Amyloidosis: Structure and Diagnosis

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Questions and Answers

What is the most common form of amyloidosis?

  • Reactive systemic AA amyloid (due to a systemic inflammatory disease)
  • Aβ amyloid (Alzheimer’s disease)
  • Î’2-macroglobulin amyloid (associated with hemodialysis)
  • Primary AL amyloid (due to a plasma cell disorder) (correct)

Which type of amyloid is associated with hereditary disease?

  • Alpha-ANF in atria of the heart
  • ATTR amyloid in peripheral and autonomic nerves (correct)
  • AA amyloid in rheumatoid arthritis
  • A-Cal amyloid in medullary thyroid cancer

Which of the following amyloid types is linked to a systemic inflammatory response?

  • Primary AL amyloid
  • Aβ amyloid
  • Î’2-macroglobulin amyloid
  • Reactive systemic AA amyloid (correct)

Which type of amyloid is commonly associated with patients undergoing hemodialysis?

<p>Î’2-macroglobulin amyloid (C)</p> Signup and view all the answers

Which amyloid type is not typically related to cancer?

<p>AA amyloid in rheumatoid arthritis (B)</p> Signup and view all the answers

Which of the following symptoms is NOT commonly associated with general manifestations of amyloid?

<p>Macroglossia (A)</p> Signup and view all the answers

What is a major consequence of amyloid infiltration into the kidney?

<p>Proteinuria (D)</p> Signup and view all the answers

Which of the following complications can arise from cardiac amyloidosis?

<p>Restrictive cardiomyopathy (A)</p> Signup and view all the answers

In amyloidosis, microhemorrhages are mainly caused by what pathological change?

<p>Increased fragility of blood vessels (B)</p> Signup and view all the answers

What type of treatment is commonly utilized for AL amyloidosis?

<p>Chemotherapy targeting malignant plasma cells (D)</p> Signup and view all the answers

The presence of massive macroglossia in an amyloidosis patient indicates what?

<p>Gastrointestinal involvement (C)</p> Signup and view all the answers

What is the main purpose of the Congo Red stain in diagnosing amyloidosis?

<p>To confirm amyloid presence via birefringence (C)</p> Signup and view all the answers

What does the prognosis generally indicate for patients diagnosed with amyloidosis?

<p>Generally poor outcomes (C)</p> Signup and view all the answers

Which treatment is utilized for the AA type of amyloidosis?

<p>Management of underlying inflammatory condition (D)</p> Signup and view all the answers

What is a common characteristic of amyloidosis in relation to its etiology?

<p>It can be localized or systemic (C)</p> Signup and view all the answers

What is the primary characteristic that amyloid proteins exhibit?

<p>Non-branching fibrils (D)</p> Signup and view all the answers

Which property is indicative of amyloid when using Congo Red staining?

<p>Red/salmon color in routine stain (D)</p> Signup and view all the answers

Which of the following forms of amyloid is associated with plasma cell disorders?

<p>AL amyloid (A)</p> Signup and view all the answers

What role does electron microscopy play in the diagnosis of amyloidosis?

<p>Detects the fibril structure at the ultrastructural level (D)</p> Signup and view all the answers

What is the sensitivity of an abdominal fat pad aspirate in diagnosing amyloidosis compared to a biopsy from affected organs?

<p>Lower than organ biopsy (B)</p> Signup and view all the answers

Why can't a diagnosis of amyloidosis be made without tissue?

<p>Tissue is required for accurate histological analysis (C)</p> Signup and view all the answers

How do amyloid fibrils typically appear under electron microscopy?

<p>Haphazardly arranged and non-branching (B)</p> Signup and view all the answers

What is the composition percentage of amyloid fibril proteins in amyloid?

<p>95% (C)</p> Signup and view all the answers

Which type of amyloid is specifically associated with Alzheimer’s disease?

<p>Aβ amyloid (D)</p> Signup and view all the answers

Which histological stain is essential for diagnosing amyloid deposits in tissue?

<p>Congo Red stain (D)</p> Signup and view all the answers

What characteristic appearance is seen with amyloid when viewed histologically?

<p>Smudgy, toothpaste-like appearance (A)</p> Signup and view all the answers

What is a less invasive method used to detect amyloid presence before deeper biopsies?

<p>Abdominal fat pad aspirate (A)</p> Signup and view all the answers

What kind of appearance do amyloid fibrils have in organ tissues when diagnosed with routine stains?

<p>Pale eosinophilic (C)</p> Signup and view all the answers

Which type of test is used for precise identification of specific types of amyloid?

<p>Mass spectrometry (D)</p> Signup and view all the answers

What is the key histologic stain used to confirm a diagnosis of amyloid in tissue?

<p>Congo Red (D)</p> Signup and view all the answers

Which type of amyloidosis is primarily associated with a plasma cell disorder?

<p>Primary Amyloidosis (AL) (A)</p> Signup and view all the answers

What is primarily used to type different kinds of amyloid proteins?

