Liver AL amyloidosis as a possible cause of high liver stiffness values

Abstract

The liver is a common site of amyloid deposition in primary systemic amyloidosis. We report the case of a 52-year-old white woman complaining of hepatomegaly, high levels of alkaline phosphatase and serum gamma-glutamyl transferase. Other laboratory tests showed proteinuria with light-chain type lambda. Color Doppler ultrasonography showed an enlarged bright liver with hepatopetal portal blood flow. Fine-needle aspiration biopsy of abdominal fat, with Congo red stain, was positive for amyloid. No liver biopsy was performed, but transient elastography showed high liver stiffness values (75 kPa), suggestive of amyloid infiltration, as other causes of elevation had been ruled out by clinical, laboratory and radiological findings. Bone marrow morphology and immunoistochemistry confirmed low-grade plasmacytoma with amyloidosis.

Primary Hepatic Amyloidosis Presenting as Nodular Masses on the Background of Diuse Inltration and Extreme Liver Stiness on MR Elastography

“…Increased liver stiffness in hepatic amyloidosis has been described at sonoelastography [6,7]. However, MR elastographic ndings of liver amyloidosis have not been previously described.…”

Amyloidosis of the liver on shear wave elastography: case report and review of literature

“…For clinical use, values greater than 12.5 kPa are suggestive of cirrhosis. The values reported in amyloidosis using transient elastography are significantly higher at 75 kPa [47].…”

“…Amyloidosis has also been reported to increase liver stiffness, as measured by transient elastography [46,47] and MR-elastography [48]. In transient elastography, cutoff values for the diagnosis of cirrhosis have been reported to be between 11.6 and 19 kPa [19,26,[49][50][51].…”

Repeat doses of antibody to serum amyloid P component clear amyloid deposits in patients with systemic amyloidosis

“…Amyloid load was monitored as follows. Liver stiffness was measured by transient elastography (18,19) at baseline and days 14 and 42. Extra cellular volumes of the heart, liver, and spleen were measured by equilibrium MRI (20)(21)(22) at baseline and day 42.…”