scholarly journals Fatal pulmonary hemorrhage associated with vascular amyloid deposition in a cat

2018 ◽  
Vol 4 (2) ◽  
pp. 205511691881799
Author(s):  
Dianne I Mawby ◽  
Jacqueline C Whittemore ◽  
Robert L Donnell
Keyword(s):  
Complete Blood Count ◽  
Polarized Light ◽  
Pulmonary Hemorrhage ◽  
Coagulation Factor ◽  
Amyloid Deposition ◽  
Pulmonary Vasculature ◽  
Lymphoid Tissues ◽  
Initial Onset ◽  
Congo Red Staining ◽  
Pulmonary Amyloidosis

Case summary An adult female spayed Siamese-cross cat of unknown age was presented for bilateral hemorrhagic otorrhea. Nasopharyngeal polyps were diagnosed by CT and biopsy; bilateral ventral bulla osteotomies were performed. Episodic epistaxis, otic hemorrhage and hemoptysis with respiratory distress progressed over 18 months. Systolic blood pressure, complete blood count, plasma biochemistries, prothrombin time, partial thromboplastin time and coagulation factor 12, 9 and 8 activities were normal. Serial thoracic radiographs revealed patchy interstitial to alveolar patterns. Airway hemorrhage prevented diagnostic bronchoscopy. Respiratory hemorrhage was ultimately fatal. Amyloid deposition was identified in pulmonary vasculature, bronchial wall, lymphoid tissues, nasal-pharyngeal tissue and tympanic bullae based on microscopic examination and confirmed by Congo red staining with green birefringence under polarized light. Relevance and novel information Amyloidosis should be considered as a differential diagnosis in cats with spontaneous hemorrhage of the respiratory or otic tracts. Although systemic amyloidosis is associated with a grave prognosis, this case suggests that prolonged survival is possible after the initial onset of signs in cats with pulmonary amyloidosis.

scholarly journals A Unique Case of Combined Nodular and Tracheobronchial Amyloidosis

2021 ◽  
Vol 2021 (2) ◽  
Author(s):  
Feihong Ding ◽  
Yun Li ◽  
Shailesh Balasubramanian ◽  
Subha Ghosh ◽  
Jason N Valent ◽  
...  
Keyword(s):  
Light Chain ◽  
Systemic Disease ◽  
Amyloid Deposition ◽  
Misfolded Proteins ◽  
Immunoglobulin Light Chain ◽  
Anatomic Site ◽  
Unique Case ◽  
Pulmonary Amyloidosis ◽  
Immunoglobulin Light Chain Amyloidosis ◽  
Tracheobronchial Amyloidosis

ABSTRACT Amyloidosis is a heterogeneous group of diseases characterized by the extracellular deposition of misfolded proteins that can affect either systemically or locally confined to one system. Pulmonary amyloidosis is rare and can be classified into three forms according to the anatomic site of involvement: nodular pulmonary amyloidosis, tracheobronchial amyloidosis and diffuse alveolar-septal amyloidosis. The former two usually represent localized amyloid disease and the latter represents systemic disease. Typically lung parenchymal and tracheobronchial amyloidosis do not present together in localized forms of pulmonary amyloidosis. Here we report a unique case of localized pulmonary immunoglobulin light-chain amyloidosis, manifested as both parenchymal nodules and tracheobronchial amyloid deposition.

scholarly journals Histochemical Differential Diagnosis and Polarization Optical Analysis of Amyloid and Amyloidosis

2006 ◽  
Vol 6 ◽  
pp. 154-168 ◽  
Author(s):  
M. Bély
Keyword(s):  
Differential Diagnosis ◽  
Congo Red ◽  
Early Recognition ◽  
Polarized Light ◽  
Optical Analysis ◽  
Early Start ◽  
Amyloid Deposits ◽  
Protein Fibrils ◽  
Congo Red Staining ◽  
Sensitive Method

