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Difference between revisions of "Amyloid"
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→Cardiac amyloidosis: SSA mk separate section
(→Cardiac amyloidosis: SSA mk separate section) |
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*Kidney disease (proteinuria) - associated with AL amyloidosis. | *Kidney disease (proteinuria) - associated with AL amyloidosis. | ||
==Senile systemic amyloidosis== | |||
*Abbreviated ''SSA''. | *Abbreviated ''SSA''. | ||
===General=== | |||
*Previously known as ''senile cardiac amyloidosis''.<ref name=pmid15645642>{{Cite journal | last1 = Ikeda | first1 = S. | title = Cardiac amyloidosis: heterogenous pathogenic backgrounds. | journal = Intern Med | volume = 43 | issue = 12 | pages = 1107-14 | month = Dec | year = 2004 | doi = | PMID = 15645642 }}</ref> | *Previously known as ''senile cardiac amyloidosis''.<ref name=pmid15645642>{{Cite journal | last1 = Ikeda | first1 = S. | title = Cardiac amyloidosis: heterogenous pathogenic backgrounds. | journal = Intern Med | volume = 43 | issue = 12 | pages = 1107-14 | month = Dec | year = 2004 | doi = | PMID = 15645642 }}</ref> | ||
*May be referred to as ''ATTR'' = amyloidosis TTR; in SSA the TTR is not mutated. | *May be referred to as ''ATTR'' = amyloidosis TTR; in SSA the TTR is not mutated. | ||
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*Found in approx. 25% of elderly over 80 years old,<ref name=pmid15645642/> and in upto 65% of patients over 90 years old.<ref name=pmid18329550>{{Cite journal | last1 = Sharma | first1 = PP. | last2 = Payvar | first2 = S. | last3 = Litovsky | first3 = SH. | title = Histomorphometric analysis of intramyocardial vessels in primary and senile amyloidosis: epicardium versus endocardium. | journal = Cardiovasc Pathol | volume = 17 | issue = 2 | pages = 65-71 | month = | year = | doi = 10.1016/j.carpath.2007.05.008 | PMID = 18329550 }}</ref> | *Found in approx. 25% of elderly over 80 years old,<ref name=pmid15645642/> and in upto 65% of patients over 90 years old.<ref name=pmid18329550>{{Cite journal | last1 = Sharma | first1 = PP. | last2 = Payvar | first2 = S. | last3 = Litovsky | first3 = SH. | title = Histomorphometric analysis of intramyocardial vessels in primary and senile amyloidosis: epicardium versus endocardium. | journal = Cardiovasc Pathol | volume = 17 | issue = 2 | pages = 65-71 | month = | year = | doi = 10.1016/j.carpath.2007.05.008 | PMID = 18329550 }}</ref> | ||
Gross pathology | Treatment: | ||
*No effective treatment. | |||
===Gross pathology=== | |||
*Grey/black "peppering" of left atrial endocardium - in fixed specimens.<ref name=pmid5829755>{{Cite journal | last1 = Pomerance | first1 = A. | title = Senile cardiac amyloidosis. | journal = Br Heart J | volume = 27 | issue = 5 | pages = 711-8 | month = Sep | year = 1965 | doi = | PMID = 5829755 | url=http://www.ncbi.nlm.nih.gov/pmc/articles/PMC469777/pdf/brheartj00340-0085.pdf }}</ref> | *Grey/black "peppering" of left atrial endocardium - in fixed specimens.<ref name=pmid5829755>{{Cite journal | last1 = Pomerance | first1 = A. | title = Senile cardiac amyloidosis. | journal = Br Heart J | volume = 27 | issue = 5 | pages = 711-8 | month = Sep | year = 1965 | doi = | PMID = 5829755 | url=http://www.ncbi.nlm.nih.gov/pmc/articles/PMC469777/pdf/brheartj00340-0085.pdf }}</ref> | ||
**"Peppering" should be present if severe. | **"Peppering" should be present if severe. | ||
===Microscopic=== | |||
Features: | |||
*Heart most commonly involved, followed by lungs and then by kidney (renal papilla). | *Heart most commonly involved, followed by lungs and then by kidney (renal papilla). | ||
*DDx of pink of H&E is important to remember: amyloid, muscle, collagen, clotted blood. | *DDx of pink of H&E is important to remember: amyloid, muscle, collagen, clotted blood. | ||
**Amyloid vs. Fibrosis? Subendocardial fibrosis may have rim of (diffusion) preserved myocytes. (???) | **Amyloid vs. Fibrosis? Subendocardial fibrosis may have rim of (diffusion) preserved myocytes. (???) | ||
*Amyloid often present in the subepicardial tissue<ref name=pmid18329550/> - less commonly affected by ischemia. | *Amyloid often present in the subepicardial tissue<ref name=pmid18329550/> - less commonly affected by ischemia. | ||
Images: | Images: | ||