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Kato T, Muto H, Hishima T, Kawashima M, Nagai H, Matsui H, Shimada M, Hebisawa A, Doki N, Miyawaki S, Ohashi K. A 56-Year-Old Woman With Multiple Pulmonary Cysts and Severe Chest Pain. Chest 2019; 153:e105-e112. [PMID: 29731050 DOI: 10.1016/j.chest.2017.12.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Revised: 11/17/2017] [Accepted: 12/07/2017] [Indexed: 12/17/2022] Open
Abstract
A 56-year-old woman presented to our hospital with a 4-month history of worsening chest pain. She denied having any respiratory symptoms, such as dyspnea, sputum, cough, or hemoptysis, or any history of smoking or exposure to dusts. One year previously she had a vertebral fracture. There was no specific family history, including pulmonary or autoimmune diseases. Chest CT performed 3 years earlier showed multiple thin-walled pulmonary cysts, although no further investigations were performed.
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Affiliation(s)
- Takafumi Kato
- Hematology Division, Tokyo Metropolitan Ohtsuka Hospital, Tokyo, Japan; Center for Pulmonary Diseases, National Hospital Organization Tokyo National Hospital, Tokyo, Japan
| | - Hideharu Muto
- Hematology Division, Tokyo Metropolitan Ohtsuka Hospital, Tokyo, Japan; Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan.
| | - Tsunekazu Hishima
- Pathology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
| | - Masahiro Kawashima
- Center for Pulmonary Diseases, National Hospital Organization Tokyo National Hospital, Tokyo, Japan
| | - Hideaki Nagai
- Center for Pulmonary Diseases, National Hospital Organization Tokyo National Hospital, Tokyo, Japan
| | - Hirotoshi Matsui
- Center for Pulmonary Diseases, National Hospital Organization Tokyo National Hospital, Tokyo, Japan
| | - Masahiro Shimada
- Center for Pulmonary Diseases, National Hospital Organization Tokyo National Hospital, Tokyo, Japan
| | - Akira Hebisawa
- Division of Pathology, National Hospital Organization Tokyo National Hospital, Tokyo, Japan
| | - Noriko Doki
- Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
| | - Shuichi Miyawaki
- Hematology Division, Tokyo Metropolitan Ohtsuka Hospital, Tokyo, Japan
| | - Kazuteru Ohashi
- Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
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2
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Shah IA, Netto D, Ashfaq R, Krieger C. Waldenström's Macroglobulinemia Associated With Generalized AA-Amyloidosis. Int J Surg Pathol 2016. [DOI: 10.1177/106689699300100206] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The authors present a case of Waldenström's macroglobulinemia (WM) associated with generalized amyloidosis of amyloid-A type. A 77-year-old man with a 25-year history of degenerative joint disease and a 13-year history of WM died of multisystemic failure. At autopsy, generalized and severe amyloid deposits were detected. Special conventional stains and immunohistochemical examination revealed amyloid-A de posits, which are extinguishingly rare in WM. This is probably related to the disease being chronic, which results in excessive production of precursor protein. The detection of amyloid-A type fibrils was possible only through the application of the immunohis tochemical procedure. The authors emphasize using the immunohistochemical typing of amyloid deposits for the purpose of classification, therapy, and prognosis. Int J Surg Pathol 1 (2):123-128, 1993
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Affiliation(s)
- Ifat A. Shah
- Departments of Laboratory Service, Veterans Affairs Medical Centers, Dallas, Texas and Phoenix, Arizona, the University of Texas Southwestem Medical School, Dallas, Texas, and the Pathologisches Institut, University of Freiburg, Germany
| | - Dymphna Netto
- Departments of Laboratory Service, Veterans Affairs Medical Centers, Dallas, Texas and Phoenix, Arizona, the University of Texas Southwestem Medical School, Dallas, Texas, and the Pathologisches Institut, University of Freiburg, Germany
| | - Raheela Ashfaq
- Departments of Laboratory Service, Veterans Affairs Medical Centers, Dallas, Texas and Phoenix, Arizona, the University of Texas Southwestem Medical School, Dallas, Texas, and the Pathologisches Institut, University of Freiburg, Germany
| | - Christine Krieger
- Departments of Laboratory Service, Veterans Affairs Medical Centers, Dallas, Texas and Phoenix, Arizona, the University of Texas Southwestem Medical School, Dallas, Texas, and the Pathologisches Institut, University of Freiburg, Germany
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3
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Shtrasburg S, Gal R, Gruys E, Perl S, Martin BM, Kaplan B, Koren R, Nyska A, Pras M, Livneh A. An Ancillary Tool for the Diagnosis of Amyloid A Amyloidosis in a Variety of Domestic and Wild Animals. Vet Pathol 2016; 42:132-9. [PMID: 15753466 DOI: 10.1354/vp.42-2-132] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Immunohistochemistry, the standard method for diagnosing amyloid A (AA) amyloidosis, is limited in animals because it requires a large array of animal-specific anti-AA antibodies, not commercially available. The Shtrasburg method (SH method) is a highly specific and sensitive technique, helping in the diagnosis and determination of AA amyloidosis in humans. The aim of this study is to determine whether the SH method is applicable in the diagnosis of AA amyloidosis in a variety of animals. Tissue samples were obtained from animals suffering from spontaneous or experimentally induced AA amyloidosis (mice, hamsters, guinea pigs, cheetahs, cats, cows, ducks, a dog, a goose, a chicken, and a turaco). Detection of the amyloid and quantitative evaluation were performed using Congo red staining, and specific AA typing was performed by the potassium permanganate technique. The studied tissues were subjected to the SH method, which confirmed the AA nature of the amyloid deposit, by displaying in polyacrylamide gel electrophoresis protein bands consistent with the molecular weight of the species-specific AA, in all the animals examined, except mice, hamsters, and guinea pigs. N-terminal analysis of these bands corroborated their AA origin. We conclude that the SH method may be used as an ancillary simple tool for the diagnosis of AA amyloidosis in a large number of domestic and wild animals. Moreover, our findings further increase the feasibility of applying this method in humans.