Amyloidosis is characterized by extracellular deposition of protein fibrils of chemically heterogeneous composition. Early recognition and identification of amyloid deposits allows an early start of therapy, which may entail a better prognosis. Congo red staining according to Romhányi (1971) is a highly specific and sensitive method for early microscopic recognition of amyloidosis. The main and most important types of amyloidosis may be distinguished by classic histochemical methods of performate pretreatment according to Romhányi (1979), or by KMnO4oxidation according to Wright (1977) followed by Congo red staining and viewed under polarized light. Differences in the speed of breakdown (disintegration) of amyloid deposits according to Bély and Apáthy allow a more precise distinction of various types of amyloid.

scholarly journals Amphotericin-B promotes leukocyte aggregation of nylon-wool-fiber- treated polymorphonuclear leukocytes

Blood ◽  
1981 ◽  
Vol 58 (3) ◽  
pp. 518-523 ◽  
Author(s):  
LA Boxer ◽  
LM Ingraham ◽  
J Allen ◽  
RS Oseas ◽  
RL Baehner
Keyword(s):  
Amphotericin B ◽  
Polymorphonuclear Leukocytes ◽  
Pulmonary Hemorrhage ◽  
Lactic Dehydrogenase ◽  
Wool Fiber ◽  
Pulmonary Vasculature ◽  
Pulmonary Tissue ◽  
Wool Fibers ◽  
Nylon Wool

Abstract Severe pulmonary reactions have been reported in patients receiving leukocyte transfusion and amphotericin-B. To study the interaction of amphotericin-B with polymorphonuclear leukocytes (PMN), purified human PMN were incubated with 200 mg of nylon wool fiber for 60 min either in the absence or presence of 2 mM EDTA. PMN were recovered in acid citrate dextrose solution and were suspended in balanced salt solution for determination of their aggregation properties. The cells exposed to nylon wool fibers without EDTA aggregated in response to concentration as low as 1.25 micrograms/ml of amphotericin-B. Cells initially treated with EDTA, however, failed to aggregate. Serum from a patient treated with amphotericin-B aggregated PMN exposed to nylon wool fiber but not control cells, whereas serum taken before amphotericin was given without effect on the PMN treated with nylon wool fiber. Amphotericin-B at 5 micrograms/ml failed to potentiate the release of beta- glucocuronidase or lactic dehydrogenase by PMN treated by nylon wool beyond that seen with exposure to the fibers alone. Rabbit peripheral blood was similarly incubated with nylon wool fibers and the recovered PMN were infused into recipient rabbits that had received 1 mg/kg of amphotericin-B intravenously 1 hr prior to the infusion of the leukocytes. Rabbits were sacrificed 30 min after transfusion of PMN, and their lungs were excised for histologic sectioning. Those rabbits receiving a combination of amphotericin-B and 4 x 10(7) nylon-wool- fiber-treated PMN had evidence of pulmonary hemorrhage and accumulation of leukocytes in the pulmonary vasculature whereas those animals who received such cells alone had normal appearing lung tissue. In summary, amphotericin-B at concentrations achievable in vivo enhanced the aggregation of PMN damaged by incubation with nylon fiber with subsequent accumulation of the phagocytes in pulmonary tissue.

scholarly journals Amyloid Deposition Within a Large Pelvic Chronic Expanding Hematoma

2020 ◽  
Vol 154 (Supplement_1) ◽  
pp. S66-S66
Author(s):  
D M Montoya-Cerrillo ◽  
J A Diaz-Perez ◽  
A E Rosenberg
Keyword(s):  
Past History ◽  
Rare Complication ◽  
Polarized Light ◽  
Outlet Obstruction ◽  
Amyloid Deposition ◽  
Systemic Amyloidosis ◽  
Pelvic Cavity ◽  
Amyloid Protein ◽  
Soft Tissue Neoplasm ◽  
Chronic Expanding Hematoma

