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Tekin B, Gilani SI, Dasari S, Theis JD, Rech KL, Dao LN, Cubilla AL, Herrera Hernandez LP, Jimenez RE, Cheville JC, Dispenzieri A, Howard MT, McPhail ED, Erickson LA, Guo R, Gupta S. Proteomic and Clinicopathologic Assessment of Penile Amyloidosis: A Single Institutional Review of 12 Cases. Am J Clin Pathol 2023; 160:303-313. [PMID: 37203248 DOI: 10.1093/ajcp/aqad054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 04/13/2023] [Indexed: 05/20/2023] Open
Abstract
OBJECTIVES There is a paucity of data on penile amyloidosis. We aimed to assess the frequency of different amyloid types in surgical specimens from the penis involved by amyloidosis and correlate relevant clinicopathologic parameters with proteomic findings. METHODS Since 2008, our reference laboratory has performed liquid chromatography/tandem mass spectrometry (LC-MS/MS) for amyloid typing. The institutional pathology archive and reference laboratory database were queried to retrospectively identify all penile surgical pathology specimens with LC-MS/MS results between January 1, 2008, and November 23, 2022. Archived H&E-stained and Congo red-stained sections were re-reviewed. RESULTS Twelve cases of penile amyloidosis were identified, which represented 0.35% (n = 3,456) of penile surgical specimens. AL-type amyloid was most frequent (n = 7), followed by keratin-type amyloid (n = 3) and ATTR (transthyretin)-type amyloid (n = 2). AL-type amyloid cases often showed diffuse dermal/lamina propria deposition, whereas all keratin-type amyloid cases were localized to the superficial dermis. Two cases with keratin-type amyloid had concomitant cutaneous findings (penile intraepithelial neoplasia and condyloma). CONCLUSIONS This series, the largest to date, demonstrates that penile amyloidosis has a heterogeneous proteomic landscape. To the best of our knowledge, this is the first study describing ATTR (transthyretin)-type penile amyloid.
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Affiliation(s)
- Burak Tekin
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, US
| | - Sarwat I Gilani
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, US
| | - Surendra Dasari
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, US
| | - Jason D Theis
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, US
| | - Karen L Rech
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, US
| | - Linda N Dao
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, US
| | | | | | - Rafael E Jimenez
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, US
| | - John C Cheville
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, US
| | - Angela Dispenzieri
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, US
| | - Matthew T Howard
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, US
| | - Ellen D McPhail
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, US
| | - Lori A Erickson
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, US
| | - Ruifeng Guo
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, US
| | - Sounak Gupta
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, US
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Singh J. Primary localized amyloidosis causing urethral stricture disease: a mimicker of urothelial carcinoma. J Surg Case Rep 2021; 2021:rjab201. [PMID: 34055291 PMCID: PMC8159262 DOI: 10.1093/jscr/rjab201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Accepted: 04/27/2021] [Indexed: 11/24/2022] Open
Abstract
We describe a case of mild lower urinary tract symptoms and microscopic hematuria in a 53-year-old-male with hypertension found to have urethral stricture disease suspicious for urothelial carcinoma. During the investigation, cystoscopy and biopsy demonstrated eosinophilic amyloid proteins consistent with primary localized urethral amyloidosis. No systemic evidence of amyloidosis was demonstrated. Following a trial of conservative management with serial dilatations, the patient elected to proceed with surgical management by anterior urethroplasty using an excision and primary anastomosis technique. The patient has done well with resolution of his symptoms and no further recurrence of urethral amyloid disease at ongoing follow up.
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Affiliation(s)
- Jas Singh
- Department of Surgery, Section of Urology, University of Manitoba, Winnipeg, Manitoba R3P 1Y4, Canada
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Sharma R, George VV. Transanal endoscopic microsurgery: The first attempt in treatment of rectal amyloidoma. World J Gastroenterol 2015; 21:1324-1328. [PMID: 25632208 PMCID: PMC4306179 DOI: 10.3748/wjg.v21.i4.1324] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Revised: 06/26/2014] [Accepted: 08/28/2014] [Indexed: 02/07/2023] Open
Abstract
Localized amyloidosis is characterized by amyloid protein deposition restricted to one organ or tissue without systemic involvement. Gastrointestinal manifestations of localized amyloidoma are unusual, which makes amyloidoma restricted to the rectum a very rare diagnosis requiring a high index of suspicion. We present a rare account for rectal amyloidoma with an unusual presentation of obstructive symptoms and its treatment using a sophisticated surgical modality, transanal endoscopic microsurgery (TEM), which resulted in complete excision of the lesion without hospitalization and complications. The successful treatment for this rectal amyloidoma using TEM emphasizes the need to broaden its application in the treatment of various rectal lesions while preserving organ function and decreasing recurrence.
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Fernandez-Flores A, Castañón-González JA, Guerrero-Ramos B, Castro-Gaytan A, Saeb-Lima M. Systemic amyloidosis presenting with glans penis involvement. J Cutan Pathol 2014; 41:791-6. [PMID: 25093941 DOI: 10.1111/cup.12378] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Revised: 07/28/2014] [Accepted: 07/29/2014] [Indexed: 11/28/2022]
Abstract
Penile amyloidosis has been reported on many occasions in the literature, but all of these have been forms of primary cutaneous amyloidosis. Systemic amyloidosis presenting with a penile ulcer as the first manifestation has not previously been reported. We present two patients in whom an ulcer of the glans penis was the first complaint that led to a diagnosis of systemic amyloidosis. In both patients, lambda light chain type amyloid was showed immunohistochemically. Both patients presented with other manifestations of systemic amyloidosis, including nail dystrophy characterized by onycholisis, trachyonychia and onychoschizia.
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Merika EE, Darling MΙ, Craig P, Paul M, Francis N, Lachmann H, Porter W, Bunker CB. Primary cutaneous amyloidosis of the glans penis. Two case reports and a review of the literature. Br J Dermatol 2013; 170:730-4. [PMID: 24125073 DOI: 10.1111/bjd.12682] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2013] [Indexed: 11/26/2022]
Abstract
BACKGROUND Primary cutaneous amyloidosis of the penis is a rare entity. OBJECTIVES We describe two cases of primary penile cutaneous amyloidosis presenting as localized lesions on the penis and not associated with systemic amyloidosis. METHODS A comprehensive literature review of all published cases. RESULTS The rarest form of cutaneous amyloidosis, nodular amyloidosis, is the most frequent presentation of penis-limited cutaneous amyloid with a low incidence of systemic disease progression. CONCLUSIONS Although primary nodular amyloidosis is a rare entity it seems to be the most frequent presentation of penile-limited cutaneous disease, with a low incidence of systemic involvement.
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Affiliation(s)
- E E Merika
- Faculty and Division of Medicine, Department of Dermatology, Chelsea & Westminster Hospital, 369 Fulham Road, London, SW10 9NH, U.K
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