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Amyloidoma secondary to insulin injection: Cytologic diagnosis and pitfalls.

Grunes D, Rapkiewicz A, Simsir A - Cytojournal (2015)

Bottom Line: A subcutaneous abdominal mass was found on physical examination.We highlight the cytologic findings and diagnostic pitfalls.As the incidence of diabetes is increasing, cytopathologists may encounter this lesion more often on FNA.

View Article: PubMed Central - HTML - PubMed

Affiliation: Address: Department of Pathology, Division of Cytopathology, New York University School of Medicine, NYU Langone Medical Center, New York, USA.

ABSTRACT
Amyloidomas are rare tumors composed of deposits of amyloid protein not associated with systemic amyloidosis. They can present as an initial manifestation of a systemic disease process or can be a completely localized phenomenon. We present a case of amyloidoma associated with insulin injection site found incidentally in an 80-year-old male with multiple co-morbidities who presented with diverticulitis associated bleeding. A subcutaneous abdominal mass was found on physical examination. Imaging revealed a 5 cm × 1.6 cm homogenous subcutaneous lesion. A fine-needle aspiration (FNA) and core biopsy were performed under ultrasound guidance to reveal amorphous material proven to be amyloidosis at insulin injection sites (AIns) type amyloid. The patient had no treatment for this lesion and has had his care triaged to his more serious health problems. This is the first case of AIns type amyloidoma associated with insulin injection site reported in cytology literature. We highlight the cytologic findings and diagnostic pitfalls. As the incidence of diabetes is increasing, cytopathologists may encounter this lesion more often on FNA.

No MeSH data available.


Related in: MedlinePlus

Computed tomography image of abdominal wall lesion. Sections were taken at 5 mm intervals. Image 31 of series #2 shows greatest dimensions of lesion as well as its homogenous nature
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Figure 1: Computed tomography image of abdominal wall lesion. Sections were taken at 5 mm intervals. Image 31 of series #2 shows greatest dimensions of lesion as well as its homogenous nature

Mentions: An 80-year-old male with a significant medical history including myasthenia gravis diagnosed in 2006 controlled with azathioprine, coronary artery disease status postcoronary artery bypass graft in 1982, and long standing insulin dependent diabetes, first presented with a GI bleed due to diverticulitis. A mobile subcutaneous mass in the abdominal wall was noted on physical exam. CT scan showed a 5 cm × 1.6 cm homogenous mass [Figure 1]. An ultrasound guided FNA and core biopsy were done.


Amyloidoma secondary to insulin injection: Cytologic diagnosis and pitfalls.

Grunes D, Rapkiewicz A, Simsir A - Cytojournal (2015)

Computed tomography image of abdominal wall lesion. Sections were taken at 5 mm intervals. Image 31 of series #2 shows greatest dimensions of lesion as well as its homogenous nature
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4527044&req=5

Figure 1: Computed tomography image of abdominal wall lesion. Sections were taken at 5 mm intervals. Image 31 of series #2 shows greatest dimensions of lesion as well as its homogenous nature
Mentions: An 80-year-old male with a significant medical history including myasthenia gravis diagnosed in 2006 controlled with azathioprine, coronary artery disease status postcoronary artery bypass graft in 1982, and long standing insulin dependent diabetes, first presented with a GI bleed due to diverticulitis. A mobile subcutaneous mass in the abdominal wall was noted on physical exam. CT scan showed a 5 cm × 1.6 cm homogenous mass [Figure 1]. An ultrasound guided FNA and core biopsy were done.

Bottom Line: A subcutaneous abdominal mass was found on physical examination.We highlight the cytologic findings and diagnostic pitfalls.As the incidence of diabetes is increasing, cytopathologists may encounter this lesion more often on FNA.

View Article: PubMed Central - HTML - PubMed

Affiliation: Address: Department of Pathology, Division of Cytopathology, New York University School of Medicine, NYU Langone Medical Center, New York, USA.

ABSTRACT
Amyloidomas are rare tumors composed of deposits of amyloid protein not associated with systemic amyloidosis. They can present as an initial manifestation of a systemic disease process or can be a completely localized phenomenon. We present a case of amyloidoma associated with insulin injection site found incidentally in an 80-year-old male with multiple co-morbidities who presented with diverticulitis associated bleeding. A subcutaneous abdominal mass was found on physical examination. Imaging revealed a 5 cm × 1.6 cm homogenous subcutaneous lesion. A fine-needle aspiration (FNA) and core biopsy were performed under ultrasound guidance to reveal amorphous material proven to be amyloidosis at insulin injection sites (AIns) type amyloid. The patient had no treatment for this lesion and has had his care triaged to his more serious health problems. This is the first case of AIns type amyloidoma associated with insulin injection site reported in cytology literature. We highlight the cytologic findings and diagnostic pitfalls. As the incidence of diabetes is increasing, cytopathologists may encounter this lesion more often on FNA.

No MeSH data available.


Related in: MedlinePlus