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Potassium permanganate resistant amyloid in fine-needle aspirate of the liver
R Srinivasan1, R Nijhawan, U Gautam
1Department of Cytology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Abstract:
A case of primary amyloidosis, initially detected by fine-needle aspiration of the liver, is reported here. Amorphous acellular metachromatic material was seen extracellularly in between the hepatocytic cords compressing them. This material showed typical apple-green birefringence under crossed bipolars after alkaline Congo-red staining proved its amyloid nature. It was resistant to potassium permanganate pretreatment, indicating it to be of the AL type.
Insights
Primary amyloidosis was diagnosed in the liver using fine-needle aspiration. The amyloid deposits were identified as AL type, confirmed by Congo-red staining and resistance to potassium permanganate.
Area of Science:
- Hepatology
- Pathology
- Biochemistry
Background:
- Primary amyloidosis is a systemic disease characterized by amyloid protein deposition.
- Liver involvement in primary amyloidosis can be challenging to diagnose.
- Fine-needle aspiration (FNA) is a minimally invasive diagnostic technique.
Observation:
- Extracellular amorphous, metachromatic material was observed between hepatic cords.
- The material compressed the surrounding hepatocytes.
- The deposits stained positively with alkaline Congo-red.
Findings:
- Apple-green birefringence under polarized light confirmed amyloid nature.
- Resistance to potassium permanganate pretreatment indicated AL-type amyloidosis.
- FNA of the liver successfully identified primary amyloidosis.
Implications:
- Early detection of liver amyloidosis via FNA is feasible.
- Distinguishing AL-type amyloidosis is crucial for treatment.
- This case highlights FNA as a valuable tool in diagnosing hepatic amyloidosis.