[Diagnosis of Amyloidosis in Hand and Plastic Surgery Patients: Optimal Tissue Selection and Examination Methods for...

Amyloidoses are a heterogeneous group of diseases characterised by the fibrillar deposition of peptides and proteins in a β-sheet configuration. In Germany, AL and ATTR amyloidosis are among the most common systemic forms. ATTR amyloidosis is characterised by the involvement of ligamentous and tenosynovial tissue prior to cardiac involvement, which, in turn, can be be life-limiting. This highlights the growing clinical relevance of diagnosing ATTR amyloid in resection specimens from hand and plastic surgery procedures. Diseases considered relevant in this context include carpal tunnel syndrome, trigger finger, spontaneous biceps tendon rupture, and spinal canal stenosis. The prevalence of ATTR amyloid increases with age, reaching nearly 50% in the ninth decade of life. Tissue samples obtained during surgery should be fixed in formalin. Amyloid can be detected using Congo red staining and polarisation microscopy. The sensitivity of detection depends on both the amount of tissue obtained and the stage of the disease. It should be noted that all tissue and sample types carry a risk of sampling error. Once amyloid has been detected, it must be classified, as amyloidoses are now treatable and treatment depends on the specific type of amyloidosis.