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Affiliation(s)
- S Shtrasburg
- Heller Institute of Medical Research, Sheba Medical Center, Tel Hashomer 52621, Israel.
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4
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Rane S, Rana S, Mudrabettu C, Jha V, Joshi K. Heavy-chain deposition disease: a morphological, immunofluorescence and ultrastructural assessment. Clin Kidney J 2015; 5:383-9. [PMID: 26019812 PMCID: PMC4432403 DOI: 10.1093/ckj/sfs062] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2012] [Accepted: 04/26/2012] [Indexed: 11/13/2022] Open
Abstract
Heavy-chain deposition disease (HCDD) is the least common of the monoclonal immunoglobulin deposition diseases with only 24 reported cases in English literature, including the present case. The rarity of this disease merits its documentation. We present a case of HCDD from our archival material, who presented with rapidly progressive renal failure and nephrotic syndrome and was found to have nodular glomerulosclerosis on renal biopsy which on immunofluorescence and electron microscopy confirmed HCDD of immunoglobulin G1 type without any light-chain deposition. We also present an in-depth literature review on HCDD.
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Affiliation(s)
- Swapnil Rane
- Department of Histopathology , Postgraduate Institute of Medical Education and Research , Chandigarh , India
| | - Seema Rana
- Department of Histopathology , Postgraduate Institute of Medical Education and Research , Chandigarh , India
| | - Chetan Mudrabettu
- Department of Nephrology , Postgraduate Institute of Medical Education and Research , Chandigarh , India
| | - Vivekananda Jha
- Department of Nephrology , Postgraduate Institute of Medical Education and Research , Chandigarh , India
| | - Kusum Joshi
- Department of Histopathology , Postgraduate Institute of Medical Education and Research , Chandigarh , India
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5
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Biochemical properties and aggregation propensity of transforming growth factor-induced protein (TGFBIp) and the amyloid forming mutants. Ocul Surf 2014; 13:9-25. [PMID: 25557343 DOI: 10.1016/j.jtos.2014.04.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2013] [Revised: 04/01/2014] [Accepted: 04/08/2014] [Indexed: 02/07/2023]
Abstract
TGFBI-associated corneal dystrophies are characterized by accumulation of insoluble deposits of the mutant protein transforming growth factor β-induced protein (TGFBIp) in the cornea. Depending on the nature of mutation, the lesions appear as granular (non-amyloid) or lattice lines (amyloid) in the Bowman's layer or in the stroma. This review article emphasizes the structural biology aspects of TGFBIp. We discuss the tinctorial properties and ultrastructure of deposits observed in granular and lattice corneal dystrophic mutants with amyloid and non-amyloid forms of other human protein deposition diseases and review the biochemical and putative functional role of the protein. Using bioinformatics tools, we identify intrinsic aggregation propensity and discuss the possible protective role of gatekeepers close to the "aggregation-prone" regions of native TGFBIp. We describe the relative aggregation rates of lattice corneal dystrophy (LCD) and granular corneal dystrophy (GCD2) mutants using the three-parameter model, which is based on intrinsic properties of polypeptide chains. The predictive power of this model is compared with two other algorithms. We conclude that the model is able to predict the aggregation rate of mutants which do not alter overall net charge of the protein. The need to understand the mechanism of corneal dystrophies from the structural biology viewpoint is emphasized.
