Amyloidosis
Sanjay Kakar, MD
Key Facts
Etiology/Pathogenesis
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Liver involvement may be seen in AL, AA, and hereditary amyloidosis
Microscopic Pathology
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Sinusoidal pattern is more common in AL amyloidosis and vascular pattern in AA amyloidosis
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Distribution patterns show overlap and are not reliable for definite distinction between AL and AA amyloidosis
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Amyloid deposits are congophilic and show “apple green” birefringence under polarized light
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Birefringence is best demonstrated by turning light to maximum and pulling color filters out
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Immunohistochemistry for light chains and SAA help in further classification
TERMINOLOGY
Definitions
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Heterogeneous group of diseases characterized by deposition of glycoprotein fibrils in extracellular matrix and vessel walls
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Deposits composed of low molecular weight subunits (5-25 KDa) derived from normal serum proteins
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Liver involvement may be seen in all 3 types
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Primary, or AL, amyloidosis
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Deposits are composed of fragments of monoclonal light chains
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Occurs alone or associated with other hematologic diseases (plasmacytoma, multiple myeloma Waldenstrom macroglobulinemia)
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Liver involved in up to 70% of cases
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Hepatic involvement reflects advanced disease and denotes poor prognosis
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Secondary, or AA, amyloidosis
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Deposits are composed of fragments of serum amyloid A (SAA) protein, an acute phase reactant
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