Melvin Lau, MD Series Editor: Richard W. Goodgame, MD


April 09, 2008

Clinical Course and Outcome

The diagnosis of amyloidosis was not strongly suspected before liver biopsy. A liver biopsy was performed (Figures 3-5).

Figure 3.

Liver biopsy (Congo red): diffuse amyloid deposition is seen as amorphous pink material in the hepatic sinusoids.

Figure 4.

Liver biopsy (Congo red): amyloid deposition in the wall of an arteriole and in the surrounding nodule in a portal tract.

Figure 5.

Liver biopsy (H & E): In some areas of the biopsy the hepatocytes (deep blue) are replaced by the amyloid, seen as very pale blue.

The patient was discharged before all laboratory results returned. The histologic features were diagnostic of hepatic amyloidosis: sinusoidal, vascular, and nodular deposition of massive amounts of amyloid throughout the liver. The serum and urine protein electrophoresis did not show any monoclonal spike. To fulfill the diagnostic criteria (see Discussion) for AL amyloidosis, a bone marrow biopsy was planned. However, the patient was lost to follow-up.


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