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Barnidge DR, Dasari S, Ramirez-Alvarado M, Fontan A, Willrich MAV, Tschumper RC, Jelinek DF, Snyder MR, Dispenzieri A, Katzmann JA, Murray DL. Phenotyping Polyclonal Kappa and Lambda Light Chain Molecular Mass Distributions in Patient Serum Using Mass Spectrometry. J Proteome Res 2014; 13:5198-205. [DOI: 10.1021/pr5005967] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- David R. Barnidge
- Department of Laboratory Medicine and Pathology, ‡Biomedical Statistics
and Informatics, §Department of Biochemistry and Molecular Biology, ∥Department of Immunology, and ⊥Department of
Medicine, Mayo Clinic, Rochester, Minnesota 55905, United States
| | | | | | - Adrian Fontan
- Department of Laboratory Medicine and Pathology, ‡Biomedical Statistics
and Informatics, §Department of Biochemistry and Molecular Biology, ∥Department of Immunology, and ⊥Department of
Medicine, Mayo Clinic, Rochester, Minnesota 55905, United States
| | - Maria A. V. Willrich
- Department of Laboratory Medicine and Pathology, ‡Biomedical Statistics
and Informatics, §Department of Biochemistry and Molecular Biology, ∥Department of Immunology, and ⊥Department of
Medicine, Mayo Clinic, Rochester, Minnesota 55905, United States
| | | | | | - Melissa R. Snyder
- Department of Laboratory Medicine and Pathology, ‡Biomedical Statistics
and Informatics, §Department of Biochemistry and Molecular Biology, ∥Department of Immunology, and ⊥Department of
Medicine, Mayo Clinic, Rochester, Minnesota 55905, United States
| | - Angela Dispenzieri
- Department of Laboratory Medicine and Pathology, ‡Biomedical Statistics
and Informatics, §Department of Biochemistry and Molecular Biology, ∥Department of Immunology, and ⊥Department of
Medicine, Mayo Clinic, Rochester, Minnesota 55905, United States
| | - Jerry A. Katzmann
- Department of Laboratory Medicine and Pathology, ‡Biomedical Statistics
and Informatics, §Department of Biochemistry and Molecular Biology, ∥Department of Immunology, and ⊥Department of
Medicine, Mayo Clinic, Rochester, Minnesota 55905, United States
| | - David L. Murray
- Department of Laboratory Medicine and Pathology, ‡Biomedical Statistics
and Informatics, §Department of Biochemistry and Molecular Biology, ∥Department of Immunology, and ⊥Department of
Medicine, Mayo Clinic, Rochester, Minnesota 55905, United States
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7
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Chan JKC. The wonderful colors of the hematoxylin-eosin stain in diagnostic surgical pathology. Int J Surg Pathol 2014; 22:12-32. [PMID: 24406626 DOI: 10.1177/1066896913517939] [Citation(s) in RCA: 181] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The hematoxylin-eosin (H&E) stain has stood the test of time as the standard stain for histologic examination of human tissues. This simple dye combination is capable of highlighting the fine structures of cells and tissues. Most cellular organelles and extracellular matrix are eosinophilic, while the nucleus, rough endoplasmic reticulum, and ribosomes are basophilic. This review discusses the spectrum, intensity, and texture of colors observed in H&E-stained slides to illustrate their value in surgical pathology diagnosis. Changes in color of the nuclei occur in the presence of nuclear pseudoinclusions (such as papillary thyroid carcinoma) or inclusions (such as viral infection, surfactant, immunoglobulin, and biotin). The color of the cytoplasm of spindly cells can provide clues to their nature, such as basophilic (fibroblast), eosinophilic (smooth muscle and others), and amphophilic (myofibroblast). Eosinophilic globules have diagnostic value for sclerosing polycystic adenosis of salivary gland, low-grade B-cell lymphoma, solid pseudopapillary tumor of pancreas, and inclusion body fibromatosis. Eosinophilic granules are characteristic of granular cells (lysosome-rich), oncocytic cells (mitochondria-rich), and cells with secretory products (including neuroendocrine cells). Eosinophilic crystals can be diagnostic of lymphoma/plasmacytoma and crystal-storing histiocytosis. Basophilic granules or inclusions are diagnostic of acinic cell carcinoma and malakoplakia (Michaelis-Gutmann bodies). Yellow or brown inclusions are characteristic of hyalinizing trabecular adenoma of thyroid (yellow bodies), brown bowel syndrome, and malignant melanoma. Extracellular eosinophilic deposits can be produced by many conditions, but amyloid and monoclonal immunoglobulin deposition disease are important considerations. Extracellular basophilic deposits may be seen in small cell carcinoma and systemic lupus erythematosus, but they differ in that the former is blue (nuclear material) while the latter is purple (nuclear material plus immunoglobulin).
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8
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Mulligan VK, Chakrabartty A. Protein misfolding in the late-onset neurodegenerative diseases: Common themes and the unique case of amyotrophic lateral sclerosis. Proteins 2013; 81:1285-303. [DOI: 10.1002/prot.24285] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2012] [Revised: 02/27/2013] [Accepted: 02/28/2013] [Indexed: 12/12/2022]
Affiliation(s)
| | - Avijit Chakrabartty
- Department of Biochemistry; Toronto Ontario M5G 1L7 Canada
- Department of Medical Biophysics; University of Toronto; Toronto Ontario M5G 1L7 Canada
- Campbell Family Institute for Cancer Research, Ontario Cancer Institute/University Health Network; Toronto Ontario M5G 1L7 Canada
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9
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Abstract
Extramedullary plasmacytoma (EMP) of the small intestine is an unusual plasma cell neoplasm in this anatomic region with only 61 cases described so far. Clinical suspicion is infrequent owing to its location and nonspecific manifestations such as abdominal pain, obstructive symptoms or even bleeding. Diagnosis is reached through histopathological examination coupled with immunohistochemistry of the endoscopic biopsy or surgical resection specimens. Nevertheless, the differential diagnosis between EMP, lymphoma and other kinds of tumors can sometimes be troublesome. The managements include surgery, radiotherapy or chemotherapy. Generally, the prognosis of EMP is favorable, but occasionally it may relapse, or progress to a plasma cell myeloma. EMP should therefore be followed-up for a long period after treatment. In this comprehensive review of the current literature, the patients' characteristics, clinical manifestations, diagnosis, differential diagnosis, treatment and outcome were discussed.
