05 Nov

Amyloidosis and Pleural Disease: Case Reports (Part 1)

Case 1
A 71-year-old woman presented in April 1987 for evaluation of a two-year history of progressive dyspnea on exertion and right pleural effusion. She had a two-year history of seronegative rheumatoid arthritis and Sjogren’s syndrome. In August 1986 she underwent a small bowel biopsy for evaluation of chronic diarrhea and was diagnosed as having amyloidosis of the bowel. A thoracentesis was performed and the fluid characteristics are summarized in Table 2. A Cope needle biopsy of the pleura was performed (Fig 1 through 4). The crystal violet stain demonstrated metachromasia typical of amyloid deposits; congophilia typical of amyloid deposits was demonstrated with the Congo red stain, which also demonstrated green birefringence with polarization, typical of amyloid deposits. buy ortho tri-cyclen
Case 2
A 55-yeaiM)ld woman was referred for evaluation of an eight-month history of dyspnea on exertion, fatigue, pedal edema, and right pleural effusion. Physical examination revealed a thin woman, with nontender submandibular lymphadenopathy and findings consistent with biventricular congestive heart failure. Right thoracentesis and a Cope needle biopsy of the pleura was performed. Special stains with Congo red and crystal violet demonstrated amyloid deposition in the pleura. A two-dimensional echocardiogram revealed biventricular infiltrative cardiomyopathy. Results of serum protein electrophoresis and immunoelectrophoresis were normal. Bone marrow was not examined.

Table 2—Pleural Fluid Characteristics 

Case ProteinRatio LDHRatio LDH,IU/L Type of Effusion Cause of Effusion
1 0.31 0.43 127 T CHF
2 0.33 0.40 60 T CHF
3 0.19 0.20 42 T CHF
4 0.54 0.74 134 E Treated CHF
5 0.60 0.65 220 E Idiopathic

Figure_1

Figure 1. Amyloid deposits involving adipose tissue and vessels in pleural biopsy specimen (hematoxylin-eosin, X 320). 

Figure_2

Figure 2. Amyloid deposits exhibiting metachromasia in pleural biopsy specimen (crystal violet, x 320). 

Figure_3

Figure 3. Congophilia demonstrated in amyloid deposits in pleural biopsy unpolarized specimen (Congo red, x 320). 

Figure_4

Figure 4. Polarization of pleural biopsy specimen demonstrating green birefringence typical of amyloid deposits; adjacent collagen is white (Congo red, x 560). 

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