DarkProtoman

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Is the pathology of amyloidosis where the WBCs produce antibodies which somehow can't be degraded, turn into amyloid, and gum up your organs? Is it diagnosed by staining a tissue sample, such as bone marrow, with Congo red, and looking for an apple-green birefringence? Or is there another way of diagnosing it, w/o using stains, like flow cytometry? Could you diagnose it by dripping tincture of iodine onto the slide, if the lab was lacking Congo red?

Thanks!!!!
 

pathstudent

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Is the pathology of amyloidosis where the WBCs produce antibodies which somehow can't be degraded, turn into amyloid, and gum up your organs? Is it diagnosed by staining a tissue sample, such as bone marrow, with Congo red, and looking for an apple-green birefringence? Or is there another way of diagnosing it, w/o using stains, like flow cytometry? Could you diagnose it by dripping tincture of iodine onto the slide, if the lab was lacking Congo red?

Thanks!!!!
No
Yes
Yes but not flow. E.M. and X-ray crystalography
That would be hecka old school
 
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No
Yes
Yes but not flow. E.M. and X-ray crystalography
That would be hecka old school
Amyloidosis is an accumulation of amyloid protein, forming plaques in organs and tissues...so that amyloid has to come from *somewhere*; wikipedia says it can come from bence-jones proteins; isn't primary amyloidosis a complication of monoclonal B-cell proliferations? And can't you use thioflavin T --which produces red birefringence-- as an alternative to Congo red?

Thanks!
 

pathstudent

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didn't read your first question right.

There are a number of proteins in the body that have the beta-pleated sheet formation that all qualify as amyloid when they accumulate outside cells. Light chain is one of them. Calcitionin, Prealbumin, Beta-2 microglobulin and so called A-beta Amyloid are others.

Light Chain amyloidosis can be due to monoclonal plasma cells. I never heard of that thioflavin T.
 

Ale

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Rectal Bx or FNA/Bx of the abdominal fat pad are commonly biopsied places in patiens suspected for amyloid. Almost every histo lab has congo red. Bone marrow bx is an usual bx site to look for amyloid, but if the patients has indications for a BM bx and you see hyaline material in the BM Bx you can do the congo. Flow does not work, it is used to detect a B-cell monoclonal process. You can use urine electrophoresis to detect Bence Jones proteins, but this will not tell you if you have amyloidosis.

Congo red is a good stain to detect amyloid, but does not tell you what type of protein is forming the amyloid and probably you don't need it either.

If you are looking for amyloid in the atrium, diabetes, alzheimrer and/or prion dz you would only find it in the sepecific organ. These are the localized types. Medullary thyroid Ca can also produce amyloid.

Systemic amyloid can be deposited in almost all organs. The heart also is a common site to be affected in systemic amyloid.

The 7th ed of Robbins has a great section on chapter 6.
 

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Amyloidosis is a heterogenous group of diseases which are broadly classified as primary or secondary. The secondary amyloidosis can be due to lymphoproliferative diseases or any chronic inflammatory disease and it is most often systemic. The amyloidosis can be local organ limited or systemic.

The diagnosis of amyloid is best done by congo red with polarisation on a histology section. Other stains -Iodine can be used on the gross specimen, thioflavin T, treament with KMnO4 can distinguish b/w primary and secondary amyloid. EM would show non organised 10-20 nm fibrils. The secondary beta pleated structure is the fundamental characteristic of amyloid. Any protein which can make this secondary structure can give rise to amyloid.:thumbup: I recently had a case of gelatinous-drop like corneal dystrophy with corneal amyloid deposition. In this particular type of localised amyloidosis,lactoferrin derived from lacrimal gland secretion forms amyloid in the cornea.!!
:cool:
 
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Amyloidosis is a heterogenous group of diseases which are broadly classified as primary or secondary. The secondary amyloidosis can be due to lymphoproliferative diseases or any chronic inflammatory disease and it is most often systemic. The amyloidosis can be local organ limited or systemic.

The diagnosis of amyloid is best done by congo red with polarisation on a histology section. Other stains -Iodine can be used on the gross specimen, thioflavin T, treament with KMnO4 can distinguish b/w primary and secondary amyloid. EM would show non organised 10-20 nm fibrils. The secondary beta pleated structure is the fundamental characteristic of amyloid. Any protein which can make this secondary structure can give rise to amyloid.:thumbup: I recently had a case of gelatinous-drop like corneal dystrophy with corneal amyloid deposition. In this particular type of localised amyloidosis,lactoferrin derived from lacrimal gland secretion forms amyloid in the cornea.!!
:cool:
Woah...corneal amyloidosis sounds freaky! What's the PMHx, symptoms, gross path report, histology report, materials and methods, etc.? Was it featured on your institution's pathology grand rounds? Did it get into a pathology/ophthalmology journal? How did the pt.'s ophthalmologist finally treat him/her? Love to see a pic of those slides! Were the slides reviewed by the general AP/CP, or by an ophthalmopathologist --proper name for these guys, anyone?--?

Thanks!
 

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The patient underwent a corneal transplant. He presented to cornea service with complaints of central corneal opacity. The histology & CR stain showed corneal stromal deposits. The review of histology of his cornea from other eye , which was transplanted 3 years back also had amyloid. yeah, it was a cool case !! Signed out by ocular pathologist (AP+NP) :)
 
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The patient underwent a corneal transplant. He presented to cornea service with complaints of central corneal opacity. The histology & CR stain showed corneal stromal deposits. The review of histology of his cornea from other eye , which was transplanted 3 years back also had amyloid. yeah, it was a cool case !! Signed out by ocular pathologist (AP+NP) :)
That sounds so cool...in that strange Schadenfreude way we medical people look at diseases. And, what's NP? Do you mean CP?