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Oberschmid B, Siebolts U, Mechtel D, Kreibich U, Beller A, Wickenhauser C. M protein deposition in the skin: a rare manifestation of Waldenström macroglobulinemia. Int J Hematol 2011; 93:403-405. [PMID: 21384096 DOI: 10.1007/s12185-011-0794-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2010] [Revised: 02/14/2011] [Accepted: 02/15/2011] [Indexed: 10/18/2022]
Affiliation(s)
| | - Udo Siebolts
- Institute of Pathology, University of Leipzig, Leipzig, Germany.
| | - Dirk Mechtel
- Department of Dermatology, Heinrich Braun Hospital, Zwickau, Germany
| | - Ute Kreibich
- Department of Internal Medicine, Heinrich Braun Hospital, Zwickau, Germany
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11
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Bhargava P, Rushin JM, Rusnock EJ, Hefter LG, Franks TJ, Sabnis SG, Travis WD. Pulmonary light chain deposition disease: report of five cases and review of the literature. Am J Surg Pathol 2007; 31:267-76. [PMID: 17255772 DOI: 10.1097/01.pas.0000213358.18380.d2] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Light chain deposition disease (LCDD) in the lung is a rare occurrence. We describe 5 new cases of this entity, review the literature, and compare pulmonary light chain deposits to pulmonary amyloidosis. In addition, we identified 17 patients with pulmonary LCDD in the literature with sufficient clinical information to allow evaluation of clinical presentation, laboratory findings, histologic appearance, and disease progression. In these 22 patients, 2 different histologic patterns were appreciated: diffuse and nodular. A parallel with the diffuse and nodular forms of pulmonary amyloidosis is suggested. The 10 patients with nodular LCDD had an overall better prognosis compared with the 12 patients with diffuse pulmonary LCDD. However, when compared to what is reported in the literature for nodular pulmonary amyloidosis, the patients with nodular LCDD had a higher incidence of an associated lymphoproliferative and/or plasma cell dyscrasia and renal failure. Light chain deposits in the lung are histologically similar to amyloid but are not Congophilic. Their electron microscopic appearance is distinctly different with fibrils in amyloid and granular deposits in LCDD. As the diffuse forms of LCDD and amyloidosis have a similarly poor prognosis, differentiating the 2 entities is probably not critical. However, when present as nodules, LCDD is more frequently associated with an underlying plasma cell dyscrasia or renal failure than is amyloidosis, and therefore the distinction may be clinically important.
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Affiliation(s)
- Parul Bhargava
- Department of Pathology at Beth Israel Deaconess Medical Center, Boston MA 02215, USA.
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12
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Paueksakon P, Revelo MP, Horn RG, Shappell S, Fogo AB. Monoclonal gammopathy: significance and possible causality in renal disease. Am J Kidney Dis 2003; 42:87-95. [PMID: 12830460 DOI: 10.1016/s0272-6386(03)00412-8] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Patients with monoclonal gammopathy can develop a variety of related renal lesions or possibly have kidney disease unrelated to their monoclonal gammopathy. We characterized the spectrum of renal diseases associated with monoclonal gammopathy and renal diseases. METHODS Patients who underwent renal biopsy and had monoclonal gammopathy on serum and/or urine electrophoresis and/or had a renal biopsy diagnosis related to paraprotein (cryoglobulinemic glomerulonephritis [CG], monoclonal immunoglobulin deposition disease [MIDD], light chain cast nephropathy [CN], or light chain amyloidosis [AL]) were identified. RESULTS One hundred twenty-one patients met the inclusion criteria and were classified as having renal disease related or unrelated to monoclonal gammopathy. Among 66 cases of renal disease related to monoclonal gammopathy, diagnoses were CG (30.3%), MIDD (28.8%), CN (19.7%), AL (19.7%), and CN plus MIDD (1.5%). Among patients with monoclonal gammopathy in serum and/or urine (n = 87), 32 patients (36.8%, included in listing above) had related renal disease. Among 55 patients with monoclonal gammopathy and unrelated renal disease (63.2% of all patients with monoclonal gammopathy), various lesions were found, including diabetic nephropathy (18.1%), focal segmental glomerulosclerosis (18.1%), arterionephrosclerosis (12.7%), membranous glomerulonephritis (9.0%), minimal change disease (7.3%), various immune complex diseases, interstitial nephritis, or nonspecific changes. CONCLUSION The majority of patients with serum and/or urine monoclonal gammopathy who undergo renal biopsy have disease unrelated to monoclonal gammopathy deposition. This likely reflects the high frequency of monoclonal gammopathy of undetermined significance in older patients and the frequent use of serum and/or urine protein electrophoresis as screening tools in adult patients with renal disease.
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Affiliation(s)
- Paisit Paueksakon
- Department of Pathology, Vanderbilt University Medical Center, Nashville, TN 37232, USA
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13
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Kameyama M, Ishikawa Y, Shibahara T, Kadota K. Plasma cell myeloma producing IgG, IgM, and IgA immunoglobulins in a cow. J Vet Diagn Invest 2003; 15:166-9. [PMID: 12661728 DOI: 10.1177/104063870301500212] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
A diagnosis of plasma cell myeloma was made in a 6-year-old Holstein cow that showed continuous nosebleed, progressing emaciation, and hyperglobulinemia. Necropsy revealed enlargement of the caudal mesenteric lymph nodes. Lymph nodes and spleen were infiltrated by neoplastic plasma cells. Renal lymph nodes, bone marrow, and kidneys also were affected. Amyloid-like material that was negative for Congo red was present in most of the affected lymph nodes. Congo red-positive amyloid material was noted in spleen, kidneys, liver, and adrenal glands. Neoplastic plasma cells exhibited immunohistochemical reactions for lambda-light chain and 3 classes of heavy chain but not for kappa-light chain. Nonamyloid deposits were labeled with antisera against lambda-light chain and heavy chains. Plasmacytoid cells, which stained positively for IgG, IgM, or IgA, were intermingled in all lesions. Production of 3 types of immunoglobulins may be caused by heavy-chain class switching, constantly occurring in certain proportions.