Abstract Introduction/Objective Chronic expanding hematoma (CEH) is a relatively rare complication of trauma that is usually mistaken for a soft tissue neoplasm. The identification of amyloid protein is of paramount clinical importance to exclude serious conditions causing systemic amyloidosis. Methods The case was retrieved from the pathology files at the University of Miami Hospital (UMH). Morphology and special stains were reviewed. The study was approved by the Institutional Review Board at UMH. Results A 44-year-old man with past history of a stab wound in the left buttock in the 1990s, was admitted with worsening abdominal pain, constipation, urinary obstruction and acute kidney injury. CT-scan showed a large mass involving the left gluteal area and pelvic cavity involving urinary bladder causing outlet obstruction and bilateral hydroureteronephrosis. Multiple radiology-guided biopsies were taken all identifying only fibrin, blood cells, and necrotic inflammatory cells. Excision of the gluteal mass and drainage of the pelvic component was performed confirming the diagnosis of CEH. Amyloid deposition with congo red stain birefringence under polarized light was identified. The patient’s symptoms and renal function improved and have been under follow-up for 1 month. Conclusion We have identified amyloid protein deposition whiting a CEH. This is an unusual finding with no previous description found in our search. The identification of amyloid whiting tumor-like lesions is relevant to exclude causes of systemic amyloidosis.

scholarly journals AMYLOID GOITER AS THE FIRST RECOGNIZABLE MANIFESTATION OF IMMUNOGLOBULIN LIGHT CHAIN AMYLOIDOSIS

2019 ◽  
Vol 5 (5) ◽  
pp. e326-e329 ◽  
Author(s):  
John J. Orrego ◽  
Joseph A. Chorny
Keyword(s):  
Light Chain ◽  
Congo Red ◽  
Monoclonal Gammopathy ◽  
Amyloid Deposition ◽  
Systemic Amyloidosis ◽  
Cardiac Conduction ◽  
Light Chain Amyloidosis ◽  
Amyloid Goiter ◽  
Congo Red Staining ◽  
Bethesda System

Objective: Clinically apparent thyroid enlargement due to massive amounts of amyloid deposition, known as amyloid goiter, is rare. Endocrinologists should become familiar with this manifestation of systemic amyloidosis, which may be diagnosed by Congo red staining of the specimen obtained by fine-needle aspiration. Methods: We describe a 70-year-old man who presented with a slowly enlarging goiter. It was asymptomatic, predominantly left-sided, nontoxic, and multinodular with atypia of undetermined significance (Bethesda System category III) by cytology. The goiter tested negative using the ThyraMIR miRNA Gene Expression Classifier kit (eviCore Healthcare, Bluffton, SC). Results: Left thyroid lobectomy produced a 220-g specimen with nodular hyperplasia and prominent amyloid deposition confirmed by Congo red staining. Liquid chromatography tandem mass spectrometry detected a peptide profile consistent with light chain amyloid deposition of the lambda type, formerly called primary amyloidosis. In retrospect, he had been diagnosed with restrictive cardiomyopathy, cardiac conduction system disease, coronary artery disease, non-nephrotic range proteinuria, and chronic kidney disease, which had been attributed to his longstanding type 2 diabetes mellitus. Extensive workup subsequently demonstrated cardiac amyloidosis and monoclonal gammopathy of unknown significance, consistent with light chain amyloidosis. Conclusion: Amyloid goiter should be included in the differential diagnosis of enlarging goiters with Bethesda System category III cytology in patients with monoclonal gammopathy of uncertain significance, clinical manifestations of systemic amyloidosis, or known diagnosis of monoclonal cell dyscrasia.

scholarly journals A Concise Review of Amyloidosis in Animals

2012 ◽  
Vol 2012 ◽  
pp. 1-11 ◽  
Author(s):  
Moges Woldemeskel
Keyword(s):  
Microscopic Examination ◽  
Protein Misfolding ◽  
Polarized Light ◽  
Amyloid Deposit ◽  
Clinical Findings ◽  
Wild Animals ◽  
Concise Review ◽  
Underlying Causes ◽  
Congo Red Staining ◽  
Misfolding Diseases