Did this case get published, or featured in pathology/ophthalmology gand rounds?

Can a hematologist take additional training in hematopathology, or is hematopathology the sole province of pathologists?
 

pathfreak

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NP- neuropathologist. Ocular pathology is practised by either ophthalmologists who are board certified in pathology as well or by mostly neuropathologists who start signing out ocular pathology for one or other reason.

This case would be presented in ophthalmology grand rounds. Publication would need genetic studies . M1S1 mutations are seen in gelatinous drop like corneal dystrophy.

I think hematopathologists are mostly AP-CP trained pathologist. Dont know for sure..
 

Neddy

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That sounds so cool...in that strange Schadenfreude way we medical people look at diseases. And, what's NP? Do you mean CP?

Did this case get published, or featured in pathology/ophthalmology gand rounds?

Can a hematologist take additional training in hematopathology, or is hematopathology the sole province of pathologists?
There was a hematology-trained hemepath fellow at my former institution, but she had very specific goals that didn't involve signing out surg path cases, even heme.
 

yaah

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Heme-onc people are eligible to do hemepath fellowships. I am not sure what they can do with it though, whether they would be allowed to sign out cases and if so, what kind. Most heme-onc people are busy enough without having to worry about making the biopsy dx as well.
 

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NP- neuropathologist. Ocular pathology is practised by either ophthalmologists who are board certified in pathology as well or by mostly neuropathologists who start signing out ocular pathology for one or other reason.

This case would be presented in ophthalmology grand rounds. Publication would need genetic studies . M1S1 mutations are seen in gelatinous drop like corneal dystrophy.

I think hematopathologists are mostly AP-CP trained pathologist. Dont know for sure..
I think there are rare examples of people being AP only heme or CP only heme... but generally they are AP/CP-Heme
 
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NP- neuropathologist. Ocular pathology is practised by either ophthalmologists who are board certified in pathology as well or by mostly neuropathologists who start signing out ocular pathology for one or other reason.

This case would be presented in ophthalmology grand rounds. Publication would need genetic studies . M1S1 mutations are seen in gelatinous drop like corneal dystrophy.

I think hematopathologists are mostly AP-CP trained pathologist. Dont know for sure..
So, is the training for an ocular pathologist: MD->transitional year->ophthalmology residency->board certification in ophthalmology->ocular pathology residency->board certification in ocular pathology? Any subspecialities of ocular pathology?

Thanks!
 

yaah

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There is no ocular pathology residency. Maybe a fellowship, although I don't think there are that many of those officially, you would probably be able to create one with the right mentorship. You could also probably do it as part of another fellowship (like NP) with some extra training.

So the pathway is either MD->Pathology residency-> fellowship or MD->Transitional->ophtho->fellowship. I don't know though, ocular path isn't an accredited fellowship so you could probably do it as long as you were able to convince people you knew your stuff.
 
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There is no ocular pathology residency. Maybe a fellowship, although I don't think there are that many of those officially, you would probably be able to create one with the right mentorship. You could also probably do it as part of another fellowship (like NP) with some extra training.

So the pathway is either MD->Pathology residency-> fellowship or MD->Transitional->ophtho->fellowship. I don't know though, ocular path isn't an accredited fellowship so you could probably do it as long as you were able to convince people you knew your stuff.
Have you guys ever seen retinal herpes complicated by detachment?
 

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There is no accredited fellowship in ocular pathology, as far as I know. The ocular pathologists in 80's were mostly ophthalmologists (Dr. Green at Hopkins, Dr Jakobeic at MGH, Dr Eagle at Philly, Dr Klintworth at Emory & many more). Many of them were board certified in pathology also. There are very few new generation ocular pathologists( at Mayo,Hopkins, Emory, philly). Most of them are pathologists, who have been trained by the "old-school ocular pathologists" at some time in their career. So the track for ocular pathologist would be: MD-Path (AP+CP/AP+NP)-1-2 yr eye path training-ready to sign out PAM.

I have seen corneal ,conj herpes, dont know about retinal herpes. My guess is pathologist would never see it , surgeon would not enucleate eye with active herpes. And by the time eye would come out, active infection would have been taken care of by acyclovir. :)
 
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There is no accredited fellowship in ocular pathology, as far as I know. The ocular pathologists in 80's were mostly ophthalmologists (Dr. Green at Hopkins, Dr Jakobeic at MGH, Dr Eagle at Philly, Dr Klintworth at Emory & many more). Many of them were board certified in pathology also. There are very few new generation ocular pathologists( at Mayo,Hopkins, Emory, philly). Most of them are pathologists, who have been trained by the "old-school ocular pathologists" at some time in their career. So the track for ocular pathologist would be: MD-Path (AP+CP/AP+NP)-1-2 yr eye path training-ready to sign out PAM.

I have seen corneal ,conj herpes, dont know about retinal herpes. My guess is pathologist would never see it , surgeon would not enucleate eye with active herpes. And by the time eye would come out, active infection would have been taken care of by acyclovir. :)
I pretty much guessed that...why did I ask this?