Urinary Cytopathology in Primary Bladder Amyloidosis

Abstract

Background: Amyloidosis results from the accumulation of unique extracellular proteins which are not able to be degraded via the usual mechanism of lysosomal proteolysis. Isolated collections of amyloid within the bladder are extremely uncommon, and a cytopathologic description in voided urine has not been described to date. Methods: A retrospective review was performed at a tertiary-care hospital, and 3 patients with isolated bladder amyloidosis and corresponding voided urine specimens were identified. The following clinical data were collected for each case: age, gender, treatment and follow-up information. Results: The patient age range was 76-84 years, with 2 males and 1 female. Amyloidosis was never clinically suspected. In 1 patient, a urinary amyloid manifested, which was thought to represent extraneous debris at the time of original diagnosis. Two patients never manifested signs of systemic amyloidosis or multiple myeloma, and the third was found to have a monoclonal gammopathy. Conclusions: Our results show the difficulty of diagnosing urinary amyloid in the absence of clinical suspicion. Further, the presence of urinary amyloid is unlikely in patients with bladder amyloidosis as the cohesive nature of the protein makes spontaneous shedding uncommon. Testing for systemic amyloidosis is warranted and if the disease is localized, a favorable outcome can be expected.

Sarcomatoid Malignant Pleural Mesothelioma: A Case Report

“…Pleural effusion cytology positivity rated is approx. 26% [5], and the positive rate is comparatively lower in the sarcomatoid subtype than epithelioid type [6]. The rates of diagnosis by blind percutaneous pleural biopsy and CT-guided pleural biopsy were reported 31% [7] and 80% [8], respectively.…”

Biomarker, Molecular, and Technologic Advances in Urologic Pathology, Oncology, and Imaging

“…63,64 Patients typically present with grossly painless hematuria and lower urinary tract symptoms in the fifth to seventh decades of life with an equal sex distribution. [63][64][65][66][67][68] The diagnosis is difficult to make by cytologic examination of urine specimens because deposition within the bladder wall shows poor correlation with precipitation in urine. 64,66,68. The most common subtype of amyloid involving the bladder is amyloid light chain (AL), with conflicting reports on the predominant light chain (k versus j).…”