Amyloidosis refers to a group of protein misfolding diseases characterized by deposition of a particular amyloid protein in various organs and tissues of animals and humans. Various types and clinical forms of amyloidosis, in which the pathology and pathogenesis is diverse depending upon the underlying causes and species affected, are reported in domestic and wild animals. The clinical findings are also quite variable consequent to the variation of the tissues and organs involved and the extent of functional disruption of the affected organs in various animal species. The affected organs may be enlarged and exhibit variable pallor grossly, or the amyloid deposit may be discernible only after microscopic examination of the affected tissues. Amyloid appears as a pale eosinophilic homogenous extracellular deposit in tissues. However, microscopic examination and Congo red staining with green birefringence under polarized light are needed to confirm amyloid and differentiate it from other apparently similar extracellular deposits such as collagen and fibrin. Identifying the type of amyloid deposit needs immunohistochemical staining, ultrastructural characterization of the amyloid fibril, and if feasible also genetic studies of the involved species for clinical and prognostic purposes. This paper provides a concise review of the occurrence of amyloidosis in domestic and wild animals.

scholarly journals Surveillance of Amyloidosis and other Diseases at Necropsy in Captive Trumpeter Swans (Cygnus Buccinator)

2005 ◽  
Vol 17 (3) ◽  
pp. 295-298 ◽  
Author(s):  
David K. Meyerholz ◽  
Yannick F. Vanloubbeeck ◽  
Shannon J. Hostetter ◽  
Dianna M. Jordan ◽  
Amanda J. Fales-Williams
Keyword(s):  
Parasitic Infection ◽  
Pulmonary Hemorrhage ◽  
Amyloid Deposition ◽  
Diagnostic Features ◽  
Diagnostic Laboratory ◽  
Cygnus Buccinator ◽  
Veterinary Pathology ◽  
Trumpeter Swan ◽  
Trumpeter Swans ◽  
Etiologic Diagnosis

The purpose of this study was to characterize the incidence and diagnostic features of amyloidosis and other diseases found at necropsy in captive trumpeter swans ( Cygnus buccinator). A search of Iowa State University's Department of Veterinary Pathology and Veterinary Diagnostic Laboratory databases yielded 31 trumpeter swan ( C. buccinator) necropsy cases from captive swans in protected habitats. Eleven of the 31 birds had amyloid deposition most commonly in the spleen (8 of 11), liver (7 of 11), and kidney (6 of 11) and less often in the pancreas (2 of 11) and adrenal gland (2 of 11). Amyloid deposition effaced normal tissue with adjacent necrosis and hemorrhage in severe cases. Amyloidosis was most often diagnosed in February and March. Other disease diagnoses in the trumpeter swans included aspergillosis (5 of 31, 16%); bacterial infection (5 of 31, 16%); lead toxicosis (3 of 31, 10%); gout (2 of 31, 6%); parasitic infection (2 of 31, 6%); vitamin E deficiency (1 of 31, 3%); trauma (1 of 31, 3%); and ventricular foreign body (1 of 31, 3%). Histopathologic, toxicologic, and microbiologic analyses did not define an etiologic diagnosis in the deaths of 9 trumpeter swans. In these cases, necropsy lesions included emaciation (5 of 9), enteritis (1 of 9), pulmonary hemorrhage (1 of 9), and no lesions (3 of 9). The number of trumpeter swan case submissions was greatest in January and February. This study provides a reference for veterinary diagnosticians concerning incidence and diagnostic features of amyloidosis and other diseases in captive trumpeter swans of the midwestern United States.

