This 46-year-old white male with a long-standing history of rheumatoid arthritis was admitted for treatment of pneumonia. Subsequently, complications associated with lung abscesses, empyema, and septicemia led to the patient's death.
The liver weighed 2600 grams. It was yellowish-tan in color and cut with difficulty (fibrosis?). No other pathological changes were noted except for pneumonia and lung abscesses.
This is a gross photograph of kidney from this case. Note the pale yellow material within the cortex (arrows). This is indicative of amyloid within the cortex and the glomeruli. Also note that there are multiple red spots in the cortex. These represent congested glomeruli due to the vascular compromise produced by the amyloid.
Liver: Amyloid H&E
Liver: Amyloid Congo Red
Normal Liver H&E
This is secondary amyloidosis because it is secondary to a chronic inflammatory condition. This would be an AA type of amyloid.
Serum amyloid-associated" protein is a protein produced by the liver when stimulated by interleukins 1 and 6.
Hyaline is a descriptive histologic term which refers to an alteration within cells or in the extracellular space which has a homogeneous, glassy, pink appearance in routine histologic sections stained with hematoxylin and eosin.
Amyloid is homogeneous, glassy, and pink in appearance; thus, we describe amyloid as having a hyaline appearance.
Kidneys, heart, gastrointestinal tract, and tongue.
- eMedicine Medical Library: Amyloidosis
- eMedicine Medical Library: Amyloidosis, AA (Inflammatory)
- Merck Manual: Amyloidosis
- Obici L, Merlini G. AA amyloidosis: basic knowledge, unmet needs and future treatments. Swiss Med Wkly 2012 May 31;142:w13580.
Related IPLab Cases
In alcoholics, aspiration pneumonia is common--bacteria enter the lung via aspiration of gastric contents.
An abscess is a collection of pus (white blood cells) within a cavity formed by disintegrated tissue.
A normal liver weighs 1650 grams (range: 1500 to 1800 grams).