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Affiliation(s)
- Mamoru Kameyama
- Himeji Livestock Hygiene Service Center, 2-10-16 Taderahigashi, Himeji 670-0081, Japan
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15
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Abstract
Primary amyloidosis is a plasma cell dyscrasia in which insoluble immunoglobulin light chain fragments are produced and polymerize into fibrils that deposit extracellularly, causing visceral organ dysfunction and death. The disorder is rare. Its recognition requires understanding the association between nephrotic syndrome, cardiomyopathy, peripheral neuropathy, and hepatomegaly with amyloidosis. The most important screening test for amyloidosis is immunofixation of the serum and urine to detect a monoclonal immunoglobulin light chain. All patients need the diagnosis confirmed histologically. The least invasive source of tissue for amyloid detection is the subcutaneous fat. The most important prognostic factor is whether there is cardiac involvement, which is best assessed by echocardiography with Doppler studies. Therapies used include oral melphalan/prednisone and high-dose corticosteroids. High-dose chemotherapy followed by stem cell reconstitution seems to provide the highest reported response rates. Transplant is associated with unique morbidities not seen in the transplantation of patients with other hematologic malignancies.
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Affiliation(s)
- Morie A Gertz
- Division of Hematology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
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16
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Abstract
Amyloidosis is considered rare but has an incidence similar to that of Hodgkin's disease and chronic granulocytic leukemia. The diagnosis should be considered in any patient with unexplained nephrotic-range proteinuria, heart failure, peripheral neuropathy, or hepatomegaly. If a monoclonal protein is found in a patient with any of these clinical presentations, a biopsy should be performed and the specimen stained with Congo red. The simplest source of diagnostic material is subcutaneous fat tissue. Treatment usually consists of chemotherapy, which may be oral and low dose or high dose with stem cell rescue.
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Affiliation(s)
- M A Gertz
- Division of Hematology and Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
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17
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Kambham N, Markowitz GS, Appel GB, Kleiner MJ, Aucouturier P, D'agati VD. Heavy chain deposition disease: the disease spectrum. Am J Kidney Dis 1999; 33:954-62. [PMID: 10213655 DOI: 10.1016/s0272-6386(99)70432-4] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
A 45-year-old white woman was found to have microscopic hematuria during her annual physical examination. After a negative urologic workup, she returned 5 months later with nephrotic syndrome, renal insufficiency, and hypocomplementemia. Renal biopsy showed a nodular sclerosing glomerulopathy that could not be further characterized because of inadequate tissue for immunofluorescence. The patient returned 8 months later with chronic renal failure. A repeat renal biopsy showed deposits composed of immunoglobulin G (IgG) heavy chain and complement components C3 and C1 along glomerular, tubular, and vascular basement membranes, with negativity for kappa and lambda light chains, findings consistent with heavy chain deposition disease (HCDD). The heavy chain subclass was exclusively IgG3. Staining with monoclonal antibodies to epitopes of the constant domains of IgG heavy chain showed a CH1 deletion, indicating a truncated heavy chain. On review of the previously reported cases of HCDD, common clinical presentations include nephrotic syndrome, renal insufficiency, hematuria, and, in some cases, hypocomplementemia. In most patients, the hematologic disorder is mild, without overt myeloma. Light microscopy shows a nodular sclerosing glomerulopathy, and heavy chain deposits are detectable within basement membranes throughout the kidney by immunofluorescence and electron microscopy. There is no effective treatment for this condition, and virtually all patients progress to chronic renal failure.
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Affiliation(s)
- N Kambham
- Department of Pathology, Renal Pathology Laboratory, New York, NY, USA
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18
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Appenzeller P, Leith CP, Foucar K, Scott AA, Bigler CF, Thompson CT. Cutaneous Waldenstrom macroglobulinemia in transformation. Am J Dermatopathol 1999; 21:151-5. [PMID: 10218675 DOI: 10.1097/00000372-199904000-00007] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Waldenstrom macroglobulinemia is a low-grade B-cell lymphoproliferative disorder of the elderly with characteristic monoclonal IgM-producing neoplastic infiltrates of the bone marrow, lymph node, and spleen. Cutaneous manifestations are usually nonspecific such as purpura, ulcers, and urticarial lesions. These lesions are caused by hyperviscosity of the blood, immune complex-mediated vascular damage, paraprotein deposition, and amyloid deposition. Specific skin lesions occur rarely and generally consist of translucent, flesh-colored papules composed of monoclonal IgM deposits. Rarely, there may be violaceous lesions composed of low-grade lymphoplasmacytic infiltrates characteristic of Waldenstrom macroglobulinemia. Both cutaneous manifestations of the disease, as well as disease transformation to high-grade, large cell lymphoma are rare. We report two very unusual cases of Waldenstrom macroglobulinemia with documented skin disease that demonstrated transformation to high-grade lymphoma. Both patients were elderly men with long-standing Waldenstrom macroglobulinemia involving the bone marrow, who subsequently developed skin involvement by the disease. Waldenstrom macroglobulinemia can rarely manifest as cutaneous disease, sometimes as a high-grade transformation of low-grade Waldenstrom macroglobulinemia elsewhere. Distinction of cases of transformed Waldenstrom macroglobulinemia from de novo cutaneous large cell lymphoma may be important, because the two entities are likely biologically different.
