Secondary amyloidosis: diagnosis from an endometrial biopsy

Yue, Cheung Cho; Lampman, James H.; Park, Chan H.; Ballou, Stanley P.

doi:10.1002/art.1780261026

Cited by 4 publications

(10 citation statements)

References 2 publications

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“…Cases of amyloidosis affecting the female genital tract have been described before and have been associated with menorrhagia 2–4 . Postmenopausal bleeding has also been associated with isolated amyloid deposition to the uterine cervix 5 .…”

Section: Discussionmentioning

confidence: 99%

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Uterine amyloidosis in menopause

Jongen

Grond²,

Veelen

et al. 1998

BJOG

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A 78 year old woman was admitted to our hospital because of postmenopausal bleeding. Cervical dilatation and uterine curettage appeared to be impossible due to a very narrow vaginal introitus after an anterior colporrhaphy. Transrectal ultrasonography revealed highly reflective scattering densities of a punctate nature (Fig. 1). As bleeding persisted and endometrial pathology could not be excluded, an abdominal hysterectomy was performed. During a difficult operation a crumbly irregular uterus, bleeding on every touch, was removed accompanied by bilateral salpingo-oophorectomy. Total blood loss during the procedure amounted to 4 L. Apart from blood transfusion the post-operative course was uneventful.The surgical specimen consisted of a 88 g uterus with frayed and crumbly ovaries and fallopian tubes. Histologically, the endometrium was atrophic, no hyperplasia or carcinoma was found (endometrial thickness < I mm). However, massive deposits of amorphous, eosinophilic substance were found in the myometrial stroma with encroachment on smooth muscle cells and local atrophy, and in vessel walls of the uterine corpus and fallopian tubes (Fig. 2). The left ovary was normal. The right ovary could not be identified. Some deposits had elicited a foreign body giant cell reaction and metaplastic bone formation. Congo red stains imparted a pinkish colour to the deposits and showed green birefringence with cross-polarised light consistent with amyloid. The amyloid deposits were found to be resistant to pretreatment with potassium permanganate. Immunostaining with antibodies to serum amyloid A protein, prealbumin and p 2 microglobulin were negative. These observations are consistent with immunoglobulin light chain-derived (AL) amyloidosis. Subsequent extensive haematological analysis did not reveal a plasma cell dyscrasia or any other B-cell neoplasm. Repeated urinanalyses for Bence Jones proteins were negative and serum immunoelectrophoresis and quantitative immunoglobulins findings were normal. Thor-

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Section: Discussionmentioning

confidence: 99%

“…Severe haemorrhagic complications have been associated with amyloidosis and are most probably due to amyloid angiopathy 6 . After diagnosis by uterine curettage or endometrial biopsy 4 further examination of the patient for signs of systemic amyloid disease is indicated.…”

Section: Discussionmentioning

confidence: 99%

Uterine amyloidosis in menopause

Jongen

Grond²,

Veelen

et al. 1998

BJOG

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“…Primary amyloidosis is the most common type of systemic amyloidosis. Secondary amyloidosis may occur as a result of chronic inflammation and malignant tumors . Localized amyloidosis is rare but has been reported to occur in several organs of the body, including the lung, bladder, gastrointestinal tract, breast, skin and cervix .…”

Section: Introductionmentioning

confidence: 99%

Primary localized amyloidosis of the uterine cervix during pregnancy

Kogiku

Konda

et al. 2020

J of Obstet and Gynaecol

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Amyloidosis of the uterine cervix is rare. A 35-year-old pregnant woman underwent a cervical biopsy and was found to have amyloid deposits. The results of liquid chromatography-tandem mass spectrometry revealed that these deposits mainly consisted of immunoglobulin light chain (kappa chain). After undergoing several examinations, the patient was diagnosed with localized amyloidosis, without systemic or secondary amyloidosis. She underwent a normal delivery without disease exacerbation. The possible presence of systemic and secondary amyloidosis must be evaluated carefully during the diagnosis of localized cervical amyloidosis.

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“…AA amyloidosis was found in 8.6% of 2246 patients with FMF in a study conducted in Turkey [4]. Gynecological amyloidosis has also been documented, albeit rarely [5][6][7][8][9][10][11][12][13]. The majority of reported cases were localized amyloidoses [5,6].…”

Section: Introductionmentioning

confidence: 99%

“…The majority of reported cases were localized amyloidoses [5,6]. Uterine amyloidosis associated with systemic amyloidosis has been described in a few cases, mostly comprised of primary amyloidosis (AL), whereas uterine AA amyloidosis has been reported just in one case who had RA [9][10][11][12][13].…”

Section: Introductionmentioning

confidence: 99%

Menorrhagia due to uterine amyloidosis in familial Mediterranean fever: case-based review

2020

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Amyloidosis is described by the deposition of misfolded proteins in the tissues. Amyloidoses are classified into two as systemic and localized. Out of the systemic forms, AL (light chain) amyloidosis is the most prevalent type; however, amyloid A (AA) amyloidosis is more frequently encountered in the rheumatology practice. AA amyloidosis stands out as a major complication of familial Mediterranean fever (FMF). Splenic and renal involvement is more likely in FMF-associated systemic amyloidosis. The involvement of thyroid and adrenal glands has also been described, although infrequently. Amyloidoses have a heterogeneous plethora of clinical manifestations, with certain phenotypes associated with specific amyloid forms. Gynecological amyloidosis is a rare condition. Uterine involvement may occur in a localized fashion or may also arise as a part of systemic involvement, albeit at a lesser ratio. Several cases of uterine AL amyloidosis have been documented so far as an organ involvement in systemic AL amyloidosis. On the other hand, uterine amyloidosis associated with AA amyloidosis has been described merely in one case with rheumatoid arthritis (RA). Here, we presented a 40-year-old female patient with FMF known for 38 years who underwent splenectomy and hysterectomy due to massive splenomegaly, deep anemia, and persistent menometrorrhagia. Histological examinations of materials revealed uterine and splenic AA amyloidosis. This case report is first-of-its-kind to describe FMF-associated uterine AA amyloidosis and also provides a discussion of possible mechanisms of amyloidosis-induced uterine bleeding.

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Secondary amyloidosis: diagnosis from an endometrial biopsy

Cited by 4 publications

References 2 publications

Uterine amyloidosis in menopause

Uterine amyloidosis in menopause

Primary localized amyloidosis of the uterine cervix during pregnancy

Menorrhagia due to uterine amyloidosis in familial Mediterranean fever: case-based review

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