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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

Core biopsy. (a) This core biopsy slide shows amorphous eosinophilic dense material (H and E, ×20). (b) The material is homogeneous and red with Congo stain (Congo, ×20). (c) The core biopsy shows apple green/yellow birefringence (Congo, under polarized light, ×40)
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Figure 4: Core biopsy. (a) This core biopsy slide shows amorphous eosinophilic dense material (H and E, ×20). (b) The material is homogeneous and red with Congo stain (Congo, ×20). (c) The core biopsy shows apple green/yellow birefringence (Congo, under polarized light, ×40)

Mentions: Core biopsy showed fragments of a cellular pink waxy material and hyalinized tissue [Figure 4a]. Cytokeratin stains were performed on the surgical specimen and were negative. Congo red stain was positive; green birefringence was seen under polarized light [Figure 4b]. Lambda and kappa immunohistochemical stains did not show restriction.


Amyloidoma secondary to insulin injection: Cytologic diagnosis and pitfalls.

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

Core biopsy. (a) This core biopsy slide shows amorphous eosinophilic dense material (H and E, ×20). (b) The material is homogeneous and red with Congo stain (Congo, ×20). (c) The core biopsy shows apple green/yellow birefringence (Congo, under polarized light, ×40)
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 4: Core biopsy. (a) This core biopsy slide shows amorphous eosinophilic dense material (H and E, ×20). (b) The material is homogeneous and red with Congo stain (Congo, ×20). (c) The core biopsy shows apple green/yellow birefringence (Congo, under polarized light, ×40)
Mentions: Core biopsy showed fragments of a cellular pink waxy material and hyalinized tissue [Figure 4a]. Cytokeratin stains were performed on the surgical specimen and were negative. Congo red stain was positive; green birefringence was seen under polarized light [Figure 4b]. Lambda and kappa immunohistochemical stains did not show restriction.

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