AMYLOIDOSIS: PART 3: Morphology, Diagnosis, Special stains, clinical features & Prognosis

The Part 3 of 3 parts tutorial on Amyloidosis.In this part i have described the morphology of different organs and diagnosis of amyloidosis. Visit http://ilovepathology.com/ for more topics in Pathology!
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AMYLOIDOSIS 3

Organs Involved in Amyloidosis
Primary Amyloidosis: Heart, GIT, Respiratory tract, peripheral nerves, skin and tongue
Secondary Amyloidosis: Kidney, liver, spleen, lymphnode adrenals and thyroid
Familial Mediterranean fever: Widespread.
Kidney, blood vessels , spleen, respiratory tract and liver
Morphology of Amyloidosis
Macroscopy/ Gross examination
May or may not be visible
If the deposits are too much, then the organ is enlarged, gray, waxy and firm.
Microscopic Examination
Extracellular
Can be adjacent to basement membranes, if the deposits are more, it encroaches on cells and destroy
Can be perivascular or vascular
Amorphous, eosinophilic, glassy/hyaline like
Should be differentiated from collagen, fibrin etc
v1. Congo Red Stain
Ordinary light: Amyloid appears red/pink
Polarizing microscopy: Apple Green Birefringence
Cross beta pleated sheet confirmation is the reason for this special staining property!
Diagnosis of amyloidosis
Despite strong suspicion, the diagnosis of systemic amyloidosis has to be confirmed by tissue diagnosis/ histopathological examination
Abdominal fat pad aspiration /biopsy is the preferred method for diagnosis.
Simplicity, low cost, less complications and good accuracy
Rectal and Gingival biopsy ( previously these were preferred) or labial salivary gland biopsy.
vRectal and Gingival biopsy ( previously these were preferred) or labial salivary gland biopsy.
To know the type of Amyloid: Immunohistochemistry is currently the standard method for amyloid typing in routine practice.

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