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Affiliation(s)
- P Appenzeller
- Department of Pathology, University of New Mexico Health Sciences Center, Albuquerque, USA
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19
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Hamidou MA, Gires C, Moreau A, Martin S, Buzelin F, Grolleau JY. Lambda light chain deposition disease presenting as sicca syndrome. ARTHRITIS AND RHEUMATISM 1997; 40:587-8. [PMID: 9082951 DOI: 10.1002/art.1780400330] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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20
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Pambuccian SE, Horyd ID, Cawte T, Huvos AG. Amyloidoma of bone, a plasma cell/plasmacytoid neoplasm. Report of three cases and review of the literature. Am J Surg Pathol 1997; 21:179-86. [PMID: 9042284 DOI: 10.1097/00000478-199702000-00007] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Tumoral amyloidosis (amyloidoma) of bone is a rare condition characterized by the massive destructive deposition of AL amyloid in bones. We report three cases. The patients ranged in age from 45 to 78 years and had tumors located in the lumbar spine, scapula, and humeral head measuring 6.5 to 18 cm. The radiologic diagnosis was chondrosarcoma in two cases. Microscopically, there were large, rounded deposits of amorphous eosinophilic material surrounded by numerous giant cells and a sparse lymphoplasmacytic infiltrate. The deposits proved to be composed of AL amyloid showing potassium permanganate resistant congophilia. Immunohistochemistry showed immunoglobulin IgG lambda, IgG kappa, and IgM lambda monoclonality of the plasma cell and (in one case) lymphoid infiltrate. The tumors were classified by morphology and immunohistochemistry as solitary plasmacytomas of bone (two cases) and plasmacytoid lymphoma (one case). During the relatively short follow-up period, one patient progressed to symptomatic generalized amyloidosis and died, one patient died of recurrent tumor, and one patient is alive with no evidence of disease. An extensive review of the world literature showed 34 well-documented similar cases, occurring most often in the spine and skull, causing neurologic symptoms, tending to occur in middle-aged men and frequently progressing to generalized disease. Most if not all AL amyloidomas of bone represent solitary plasmacytomas of bone or plasmacytoid lymphomas.
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MESH Headings
- Aged
- Amyloid/analysis
- Amyloidosis/pathology
- Amyloidosis/therapy
- Anatomy, Cross-Sectional
- Bone Neoplasms/chemistry
- Bone Neoplasms/pathology
- Bone Neoplasms/therapy
- Fatal Outcome
- Female
- Humans
- Immunohistochemistry
- Leukemia, Lymphocytic, Chronic, B-Cell/chemistry
- Leukemia, Lymphocytic, Chronic, B-Cell/pathology
- Leukemia, Lymphocytic, Chronic, B-Cell/therapy
- Male
- Microscopy, Electron
- Middle Aged
- Plasmacytoma/chemistry
- Plasmacytoma/pathology
- Plasmacytoma/therapy
- Tomography, X-Ray Computed
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Affiliation(s)
- S E Pambuccian
- Department of Pathology, Lenox Hill Hospital, New York, New York, USA
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Affiliation(s)
- E Loucas
- Department of Dermatology, Tulane University Medical Centre, New Orleans, Louisiana 70112, USA
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22
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Affiliation(s)
- E Pascali
- Institute of General Clinical Medicine, University of Trieste, Cattinara Hospital, Italy
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23
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Zhou H, Linke RP, Schaefer HE, Möbius W, Pfeifer U. Progressive liver failure in a patient with adult Niemann-Pick disease associated with generalized AL amyloidosis. Virchows Arch 1995; 426:635-9. [PMID: 7655746 DOI: 10.1007/bf00192120] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
We report a case in which an adult form of Niemann-Pick disease (type B of NPD) was associated with a rapidly progressive generalized AL amyloidosis of kappa type. Both diagnosis were made by biopsy, the NPD by bone marrow biopsy and fibroblast culture, the amyloidosis by liver biopsy. Malignant non-Hodgkin lymphoma was not found. The patient, a 67-year-old woman, died from hepatic coma subsequent to a progressive liver failure. We discuss possible relations between the lysosomal storage disease and the development and rapid progression of amyloidosis.
