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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

Fine-needle aspiration smears of amyloid, Diff Quik stain. (a) Smear shows abundant deep blue/purple colored amorphous material (×20). (b) On high power, this material resembles has tissue paper appearance, resembling keratin debris (×40)
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Figure 2: Fine-needle aspiration smears of amyloid, Diff Quik stain. (a) Smear shows abundant deep blue/purple colored amorphous material (×20). (b) On high power, this material resembles has tissue paper appearance, resembling keratin debris (×40)

Mentions: Immediate adequacy assessment during the procedure was deemed to be inadequate for all three passes. Needle rinses were collected for a cell block. Smears contained abundant material and showed small and large aggregates of thick orangeophilic material with a flaky texture on Papanicolaou stain and fluffy magenta colored acellular material on Diff Quik stain [Figures 2 and 3]. Smaller aggregates mimicked anucleated squamous cells whereas larger collections of this material were interpreted as proteinaceous fluid and keratin debris. Scattered spindled cells were also present. Cell block contained scant pink acellular proteinaceous material. The FNA was signed out as “anucleated squamous cells, and acellular keratin debris, consistent with epidermal inclusion cyst or dermoid cyst.”


Amyloidoma secondary to insulin injection: Cytologic diagnosis and pitfalls.

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

Fine-needle aspiration smears of amyloid, Diff Quik stain. (a) Smear shows abundant deep blue/purple colored amorphous material (×20). (b) On high power, this material resembles has tissue paper appearance, resembling keratin debris (×40)
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 2: Fine-needle aspiration smears of amyloid, Diff Quik stain. (a) Smear shows abundant deep blue/purple colored amorphous material (×20). (b) On high power, this material resembles has tissue paper appearance, resembling keratin debris (×40)
Mentions: Immediate adequacy assessment during the procedure was deemed to be inadequate for all three passes. Needle rinses were collected for a cell block. Smears contained abundant material and showed small and large aggregates of thick orangeophilic material with a flaky texture on Papanicolaou stain and fluffy magenta colored acellular material on Diff Quik stain [Figures 2 and 3]. Smaller aggregates mimicked anucleated squamous cells whereas larger collections of this material were interpreted as proteinaceous fluid and keratin debris. Scattered spindled cells were also present. Cell block contained scant pink acellular proteinaceous material. The FNA was signed out as “anucleated squamous cells, and acellular keratin debris, consistent with epidermal inclusion cyst or dermoid cyst.”

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