<p>Mass spectrometry (C)</p> Signup and view all the answers

What is the amyloid fibril protein associated with Reactive Systemic Amyloidosis?

<p>AA (amyloid associated protein) (B)</p> Signup and view all the answers

What condition is characterized by amyloid deposits in the atria of the heart?

<p>Isolated Atrial Amyloidosis (B)</p> Signup and view all the answers

Which amyloid fibril protein is primarily associated with Alzheimer's Disease?

<p>Aβ (β-amyloid) (A)</p> Signup and view all the answers

Which type of amyloidosis is characterized by amyloid deposits in the pancreatic islets?

<p>Diabetes Mellitus (B)</p> Signup and view all the answers

What etiology is commonly associated with Hemodialysis-Associated Amyloidosis?

<p>Long-term dialysis for renal failure (A)</p> Signup and view all the answers

What is the amyloid fibril protein involved in Hereditary Amyloid due to Familial Mediterranean Fever?

<p>AA (amyloid associated protein) (B)</p> Signup and view all the answers

Which type of amyloidosis is commonly seen in chronic inflammatory conditions?

<p>Reactive Systemic Amyloidosis (C)</p> Signup and view all the answers

What is the amyloid fibril protein in Systemic Senile Amyloidosis?

<p>TTR (transthyretin) (D)</p> Signup and view all the answers

Which amyloidosis involves deposits in multiple organs, primarily affecting the heart?

<p>Systemic Senile Amyloidosis (A)</p> Signup and view all the answers

In which condition is monoclonal light chains found in urine, associated with 'Bence-Jones proteinuria'?

<p>Primary Amyloidosis (AL) (B)</p> Signup and view all the answers

What is a common characteristic of localized amyloidosis?

<p>Discrete nodular masses in one specific organ (B)</p> Signup and view all the answers

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Study Notes

Amyloidosis Overview

  • Amyloidosis is characterized by extracellular deposits of fibrillary proteins causing tissue damage and functional issues.
  • Over 20 different proteins can form amyloid, all resulting in specific protein formations with classic tissue appearances.

Physical and Chemical Properties

  • Amyloid proteins are insoluble; they aggregate into non-branching fibrils measuring 7.5-10 nm in diameter.
  • Exhibit a characteristic β-pleated sheet configuration present in all amyloid types.

Diagnosis of Amyloidosis

  • Diagnosis requires tissue samples; non-invasive methods include abdominal fat pad aspirate.
  • Congo Red stain is the key histological test, showing a red/salmon color, with apple green birefringence under polarized light.

Composition of Amyloid

  • Composed of 95% fibril proteins, including:
    • AL (light chains from plasma cell disorders).
    • AA (associated with systemic inflammatory diseases like rheumatoid arthritis).
    • Aβ (β-amyloid linked to Alzheimer's disease).
  • Contains 5% amyloid P component and other glycoproteins.

More Advanced Diagnostic Techniques

  • Utilization of electron microscopy can identify amyloid fibrils at an ultrastructural level.
  • Mass spectrometry can precisely classify amyloid type by analyzing micro-dissected tissue.

Specific Types of Amyloid

  • Primary Amyloidosis (AL Type): Linked to plasma cell disorders producing monoclonal light chains, causing "Bence-Jones proteinuria."
  • Reactive Systemic Amyloidosis (AA Type): Associated with chronic inflammatory conditions, derived from serum amyloid A protein.
  • Hemodialysis-Associated Amyloidosis: Results from long-term dialysis leading to β-2 microglobulin accumulation.
  • LECT2 Amyloid: A recently recognized type; comprised of LECT2 protein, often affecting Hispanic populations.
  • Familial Mediterranean Fever: An autosomal recessive disorder resulting from excess IL-1 production related to pyrin gene mutations.

Clinical Manifestations

  • General symptoms include weakness, weight loss, and syncope.
  • Skin: Tan/pink papules and periorbital hemorrhage.
  • Kidney: Proteinuria and risk of renal failure due to amyloid infiltration.
  • Heart: Congestive heart failure and arrhythmias due to myocardial stiffness from amyloid deposits.
  • Gastrointestinal Tract: Malabsorption and enlargement of the tongue (macroglossia).
  • Vascular Involvement: Fragile blood vessels can cause severe hemorrhage.

Treatment Options

  • Treatment is type and etiology-dependent:
    • For AL type, chemotherapy and bone marrow transplants are common.
    • For AA type, managing the underlying inflammatory condition is critical.
    • Alzheimer's treatment includes investigational drugs targeting β-amyloid.
    • Developments in therapy like Eprodisate aim to inhibit amyloid deposition but have shown disappointing trial results.

Summary Points

  • Amyloidosis encompasses various systemic or localized forms and may include hereditary factors.
  • Tissue biopsy is necessary for diagnosis, with Congo Red staining being essential.
  • Prognosis can be poor, but ongoing research is developing new therapeutic options.

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