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Affiliation(s)
- H Zhou
- Pathologisches Institut der Universität, Bonn, Germany
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Walley V, Kisilevsky R, Young I. Amyloid and the cardiovascular system: A review of pathogenesis and pathology with clinical correlations. Cardiovasc Pathol 1995; 4:79-102. [DOI: 10.1016/1054-8807(95)90411-l] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/1994] [Accepted: 01/23/1995] [Indexed: 12/30/2022] Open
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Ghiso J, Wisniewski T, Frangione B. Unifying features of systemic and cerebral amyloidosis. Mol Neurobiol 1994; 8:49-64. [PMID: 7916192 DOI: 10.1007/bf02778007] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Amyloidosis is a generic term for a group of clinically and biochemically diverse diseases that are characterized by the deposition of an insoluble fibrillar protein in the extracellular space. Over 16 biochemically distinct amyloids are known. Despite this diversity, all amyloids have a particular ultrastructural and tinctorial appearance, a beta-pleated sheet structure, and are codeposited with a group of amyloid-associated proteins. The most common amyloidosis is Alzheimer's disease (AD), where A beta is the main component of the amyloid. Recently it has been found that A beta exists as a normal soluble protein (sA beta) in biological fluids. This links AD more closely to some of the systemic amyloidoses, where the amyloid precursor is found in the circulation normally. Numerous mutations have been found in the A beta precursor (beta PP) gene, associated with familial AD. Many mutations are also found in some of the hereditary systemic amyloidoses. For example, over 40 mutations in the transthyretin (TTR) gene are associated with amyloid. However, both A beta and TTR related amyloid deposition can occur with no mutation. The pathogenesis of amyloid is complex, and appears to be associated with genetic and environmental risk factors that can be similar in the systemic and cerebral amyloidoses.
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Affiliation(s)
- J Ghiso
- Department of Pathology, New York University Medical Center, NY 10016
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Yowell RL, Hammond EH. Cardiac paraprotein associated with Waldenstrom's macroglobulinemia: a case report. Ultrastruct Pathol 1994; 18:229-32. [PMID: 8191631 DOI: 10.3109/01913129409016294] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
A case of myocardial paraprotein deposition in a patient with Waldenstrom's macroglobulinemia is presented. Routine light microscopy revealed diffuse widening of interstitial regions by pale eosinophilic material that had a grayish cast on trichrome stains and was Congo red negative. Immunofluorescence showed strong immunoglobulin M and kappa light chain staining around blood vessels but predominantly around myocytes. Ultrastructural examination revealed massive deposition of flocculent electron-dense material around myocytes and occasionally around blood vessels.
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Affiliation(s)
- R L Yowell
- LDS Hospital Electron Microscopy Laboratory, Salt Lake City, Utah
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Affiliation(s)
- E H Hammond
- Department of Pathology, LDS Hospital, Salt Lake City, Utah 84143
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Török L, Borka I, Szabó G. Waldenström's macroglobulinaemia presenting with cold urticaria and cold purpura. Clin Exp Dermatol 1993; 18:277-9. [PMID: 8348727 DOI: 10.1111/j.1365-2230.1993.tb02188.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
A case of Waldenström's macroglobulinaemia presenting with non-specific dermatological symptoms (cold urticaria and cold purpura) is described in a 37-year-old female patient. Progressive telangiectasia and spider naevi were also observed. Involvement of the skin may be explained by the presence of macroglobulins with cryoprotein-like qualities. This facilitated an early diagnosis.
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Affiliation(s)
- L Török
- Dermatology Department, County Hospital Bács-Kiskun, Kecskemét, Hungary
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29
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Armin AR, Rosenbaum L, Chapman-Winokur R, Hawkins ET. Intravascular immunoglobulin crystalloids in monoclonal cryoglubulinemia-associated dermatitis: ultrastructural findings. J Cutan Pathol 1993; 20:74-8. [PMID: 8468421 DOI: 10.1111/j.1600-0560.1993.tb01254.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
A 46-year-old woman developed polyarthritis, purpuric skin rashes, nasal septal perforation and marginal furrowing of corneas in 1980. Monoclonal IgG, kappa cryoglobulinemia was found in the patient's serum. No underlying lymphoproliferative disorder has been found in ten years since her original diagnosis. In 1991, she developed palpable purpura on both lower extremities with subsequent necrosis and ulceration. A skin biopsy revealed fibrin thrombi within capillaries in the papillary dermis, and immunofluorescence studies showed IgG and light chain kappa within the fibrin thrombi. An electron microscopy study showed intravascular immunoglobulin crystalloid structures with a mean diameter of 80.3A degrees (8.03 nm), mixed with fibrin and red blood cells. The exclusive vascular location of these crystalloids may have implication in the pathogenesis of skin lesions.
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Affiliation(s)
- A R Armin
- Department of Anatomic Pathology, William Beaumont Hospital, Royal Oak, MI
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30
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Pablos JL, Cogolludo V, Pinedo F, Carreira PE. Subcutaneous nodular amyloidosis in Sjögren's syndrome. Scand J Rheumatol 1993; 22:250-1. [PMID: 8235497 DOI: 10.3109/03009749309095133] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
We describe a female patient with primary Sjögren's syndrome (SS) associated with a subcutaneous tumor formed by amyloid surrounded by mature IgG-kappa plasma cells, in the absence of lymphoproliferation or amyloid deposit in other organs. This case represents an unusual presentation of localized amyloidosis, without systemic involvement. Together with other reported cases this suggests that only immunocytic and not reactive systemic amyloidosis develops in chronic SS patients.
