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A comprehensive panel of testing for amyloidosis.

Hong Tang1, Feifei Zhao2, Yingwei Zhu3

  • 1Department of Pathology, Jiangnan University Medical Center, Wuxi, Jiangsu, China.

Journal of Histotechnology
|September 10, 2025
PubMed
Summary

Accurate diagnosis of systemic amyloidosis relies on liver biopsy evaluation. Congo red staining is key, while laser microdissection with mass spectrometry offers superior typing specificity, especially for limited samples.

Keywords:
Congo red stainingLiverimmunofluorescencelaser microdissectionmass spectrometry analysispolarized lightsystemic AL-type amyloidosistransmission electron microscopy

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Area of Science:

  • Pathology
  • Biochemistry
  • Medical Diagnostics

Background:

  • Amyloidosis is a group of rare diseases involving extracellular amyloid deposition.
  • Accurate early diagnosis of systemic amyloidosis is challenging and requires specialized pathological evaluation of biopsy specimens.

Purpose of the Study:

  • To evaluate and compare various histopathological techniques for diagnosing hepatic amyloidosis.
  • To determine the most effective methods for amyloid detection and precursor protein identification in liver biopsies.

Main Methods:

  • Analysis of formalin-fixed, paraffin-embedded liver biopsy specimens.
  • Utilized Congo red staining, electron microscopy, immunohistochemistry (IHC), immunofluorescence, and Congo red-assisted laser microdissection with mass spectrometry (LMD/MS).
  • Employed Failure Mode and Effects Analysis (FMEA) for quality control.

Main Results:

  • Classical Congo red staining showed characteristic birefringence under polarized light.
  • Immunohistochemistry (IHC) identified kappa light chain positivity.
  • Laser microdissection with mass spectrometry (LMD/MS) specifically identified immunoglobulin kappa light chain as the precursor protein, offering high specificity.

Conclusions:

  • Congo red staining with polarized light remains the primary method for amyloid detection.
  • LMD/MS provides superior specificity for amyloid typing compared to IHC, immunofluorescence, or electron microscopy, particularly useful for small samples.
  • Histopathological assessment is the gold standard for diagnosing hepatic amyloidosis, necessitating the integration and refinement of these diagnostic techniques.