Initial Diagnosis of Unsuspected Primary Amyloidosis (AL) by Liver Biopsy

Abstract

While the liver is commonly involved in systemic amyloidosis, review of the literature indicates that clinically evident hepatic amyloidosis is not usually encountered. Three patients with clinically unsuspected primary amyloid light chain (AL) type of amyloid osis diagnosed by liver biopsy are described. All patients presented with signs, symp toms, and biochemical abnormalities consistent with intrinsic liver disease. The first patient had cholestatic hepatitis with jaundice, the second had hepatomegaly and weight loss, and the third had cholestatic liver disease. All three liver biopsies showed extensive sinusoidal deposition of amyloid material that stained positively with Congo red with and without prior potassium permanganate digestion, consistent with AL type amyloid. Ultrastructural examination of one of the cases showed straight, non- branching fibrils having the characteristic appearance of amyloid. Immunocytochemi cal staining in another case revealed the hyaline material to be positive for lambda light chains and negative for kappa light chains. These cases demonstrate that primary amyloidosis can present with liver abnormalities that dominate the clinical picture and that liver biopsy may be the initial diagnostic procedure of unsuspected primary amyloidosis. Int J Surg Pathol 1 (1): 57-64, 1993

Spectral computation of reactive bi-directional hydromagnetic non-Newtonian convection flow from a stretching upper parabolic surface in non-Darcyporous medium

“…Basha et al [18] presented Keller box numerical solutions for entropy generation in tangent hyperbolic nanofluid flow from a circular geometry cylinder with nonlinear Boussinesq approximation, also computing isotherms and streamline distributions. Haddad et al [19] confirmed experimentally the important contributions of Brownian motion and thermophoresis in natural convection flows of nanofluids. Mustafa et al [20] used homotopy and MATLAB bvp4c quadrature to simulate numerically the Hiemenz stagnation flow of a nanofluid from an exponentially stretching sheet, noting that both temperature and the thermal boundary layer thickness are enhanced with greater Brownian motion and thermophoresis effects.…”

Acute liver failure due to primary amyloidosis in a nephrotic syndrome: a swiftly progressive course

“…As in other cases with clinically unsuspected primary amyloidosis,15 the diagnosis was made by liver biopsy. Bleeding diathesis may occur, due to factor X deficiency (amyloid fibrils binding in the liver and spleen), a decrease of vitamin K-dependent clotting factors, increased antithrombin activity fibrinolysis and intravascular coagulation.…”

Fine‐needle aspiration cytology of amyloid associated with nonneoplastic and malignant lesions

“…Diagnostic Cytopathology, Vol 18,No 4 ing renal-cell carcinoma, [51][52][53][54] medullary carcinoma of the thyroid, [19][20][21][22][23] multiple myeloma, 14,25,51,53 prolactinoma, 55 cervical carcinoma, 51,53,56 basal-cell carcinoma, 57,58 lymphoma, 51 esophageal carcinoma, 51,53 nasopharyngeal carcinoma, 59 vaginal squamous-cell carcinoma, 60 thymoma, 61 Hodgkin's disease, 51,53,62 plasmacytoma, 63 islet-cell adenoma, 64 and pheochromocytoma and parathyroid adenoma. 65 Whether in bone marrow or in other sites, amyloid may be associated with atypical plasma cells and lymphocytes, as seen in one of our cases.…”

“…Amyloid may be deposited in a wide variety of tissues and in various benign and malignant conditions. The appearance of amyloid and its associations in surgical biopsy material have been welldescribed; however, while reported in the surgical pathology literature, [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18] FNA cytology of amyloid and the association with a variety of neoplastic conditions, with the exception of medullary thyroid carcinoma [19][20][21][22] and plasma cell tumors, [23][24][25] have not been stressed. We report on 6 fine-needle aspiration (FNA) cases of amyloid from various body sites which occurred over a 6-yr period from July 1990-July 1996 at East Carolina University School of Medicine and the Pitt County Memorial Hospital, Greenville, NC.…”