Pulmonary Extranodal Marginal Zone Lymphoma Of MALT Type Associated With Pulmonary Amyloidosis - Two Case Reports

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 5061-5061
Author(s):  
Jay Yang ◽  
Radhakrishnan Ramchandren ◽  
Jeffrey A. Zonder
Keyword(s):  
Malt Lymphoma ◽  
Light Chain ◽  
Marginal Zone ◽  
Pulmonary Nodules ◽  
Amyloid Deposition ◽  
Marginal Zone Lymphoma ◽  
Al Amyloidosis ◽  
Extranodal Marginal Zone Lymphoma ◽  
Pet Ct ◽  
Pulmonary Amyloidosis

Background Light chain (AL) amyloidosis is typically a systemic disease resulting from the malignant production and deposition of immunoglobulin light chain fragments in various tissues. Pulmonary AL amyloidosis is uncommon but can be seen concomitantly with non-Hodgkin lymphoma (NHL) as one of two distinct syndromes. In the more common presentation, a NHL, typically lymphoplasmacytic lymphoma or extranodal marginal zone lymphoma, produces a measurable serum/urine M-protein or light chain resulting in a systemic AL amyloidosis. There have also been sporadic reports of a less common, nodular form of pulmonary AL amyloidosis due to peritumoral amyloid deposition in patients with pulmonary extranodal marginal zone lymphoma of MALT type. This latter association is probably under-recognized. Here we present two cases from our institution with important diagnostic and therapeutic implications. Case 1 A 60 year old male was found to have bilateral pulmonary nodules. A percutaneous biopsy of the largest lesion in the left perihilar region revealed a MALT lymphoma. He was treated with eight cycles of R-CVP with a partial response. Significant residual disease led to further treatment with radioimmunotherapy using ibritumomab tiuxetan but without additional radiographic improvement. Due to concerns about the persistence of multiple pulmonary nodules, the original diagnostic biopsy was stained with Congo red to reveal amyloid deposition. No measurable monoclonal protein was present in the serum or urine. He has been observed now for an additional 4 years without evidence of progression. This patient has pulmonary amyloidosis in a nodular pattern in conjunction with a pulmonary MALT lymphoma. Pathologic review has shown the individual pulmonary nodules to be composed of both lymphoma and amyloid. The decrease in the size of the nodules with initial chemotherapy indicates a response to therapy, likely of the lymphoma component. The lack of response to typically effective additional therapy and the stability of the nodules over an extended period of time lead us to conclude that the residual nodules are likely to be primarily composed of amyloid. The initial lack of recognition of the amyloid component was disadvantageous and made determination of treatment response difficult. Case 2 A 37 year old male with HIV was found to have multiple pulmonary nodules. Pulmonary wedge resection revealed an extranodal marginal zone lymphoma of MALT type and amyloidosis that was confirmed as AL type by laser dissection and mass spectroscopy. Initial PET/CT demonstrated widespread FDG-avid lymphadenopathy and non-FDG-avid pulmonary nodules. There was no other evidence of systemic amyloidosis. The patient has been treated with three cycles of bendamustine and rituximab. Restaging PET/CT has shown a decrease in FDG-avid lymphadenopathy but no significant improvement in the size or number of pulmonary nodules. His chemotherapy is being continued. This patient has pulmonary AL amyloidosis in association with a stage IV extranodal marginal zone lymphoma. At first glance, the patient appears to have had a discordant response to initial treatment. However, the diagnosis of amyloidosis allows us to determine that his lymphoma has responded to therapy and the lack of response seen in the lungs is likely due to the presence of persistent amyloid. If the diagnosis of pulmonary amyloidosis was not made or known, this may have been mistakenly considered as refractory disease resulting in an unnecessary change in therapy. Conclusion The association between pulmonary amyloidosis and extranodal marginal zone lymphoma of MALT type may be more prevalent than previously recognized. All cases of pulmonary MALT lymphoma should be carefully examined for evidence of amyloid deposition. If proven, imaging studies, serum/urine electrophoresis and serum free light chain studies and organ assessments will help to determine whether the amyloid is a nodular form due to local deposition of light chain fragments or a systemic amyloidosis secondary to NHL. The former has a better prognosis than its systemic counterpart since the amyloidosis is typically localized to the lungs, has a more indolent course and is unlikely to involve other organs. As the above cases highlight, assessment of lymphoma response is greatly complicated by the concurrent presence of amyloid and PET/CT may be particularly useful in this scenario. Disclosures: No relevant conflicts of interest to declare.

