Fat aspiration for amyloid

[LADoc00]

---

Members do not see this ad.

Anyone ever done this?? My experience has always been rectal biopsies for amyloid dx then I mentioned fat aspiration has less complications and is as specific (I think it is as specific and sensitive but I may be pullin that out my rear) to some docs in the line at the hospital coffee cart and I started getting specimens...unfortunately they werent listening to me because instead of needle aspirates they sent massive liposuction specimens!

mkay, anyone ever interpet these? They are kind a cytology-like specimen, so maybe pathdawg knows..

 

[pathdawg]

Anyone ever done this?? My experience has always been rectal biopsies for amyloid dx then I mentioned fat aspiration has less complications and is as specific (I think it is as specific and sensitive but I may be pullin that out my rear) to some docs in the line at the hospital coffee cart and I started getting specimens...unfortunately they werent listening to me because instead of needle aspirates they sent massive liposuction specimens!

mkay, anyone ever interpet these? They are kind a cytology-like specimen, so maybe pathdawg knows..

Yep. Amyloid can indeed be diagnosed by fna of abdominal fat tissue. Use a big needle and make thick smears. Amyloid is obviously best seen with Diff-Quik stain. I try to get a decent cell block so I can confirm with Congo Red.

This technique is certainly less invasive. I am not sure if its more sensitive and specific than rectal bx.

btw, this is the exact reason why I don't talk to clinicians in the coffee cart line. Sometimes, those guys are best left in the dark.

How's the new practice gig going, LA?

 

[LADoc00]

Yep. Amyloid can indeed be diagnosed by fna of abdominal fat tissue. Use a big needle and make thick smears. Amyloid is obviously best seen with Diff-Quik stain. I try to get a decent cell block so I can confirm with Congo Red.

This technique is certainly less invasive. I am not sure if its more sensitive and specific than rectal bx.

btw, this is the exact reason why I don't talk to clinicians in the coffee cart line. Sometimes, those guys are best left in the dark.

How's the new practice gig going, LA?

Hmm, okay here is what I did with the specimen: I took small pieces of fat and made thick smears, then took those thick smears and stained em with congo red. I cant see amyloid with DQ staining🙁 I lack the mad cyto skillz. I then took the remainder of fat and plan on well fixing that in formalin and making blocks to stain up from congo red in case I cant see anything on the thick smears. All in all Im making crap up as I go here.

My new gig is sweetness. I will never work in academics/government again! Was telling some docs yesterday, Im no longer a pathologist, Im a business man who's current business is pathology (that could change at any time). Was interesting, I actually starting doing something I have never heard another pathologist do, calling patients to collect on my billz. I get them on the phone, tell them all the mad training needed to do what I do, explain how America is sinking into the craphole because politicians and big government are robbing healthcare etc etc. and you know what? they love it. I had some old lady tell me she wanted me to be her primary care doc! LOL. Another person sent in a donation because he thought I was running for office.

 

[djmd]

I actually starting doing something I have never heard another pathologist do, calling patients to collect on my billz. I get them on the phone, tell them all the mad training needed to do what I do, explain how America is sinking into the craphole because politicians and big government are robbing healthcare etc etc. and you know what? they love it. I had some old lady tell me she wanted me to be her primary care doc! LOL. Another person sent in a donation because he thought I was running for office.

Personally, I think of you as more an Info-tainer.
Sounds like you need your own webpage, radio show and newspaper column.
Your department bills directly? For clinical tests or anatomic? I would have thought you would bill the hospital and they would bill the patients...?

 

[LADoc00]

Personally, I think of you as more an Info-tainer.
Sounds like you need your own webpage, radio show and newspaper column.
Your department bills directly? For clinical tests or anatomic? I would have thought you would bill the hospital and they would bill the patients...?

You have much to learn young padawa.

 

[djmd]

You have much to learn young padawa.

Tell me about it. Plus I am too old to begin the training.
I almost asked something about billing in the flow discussion, but back down because of the cluelessness of my current understanding 😕 .

 

[pathdawg]

I actually starting doing something I have never heard another pathologist do, calling patients to collect on my billz. I get them on the phone, tell them all the mad training needed to do what I do, explain how America is sinking into the craphole because politicians and big government are robbing healthcare etc etc. and you know what? they love it. I had some old lady tell me she wanted me to be her primary care doc! LOL. Another person sent in a donation because he thought I was running for office.

You da man. I love that you call up pts and ask for your money. Thats so awesome! Next, you should send over a Soprano's-like enforcer (I'm thinking a Paulie Walnuts-type) to collect.

 

[yaah]

Anyone ever done this?? My experience has always been rectal biopsies for amyloid dx then I mentioned fat aspiration has less complications and is as specific (I think it is as specific and sensitive but I may be pullin that out my rear) to some docs in the line at the hospital coffee cart and I started getting specimens...unfortunately they werent listening to me because instead of needle aspirates they sent massive liposuction specimens!

mkay, anyone ever interpet these? They are kind a cytology-like specimen, so maybe pathdawg knows..

