[Diagnostic problems of primary amyloidosis]

Surgical liver biopsy specimen of a women aged 58 with "biliary complaints" showed amyloid deposits of unknown nature. After a nearly two-years-course of the disease the patient died of cardiac and renal failure. Clinical findings and laboratory tests without abnormal serum globulins suggested primary amyloidosis. Morphologically amyloid was present in the heart, tongue, striated muscles and in many parenchymatous organs and endocrine glands. By electron microscopy no difference was revealed between the primary and secondary type, respectively. Differenciation between primary and secondary form of the amyloid could only be achieved by the demonstratin of resistance of the deposits against induced proteolysis with trypsin digestion under the polarization microscope. The same result was obtained in two cases of senile amyloidosis. The case presented indicates that increased level of pathologic globulins is not an obligatory phenomenon in primary amyloidosis.