• Scariest Story Contest

    Now that it's getting close to Halloween, we're running a contest to hear your scariest stories! These can be scary stories that you've experienced or stories that you've heard and the story with the most reactions will win!

    JOIN CONTEST

Pathology of amyloidosis

DarkProtoman

Membership Revoked
Removed
10+ Year Member
Mar 8, 2008
64
0
Long Beach, CA
  1. Pre-Medical
    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

    Sound Kapital
    15+ Year Member
    Mar 17, 2003
    2,962
    78
    45
    1. Pre-Health (Field Undecided)
      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
       

      DarkProtoman

      Membership Revoked
      Removed
      10+ Year Member
      Mar 8, 2008
      64
      0
      Long Beach, CA
      1. Pre-Medical
        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!
         
        About the Ads

        pathstudent

        Sound Kapital
        15+ Year Member
        Mar 17, 2003
        2,962
        78
        45
        1. Pre-Health (Field Undecided)
          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

          Full Member
          10+ Year Member
          Jan 3, 2008
          69
          0
          1. Fellow [Any Field]
            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.
             

            pathfreak

            New Member
            10+ Year Member
            Nov 3, 2007
            10
            0
            1. Fellow [Any Field]
              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:
               

              DarkProtoman

              Membership Revoked
              Removed
              10+ Year Member
              Mar 8, 2008
              64
              0
              Long Beach, CA
              1. Pre-Medical
                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!
                 

                pathfreak

                New Member
                10+ Year Member
                Nov 3, 2007
                10
                0
                1. Fellow [Any Field]
                  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) :)
                   

                  DarkProtoman

                  Membership Revoked
                  Removed
                  10+ Year Member
                  Mar 8, 2008
                  64
                  0
                  Long Beach, CA
                  1. Pre-Medical
                    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

                    New Member
                    10+ Year Member
                    Nov 3, 2007
                    10
                    0
                    1. Fellow [Any Field]
                      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

                      ... can get you a toe.
                      10+ Year Member
                      Feb 21, 2007
                      108
                      0
                      1. Resident [Any Field]
                        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

                        Boring
                        Moderator Emeritus
                        Verified Expert
                        15+ Year Member
                        Aug 15, 2003
                        28,059
                        432
                        Fixing in 10% neutral buffered formalin
                        1. Attending Physician
                          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.
                           

                          djmd

                          an Antediluvian
                          7+ Year Member
                          15+ Year Member
                          Oct 3, 2001
                          1,515
                          1
                          1. Attending Physician
                            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
                             

                            DarkProtoman

                            Membership Revoked
                            Removed
                            10+ Year Member
                            Mar 8, 2008
                            64
                            0
                            Long Beach, CA
                            1. Pre-Medical
                              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

                              Boring
                              Moderator Emeritus
                              Verified Expert
                              15+ Year Member
                              Aug 15, 2003
                              28,059
                              432
                              Fixing in 10% neutral buffered formalin
                              1. Attending Physician
                                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.
                                 

                                DarkProtoman

                                Membership Revoked
                                Removed
                                10+ Year Member
                                Mar 8, 2008
                                64
                                0
                                Long Beach, CA
                                1. Pre-Medical
                                  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?
                                   

                                  pathfreak

                                  New Member
                                  10+ Year Member
                                  Nov 3, 2007
                                  10
                                  0
                                  1. Fellow [Any Field]
                                    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. :)
                                     

                                    DarkProtoman

                                    Membership Revoked
                                    Removed
                                    10+ Year Member
                                    Mar 8, 2008
                                    64
                                    0
                                    Long Beach, CA
                                    1. Pre-Medical
                                      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?
                                       
                                      About the Ads
                                      This thread is more than 13 years old.

                                      Your message may be considered spam for the following reasons:

                                      1. Your new thread title is very short, and likely is unhelpful.
                                      2. Your reply is very short and likely does not add anything to the thread.
                                      3. Your reply is very long and likely does not add anything to the thread.
                                      4. It is very likely that it does not need any further discussion and thus bumping it serves no purpose.
                                      5. Your message is mostly quotes or spoilers.
                                      6. Your reply has occurred very quickly after a previous reply and likely does not add anything to the thread.
                                      7. This thread is locked.