****it I had to do one of these yesterday. Pretty painless and quick, I imagine easier to take as a patient than a rectal biopsy. Clinicians do some of them here, but usually we get called. I have yet to see a positive one so I don't know anything else. It's like those damn "Focus score please" biopsies of the lip to rule out Sjogren's. Either floridly positive or stark negative. You don't need a ****ing "focus score."

3 days into my FNA week and I have already decided I hate them. I feel like a clinician, running around and sticking needles in people and getting consents. WTF? I didn't go into pathology to do this. Even if once in awhile, like today, you get an FNA positive for chondrosarcoma.

 

[LADoc00]

Report: Either this person doesnt have amyloidosis or my ad lib protocol for fat smear congo red was a bust.... 😕

 

[yaah]

Report: Either this person doesnt have amyloidosis or my ad lib protocol for fat smear congo red was a bust.... 😕

We do congo red on the cell block. Not sure if other people do it differently...

 

[pathdawg]

Report: Either this person doesnt have amyloidosis or my ad lib protocol for fat smear congo red was a bust.... 😕

Either way, "next case".

 

[RyMcQ]

We do congo red on the cell block. Not sure if other people do it differently...

As chance would have it, I just got called about this. I did one FNA for amyloidosis during residency and that is the whole of my experience.

The surgeon is wondering how much fat to biopsy. I know they could do an FNA, but I don't trust them with to make a good smear.

Our cytology kind of sucks. Clinicians do the FNA and then squirt everything into cytolyte fixative. No one looks at Diff-Quik, which would help me immensely with my heme background. We get thin preps and cell blocks, and that is it for FNA.

Would there be a problem with getting a core biopsy of the fat pad? Is there some counterintuitive reason that this wouldn't work?

 

[LADoc00]

As chance would have it, I just got called about this. I did one FNA for amyloidosis during residency and that is the whole of my experience.

The surgeon is wondering how much fat to biopsy. I know they could do an FNA, but I don't trust them with to make a good smear.

Our cytology kind of sucks. Clinicians do the FNA and then squirt everything into cytolyte fixative. No one looks at Diff-Quik, which would help me immensely with my heme background. We get thin preps and cell blocks, and that is it for FNA.

Would there be a problem with getting a core biopsy of the fat pad? Is there some counterintuitive reason that this wouldn't work?

How technically would do you a core biopsy of abdominal fat?? Like using a coring gun/trucut type device they use to get liver/lung/LN type masses??

I thought the whole point with the aspirate is that its quick, out patient type work..of course it doesnt really seem to be working for me, but this guy also has no amyloid in a liver and GI bx so likely he doesnt even have amyloidosis...I need to a true positive to test this further...

 

[RyMcQ]

How technically would do you a core biopsy of abdominal fat?? Like using a coring gun/trucut type device they use to get liver/lung/LN type masses??

Something like that. I was thinking about a process similar to percutaneous breast core biopsies.

 

[yaah]

Personally, I think it would be easier to make a small incision, wedge out some fat with or without surface skin, and close 'em up. As it is, the aspiration takes probably longer than this anyway.

 

[Anna Plastic]

OK, I *really* have to get back to studying for boards, but saw this thread and couldn't resist. In my training program, we did fat pad FNA for amyloidosis, and everyone cursed them for the greasy, insensitive test it was (although it does have near 100% specificity). I was flipping through PubMed on this, and came across this abstract:

Diagn Cytopathol. 2004 Nov;31(5):300-6. Giorgadze, et al. Improved detection of amyloid in fat pad aspiration: an evaluation of Congo red stain by fluorescent microscopy.
Amyloid fat pad aspiration specimens for cases with a clinical suspicion of amyloid typically are stained with Congo red and examined by brightfield microscopy. Congophilia with apple-green birefringence by polarization microscopy (PM) is considered diagnostic for amyloid. Examination of Congo red-stained slides by fluorescent microscopy (FM) is considered by some to be a more sensitive detection method. In this study, we assessed the utility of this technique in cytopathology archival slides from abdominal fat pad aspirations previously stained with Congo red dye. Seventy-eight cases of abdominal fat pad aspirations collected during the last 5 yr and stained with the Congo red procedure were obtained from archival files. Additionally, 20 adipose tissue material slides prepared from the surgical pathology specimens were examined as controls. One representative smear was examined in each case using FM equipped with rhodamine excitation/absorption (540/570 nm) filters. Relevant clinical information was obtained in all cases. Twelve cases (15.4%) of the 78 fat pad aspiration cases were reported originally as positive by Congo red stain using polarization and apple-green birefringence as diagnostic criteria. On review, four cases were deemed unsatisfactory. By FM examination 29 of the 74 (39.2%) cases were reclassified as positive for amyloid. The results were confirmed by immunohistochemical stain for amyloid P protein and electron microscopy. A number of similar distinct fluorescence and immunohistochemical patterns were recognized in the positive cases. Minimally weak fluorescence in the adipose tissue was observed in the control cases. The use of FM in Congo red-stained fat pad smears can improve the detection of amyloid in cytology preparations.

They didn't really address the false positive rate of the fluorescent microscopy technique in the paper, but they do have pretty pictures of both polarizing and fluorescent microscopy of fat pad samples.