scholarly journals A Rare Case of Systemic AL Amyloidosis with Muscle Involvement: A Misleading Diagnosis

2018 ◽  
Vol 2018 ◽  
pp. 1-5
Author(s):  
Fabrizio Accardi ◽  
Valentina Papa ◽  
Anna Rita Capozzi ◽  
Gian Luca Capello ◽  
Laura Verga ◽  
...  
Keyword(s):  
Turning Point ◽  
Amyloid Fibrils ◽  
Polarized Light ◽  
Rare Condition ◽  
Al Amyloidosis ◽  
Initial Manifestation ◽  
Muscle Involvement ◽  
Transmission Electron ◽  
Congo Red Staining ◽  
Progressive Weakness

Muscle involvement in AL amyloidosis is a rare condition, and the diagnosis of amyloid myopathy is often delayed and underdiagnosed. Amyloid myopathy may be the initial manifestation and may precede the diagnosis of systemic AL amyloidosis. Here, we report the case of a 73-year-old man who was referred to our center for a monoclonal gammopathy of undetermined significance (MGUS) diagnosed since 1999. He reported a progressive weakness of proximal muscles of the legs with onset six months previously. Muscle biopsy showed mild histopathology featuring alterations of nonspecific type with a mixed myopathic and neurogenic involvement, and the diagnostic turning point was the demonstration of characteristic green birefringence under cross-polarized light following Congo red staining of perimysial vessels. Transmission electron microscopy (TEM) confirmed amyloid fibrils around perimysial vessels associated with collagen fibrils. A stepwise approach to diagnosis and staging of this disorder is critical and involves confirmation of amyloid deposition, identification of the fibril type, assessment of underlying amyloidogenic disorder, and evaluation of the extent and severity of amyloidotic organ involvement.

scholarly journals Pulse Granulomas in Interval Appendectomy Specimens: Histochemical Identification of Cellulose Matter

2018 ◽  
Vol 12 (3) ◽  
pp. 765-772 ◽  
Author(s):  
Shinichi Ban ◽  
Akiko Fujii ◽  
Toshiro Takimoto ◽  
Kenta Kikuchi ◽  
Woodea Kang ◽  
...  
Keyword(s):  
Acute Appendicitis ◽  
Foreign Bodies ◽  
Polarized Light ◽  
Amyloid Deposition ◽  
Vascular Lesions ◽  
Interval Appendectomy ◽  
Foreign Materials ◽  
Histopathologic Findings ◽  
Histochemical Identification ◽  
Sirius Red

Pulse granuloma is a rare pathologic condition considered to be a benign inflammatory reaction to foreign materials originated from ingested legume matter. As for pulse granulomas of the gastrointestinal tract, association with diverticular diseases is relatively common, but only a few pulse granuloma cases associated with appendicitis have been reported. This report presents histopathologic findings of pulse granuloma lesions observed in two appendectomy cases, with some histochemical examinations of cellulose matter which is reportedly a major component to provoke pulse granuloma reaction. Our patients in both cases were girls in their teens, and they underwent interval appendectomy for acute appendicitis. Both appendectomy specimens revealed ruptured walls with inflammatory granulation tissue with marked foreign body reaction including characteristic collections of ring-like, curled ribbon-like, and/or lobulated nephrosclerosis-like hyaline structures and various foreign bodies, in which microorganisms or amyloid deposition were not identified. The presence of cellulose matter was suggested by Sirius red stain, the IKI (iodine potassium iodide)-H2SO4 method, and birefringence by polarized light. Appendectomy materials due to acute appendicitis would include pulse granuloma reaction provoked by ingested materials with cellulose. Pathologists should be familiar with the concept and histopathologic features of pulse granulomas to avoid misinterpreting them as vascular lesions and/or amyloid deposition, or any infectious organisms.

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