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Affiliation(s)
- J L Pablos
- Department of Rheumatology, Hospital 12 de Octubre, Madrid, Spain
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31
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LeBoit PE, Solomon AR, Santa Cruz DJ, Wick MR. Angiomatosis with luminal cryoprotein deposition. J Am Acad Dermatol 1992; 27:969-73. [PMID: 1479103 DOI: 10.1016/0190-9622(92)70296-r] [Citation(s) in RCA: 51] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Angioendotheliomatosis has recently been separated into two types. Malignant angioendotheliomatosis is a lymphoma in which the neoplastic cells accumulate in vascular lumens. Reactive angioendotheliomatosis is a proliferation of capillaries that is less well characterized. OBJECTIVE Our purpose was to describe the clinical and histopathologic features of three cases of reactive angiomatosis in patients with cryoproteinemia. METHODS Clinical and histologic data were correlated. Immunoperoxidase staining and electron microscopy were used in the histologic evaluation. RESULTS All three cases showed tufts of capillaries with luminal deposits of cryoproteins. Immunohistochemical studies showed that the cellularity of the tufts was primarily caused by a proliferation of pericytes. CONCLUSION Cryoproteinemia can cause angiomatosis that simulates a vascular neoplasm.
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Affiliation(s)
- P E LeBoit
- Department of Pathology, University of California, San Francisco 94143-0506
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Faa G, Van Eyken P, De Vos R, Fevery J, Van Damme B, De Groote J, Desmet VJ. Light chain deposition disease of the liver associated with AL-type amyloidosis and severe cholestasis. J Hepatol 1991; 12:75-82. [PMID: 1901075 DOI: 10.1016/0168-8278(91)90913-v] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
A 67-year-old man with a 3-month history of jaundice presented with hepatomegaly. Laboratory studies revealed abnormal liver tests with raised bilirubin. Renal function was normal. Endoscopic retrograde cholangiopancreatography revealed normal extrahepatic bile ducts. Liver biopsy showed severe bilirubinostasis and a typical bile infarct. Laminar and globular deposits of PAS-positive diastase-resistant non-congophilic material were observed in the sinusoidal walls. In addition, congophilic material was detected in the portal tracts. Immunohistochemistry revealed the presence of lambda-light chain deposits both in the sinusoids and in the portal tracts. Collagens type I and IV and fibronectin appeared markedly increased in the perisinusoidal space. On electron microscopy, the deposited material in the Disse spaces was mainly composed of fibrils indistinguishable from amyloid, admixed with small amounts of granular electron-dense material. The similarities of light chain deposition disease and AL amyloidosis are discussed.
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Affiliation(s)
- G Faa
- Laboratorium voor Histo- en Cytochemie, Dienst Pathologische Ontleedkunde II, U.Z. St. Rafael, Leuven, Belgium
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Vital A, Vital C, Ragnaud JM, Baquey A, Aubertin J. IgM cryoglobulin deposits in the peripheral nerve. VIRCHOWS ARCHIV. A, PATHOLOGICAL ANATOMY AND HISTOPATHOLOGY 1991; 418:83-5. [PMID: 1846485 DOI: 10.1007/bf01600248] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
In a patient with Waldenström's macroglobulinaemia and peripheral neuropathy, direct immunofluorescence of a peripheral nerve revealed the presence of abundant IgM and kappa light chain deposits in the endoneurium. Electron microscopic examination showed the microtubular structure of these endoneurial deposits, which strongly suggested the presence of cryoglobulin; this was then found in the serum.
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Affiliation(s)
- A Vital
- Department of Pathology, Hôpital Pellegrin, Bordeaux, France
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Abstract
A renal biopsy of a 57-year-old man with nephrotic syndrome revealed marked glomerular deposition of Congo red-positive, bire-fringent material characteristic for amyloid. Ultrastructurally, however, this material is composed of nonbranching, haphazardly arranged fibrils of approximately three times the thickness of typical amyloid fibrils. To our knowledge, there has been no report of such a finding, and this unique case enlarges the morphologic spectrum of renal fibrillosis.
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Affiliation(s)
- Y Yoshikawa
- Department of Pathology, Baylor College of Medicine, Houston, TX
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36
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Abstract
Myeloma is a malignancy of plasma cells that are terminally differentiated B-lymphocytes. The clinical spectrum varies from the incidental discovery of a pathologically raised monoclonal immunoglobulin on routine electrophoresis in asymptomatic patients to widespread skeletal involvement with incapacitating bone pain. Symptoms may result from a solitary tumor mass, described as an extramedullary plasmacytoma, in virtually any part of the body. Metabolic abnormalities commonly include hypercalcemia, elevated plasma urate levels, or the development of amyloidosis, all of which may disturb renal function. High paraprotein levels cause hyperviscosity, resulting in generalized debility and varying degrees of disturbed mental function. The natural history is determined by the mass of the tumor coupled with its unique biologic features. Median survival of unselected patients, without effective treatment but once symptoms are evident, is approximately 7 months; this period can be significantly prolonged with appropriate therapy. As a first step, urgent medical management is often necessary, centering on rehydration, correction of hyperviscosity, and reversal of metabolic defects, each of which may improve renal function. Over the longer term, specific antitumor drugs have extended median survival to approximately 30 months, and most regimens include a combination of melphalan and prednisone, with or without other cytotoxic drugs. Alternative forms of treatment include sequential hemibody irradiation, recombinant alpha interferon, and in suitably selected patients, high-dose chemoradiotherapy followed by bone marrow transplantation. The latter approaches offer promising management options and are currently the subject of evaluation in controlled clinical trials.
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Affiliation(s)
- P Jacobs
- Department of Haematology, University of Cape Town Leukaemia Centre, Groote Schuur Hospital, Observatory, South Africa
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