 0–37 IU/mL) over one year before admission. Afterwards, coagulopathy appeared, and the patient’s serum CA 19-9 concentration increased continuously. At the time of admission, abdominal pain and haemorrhagic shock burst occurred, and emergency medical operation was performed. Laboratory investigations conducted upon admission showed a serum CA19-9 concentration of 392.56 IU/mL. Surgical resection of the spleen was undertaken, and pathological examination showed retiform haemangioendothelioma. The patient developed jaundice ten days after surgical excision of the spleen. Pathological examination of needle biopsy samples of the liver yielded a diagnosis of hepatic amyloidosis.

CONCLUSION

We describe a rare case of splenic retiform haemangioenthelioma concomitant with hepatic amyloidosis. Physicians should note abnormal serum CA 19-9 levels with early symptoms of fatigue and unintentional weight loss.

Diagnostic histochemistry in hepatic pathology

Histochemistry has an important, continuing role in the current assessment of hepatic biopsies and resection specimens. The evaluation of connective tissue elements in the liver can be accomplished with such methods as the Masson trichrome, Snook reticulin, Vierhoff van Gieson, orcein, and Victoria blue stains. The results contribute to the diagnosis of acute and chronic hepatitis, submassive necrosis, venous outflow obstruction, steatohepatitis, and cirrhosis. Fat stains done on frozen sections of liver tissue are routinely performed in the evaluation of donor liver allograft biopsies. Iron stains such as Perls' method and the Prussian blue technique contribute to the recognition of hemochromatosis and hemosiderosis. The rhodanine, orcein, and Timm stains for copper are used in the characterization of chronic cholestatic liver disease and Wilson's disease. Labeling of carbohydrate-based moieties in various disorders is accomplished with the digested and undigested periodic acid-Schiff method, and Congo red or crystal violet stains can be employed to detect amyloid deposition. Lastly, evaluations of the thickness of the cell plates and continuity of the reticulin framework, as seen with the Snook reticulin stain, can contribute to the diagnostic separation of benign from malignant hepatocellular neoplasms.

Renal AA Amyloidosis in Patients with Type 2 Diabetes Mellitus

Background

Type 2 diabetes mellitus (T2DM) is the leading cause of chronic kidney disease and a major cause of cardiovascular disease (CVD) mortality. Inflammation is closely involved in the pathogenesis of T2DM, and reactive amyloidosis occurs in the presence of chronic inflammation. We hypothesized that patients with T2DM may have a higher prevalence of renal AA amyloidosis (RAAA) and that this could contribute to worse atherosclerosis and CVD.

Materials and Methods

We analyzed 330 autopsy kidneys from patients with a previous T2DM diagnosis. The kidney tissue was evaluated in order to determine the presence of diabetic nephropathy and RAAA, and systemic vessels were evaluated for the presence of atherosclerosis.

Results

RAAA was detected in 9% of our study population and was associated with an increased risk for nodular sclerosis [OR (95% CI)] [11 (2.04-59.16)], for chronic ischemic cardiomyopathy [4.59 (2.02-10.42)], for myocardial infarction [3.41 (1.52-7.64)] as well as for aortic [4.75 (1.09-20.69)], coronary [3.22 (1.47-7.04)], and intrarenal atherosclerosis [3.84 (1.46-10.09)].

Conclusions

RAAA is prevalent in T2DM and is associated with worse CVD and renal disease, likely because RAAA is a marker of severe chronic inflammation.

[Amyloidosis in liver biopsies]

INTRODUCTION

We reassessed the histopathology and origin of amyloid in liver biopsies.

MATERIALS AND METHODS

All liver biopsies were retrieved from a series of 588 cases with histologically confirmed amyloidosis submitted between February 2006 and January 2009 to the Amyloid Registry of the Charité University Hospital. Liver biopsies had been fixed in formalin and embedded in paraffin. 3-5 microm thick paraffin sections were stained with hematoxylin and eosin and Congo red. Amyloid was classified immunohistochemically, using antibodies directed against amyloid P-component, AA amyloid, apolipoprotein AI, fibrinogen, lysozyme, lambda- and kappa-light chain, and transthyretin.

RESULTS

Amyloid was found in 46 liver biopsies (29 men, 17 women; mean age 60 years, range 34-87 years). Immunohistochemical classification succeeded in 42 cases. AL amyloidosis was present in 40 (87%) cases and was further categorized into AL amyloid of lambda-light chain origin in 26 (57%) cases, and kappa-light chain origin in 14 (30%) cases. ATTR and AA amyloidosis were found in a single patient each (2%). In 4 (9%) cases, amyloid remained unclassified.

CONCLUSIONS

Hepatic amyloidosis is most commonly AL amyloid of lambda- and kappa-light chain origin and is often associated with marked parenchymal atrophy.

The evaluation of the referral reasons of patients at a tertiary pediatric genetic center in Izmir, Turkey

Our study aimed to review and evaluate the referral reasons of patients at Department of Pediatric Genetics, Ege University, between 1998 and 2006. In total, 2342 patients were referred to the pediatrics outpatient clinic for dysmorphological examination and suspected genetic conditions. The files were evaluated retrospectively, and they were grouped into five categories. The subgroups included mental retardation (MR)-multiple congenital anomalies and isolated anomalies in 1472 (62.85%), syndromes that may be associated with cytogenetic abnormalities in 634 (27.07%), suspected single-gene disorders in 134 (5.72%), suspected microdeletion syndromes in 48 (2.05%), and other genetic conditions comprising complex multifactorial disorders and ambiguous genitalia in 54 (2.31%). These data have provided useful information on the frequency of different groups of genetic diseases, genetic causes of MR, and the feasibility of genetic services. In conclusion, genetic service should be encouraged among physicians and patients in addition to the diagnosis, prognosis, and disease management efforts.

Head and neck amyloidosis: a clinicopathologic study of 15 cases

Amyloidosis refers to the idiopathic, extracellular deposition of fibrillar proteins, termed amyloid, in tissues. Although amyloidosis is a rare disease, the head and neck region has been reported as a frequent site of amyloid deposits, accounting for approximately 19% of reported amyloid cases in one review. Fifteen cases of head and neck amyloid, excluding the brain, with clinical follow-up were identified in the Surgical Pathology files from 1985 to 2005 at Emory University Hospital. The histopathology, histochemistry, and patient follow-up were reviewed. Nine men and six women with an age range of 18-76 years (mean 55.7 years) were identified. The initial clinical presentation was dependent on the site of amyloid deposits. The clinical types of amyloidosis included localized amyloid deposits in the larynx and tongue, plasma cell dyscrasia associated AL amyloidosis, and hemodialysis-associated amyloidosis. Secondary amyloidosis developed in one patient with carcinoid tumor.