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Diagnosis and typing of systemic amyloidosis: The role of abdominal fat pad fine needle aspiration biopsy.

Halloush RA, Lavrovskaya E, Mody DR, Lager D, Truong L - Cytojournal (2010)

Bottom Line: SA typing using cell block sections was successful in three, un-interpretable in one, and negative in two cases.FPFNA for SA is not as good as previously reported.A negative result of FPFNA does not exclude SA.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Pathology, The Methodist Hospital, Houston TX.

ABSTRACT

Introduction: Systemic amyloidosis (SA) has a broad nonspecific clinical presentation. Its diagnosis depends on identifying amyloid in tissues. Abdominal fat pad fine needle aspiration (FPFNA) has been suggested as a sensitive and specific test for diagnosing SA.

Materials and methods: Thirty-nine FPFNA from 38 patients (16 women and 20 men, age range 40-88 years) during a 15-year period were reviewed. Smears and cell blocks were stained with Congo red (CR). A panel of antibodies (serum amyloid protein, serum amyloid A, albumin, transthyretin, kappa light chain and lambda light chain) was used on six cell blocks from five patients. The FNA findings were correlated with clinical and histological follow-up.

Results: FPFNAs were positive, confirmed by CR in 5/39 (13%), suspicious in 1/39 (3%), negative in 28/39 (72%), and insufficient for diagnosis in 5/39 (13%) of cases. In all the positive cases, SA was confirmed within 2-16 weeks. Among the 28 negative cases, SA was diagnosed in 21, the rest were lost to follow-up. Among the insufficient cases, SA was diagnosed in four and one was lost to follow-up. Specificity was 100%, whereas sensitivity was 19%. SA typing using cell block sections was successful in three, un-interpretable in one, and negative in two cases.

Conclusion: FPFNA for SA is not as good as previously reported. This may be due to different practice setting, level of experience, diagnostic technique, or absence of abdominal soft tissue involvement. A negative result of FPFNA does not exclude SA. Immune phenotyping of amyloid is possible on cell block.

No MeSH data available.


Related in: MedlinePlus

Amyloid sandwiched between two layers of fibrin. Amyloid has an amorphous pink appearance, compared to the deeply pink-red wavy appearance of fibrin (H and E, original magnification × 400)
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Figure 0004: Amyloid sandwiched between two layers of fibrin. Amyloid has an amorphous pink appearance, compared to the deeply pink-red wavy appearance of fibrin (H and E, original magnification × 400)

Mentions: Positive cases demonstrated faintly eosinophilic, glassy homogeneous material along the contour of adipocytes in smears [Figure 1a]. The same type of material was also noted in the cell block sections, in which cases it was noted not only around adipocytes but also focally in the wall of small blood vessels [Figure 2a]. The Congo red stain highlighted this material in each case in both smears and cell block sections, which also showed apple green birefringence by polarized microscopy [Figures 1b and 2b–d]. This type of material was differentiated from fibrin or hyalinized connective tissue frequently seen in the cell block sections by its characteristic location, a glassier and less eosinophic appearance, and Congo red stain positivity [Figure 2b]. In each of the positive cases, both smears and cell blocks were available and amyloid was noted in both types of tissue preparations.


Diagnosis and typing of systemic amyloidosis: The role of abdominal fat pad fine needle aspiration biopsy.

Halloush RA, Lavrovskaya E, Mody DR, Lager D, Truong L - Cytojournal (2010)

Amyloid sandwiched between two layers of fibrin. Amyloid has an amorphous pink appearance, compared to the deeply pink-red wavy appearance of fibrin (H and E, original magnification × 400)
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2822170&req=5

Figure 0004: Amyloid sandwiched between two layers of fibrin. Amyloid has an amorphous pink appearance, compared to the deeply pink-red wavy appearance of fibrin (H and E, original magnification × 400)
Mentions: Positive cases demonstrated faintly eosinophilic, glassy homogeneous material along the contour of adipocytes in smears [Figure 1a]. The same type of material was also noted in the cell block sections, in which cases it was noted not only around adipocytes but also focally in the wall of small blood vessels [Figure 2a]. The Congo red stain highlighted this material in each case in both smears and cell block sections, which also showed apple green birefringence by polarized microscopy [Figures 1b and 2b–d]. This type of material was differentiated from fibrin or hyalinized connective tissue frequently seen in the cell block sections by its characteristic location, a glassier and less eosinophic appearance, and Congo red stain positivity [Figure 2b]. In each of the positive cases, both smears and cell blocks were available and amyloid was noted in both types of tissue preparations.

Bottom Line: SA typing using cell block sections was successful in three, un-interpretable in one, and negative in two cases.FPFNA for SA is not as good as previously reported.A negative result of FPFNA does not exclude SA.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Pathology, The Methodist Hospital, Houston TX.

ABSTRACT

Introduction: Systemic amyloidosis (SA) has a broad nonspecific clinical presentation. Its diagnosis depends on identifying amyloid in tissues. Abdominal fat pad fine needle aspiration (FPFNA) has been suggested as a sensitive and specific test for diagnosing SA.

Materials and methods: Thirty-nine FPFNA from 38 patients (16 women and 20 men, age range 40-88 years) during a 15-year period were reviewed. Smears and cell blocks were stained with Congo red (CR). A panel of antibodies (serum amyloid protein, serum amyloid A, albumin, transthyretin, kappa light chain and lambda light chain) was used on six cell blocks from five patients. The FNA findings were correlated with clinical and histological follow-up.

Results: FPFNAs were positive, confirmed by CR in 5/39 (13%), suspicious in 1/39 (3%), negative in 28/39 (72%), and insufficient for diagnosis in 5/39 (13%) of cases. In all the positive cases, SA was confirmed within 2-16 weeks. Among the 28 negative cases, SA was diagnosed in 21, the rest were lost to follow-up. Among the insufficient cases, SA was diagnosed in four and one was lost to follow-up. Specificity was 100%, whereas sensitivity was 19%. SA typing using cell block sections was successful in three, un-interpretable in one, and negative in two cases.

Conclusion: FPFNA for SA is not as good as previously reported. This may be due to different practice setting, level of experience, diagnostic technique, or absence of abdominal soft tissue involvement. A negative result of FPFNA does not exclude SA. Immune phenotyping of amyloid is possible on cell block.

No MeSH data available.


Related in: MedlinePlus