Progressive insulin-derived amyloidosis in a patient with type 2 diabetes

Abstract

Here, we report a case of insulin-derived amyloidosis in the lower abdomen. The mass continued to develop even after the patient ceased injecting insulin into the mass. Histological examination led to a diagnosis of insulin-derived amyloidosis. Excision is preferable in cases of insulin-derived amyloidosis if patient’s condition permits.

Insulin-derived amyloidosis: The insulin ball, amyloidoma

“…The distinction between the 2 may not be possible on clinical grounds, but insulin-derived amyloidosis masses tend to be firmer on palpation. 1 Indeed, many cases of insulin-associated subcutaneous masses are presumed to be lipohypertrophy and further investigation may not occur. As with insulin-derived amyloidosis, patients with lipohypertrophy have reduced insulin efficacy, although less markedly than with injection into amyloid.…”

“…Insulin-derived amyloidosis is defined as a subcutaneous amyloid mass at the site of insulin injections, in which the amyloid deposit shows a positive staining result with anti-insulin antibodies. 1 Most patients present with a solitary mass. Nagase et al 2 referred to this as the ''insulin ball,'' whereas others have referred to it as an amyloidoma.…”

Insulin‐induced amyloidoma—A cytological catch

“…Histopathology shows the deposition of extracellular fibrillary proteins with a homogenous eosinophilic appearance on routine staining. Congo red staining demonstrates positive red color and yields apple‐green birefringence under polarized microscopy 10 …”

“…The other differential is to look for systemic amyloidosis, which can be excluded by immunostaining for insulin antibody and mass spectrometry‐based proteomic amyloid typing. The inclusion cyst can also be excluded by the use of techniques to demonstrate amyloid 6,10 . Patients who are having human immunodeficiency virus infection and under treatment with Enfuvirtide have also been reported to have induced amyloid deposits at injection sites 8 .…”

Type 2 Diabetes Mellitus: a reciprocal mutual interaction with amyloidosis or a presentation of an isolated primary pancreatic amyloidosis?

“…Meanwhile, secondary amyloidosis has been shown to complicate chronic inflammatory autoimmune diseases [4] and chronic diseases such as autoimmune disease and T2DM have also been suggested to be potential factors for AA amyloidosis [5]. Thus, a reciprocal interaction may be also involved; several cases of insulin-derived localized amyloidosis have been reported like those mentioned in [6,7] and a case of primary systemic amyloidosis with the history of T2DM for nine years has also been recently described [8]. Further, Inflammation is known to be closely involved in the pathogenesis of T2DM, and reactive amyloidosis occurs in the presence of chronic inflammation and renal AA amyloidosis was shown to be prevalent in T2DM [9].…”