Amyloidosis :By

Motasem Sirag Mohammed

Latefa Ghassan Salem
Lobna Mohammed Al-hassan
Hajer Mohammed Godby
Safa Abdalgafar
Maab Faisal Mohammed
Namarig Abd Alateif
Saed
Sahar Abd Alhi
Reem Salah Aldin Altayeb
Amyloidosis
 Is deposition of amorphous
eosinophillic predominant
extracellular material seen as
masses lead to loss of function .
:Classification
1. according to the source protein .
2. according to the distribution .
Localised .
Systemic .

Localised Amyloidosis :
Senile cardial .
Senile cerebral .
Systemic Amyloidosis :
Systemic Amyloidosis - I
• imunocyte dyscrasia associated
• light chains Ig (mostly )
• primary
Systemic Amyloidosis - II
• reactive systemic amyloidosis
• SAA = Serum Amyloid Associated protein
• secondary
Systemic Amyloidosis - III
• enile systemic SSA
Systemic Amyloidosis – IV
• 2 microglobulin
• Hereditary
 Causes
The cause for amyloid to be produced and to collect
in the tissues is not known.

In one's life The disease starts in the bone marrow.

Antibodies that protect the body against infection.

After the antibodies have done their work, the body
breaks them down. When the bone marrow cells
produce antibodies that cannot be broken down,
amyloidosis develops. The antibodies build up in the
blood and eventually get deposited in the tissues as
amyloid.
Risk factor
: Factors that increase your risk include
1. Age : More 50 .

2. Sex : Mane more often than women.

3. Hereditary .

4. Chronic disease .

5. Multiple myeloma .

6. End-stage kidney disease .
Sign and symptom
1. Fatigue Feeling of fullness Joint pain .
2. Low red blood cell count (anemia) .
3. Shortness of breath .
4. Weight loss .
5. Swelling of the tongue Tingling .
6. Numbness in legs and feet,
Weak hand .
7. Changes in skin color Clay-colored
8. Low red blood cell count (anemia)
complication
Some example for complication include :

1. Pain at biopsy site or right

shoulder .
2. Hemorrhage .
3. Bile peritonitis .
4. Death .
Location
1. heart .
2. kidneys .
3. Spleen .
4. Thyroid gland .
5. Brain .
6. Liver .
Amyloid Diseases
1. Alzheimer's Diseases .
2. Atrial Amyloidosis .
3. Hereditary Renal Amyloidosis .
4. Secondary Systematic Amyloidosis
.
5. Injection _ localized Amyloidosis .
Liver Amyloid
The effect of amyloid infiltration on
the functional capacity of the liver was
studied by means of ten different liver
function tests.
 Despite marked structural changes in
amyloid liver disease, there was minimal
functional alteration .
The congo red test proved again to be
one of the more sensitive indices of
hepatic amyloid involvement .
exclusively vascular involvement was more
common in the primary form .
 Amyloidosis of the liver should be
suspected in patients with anemia,
albuminuria or azotemia .
In these instances liver biopsy should be
employed since it is the most accurate
diagnostic procedure because of the
diffuse nature of the lesion in all forms of
amyloid disease .
Clinical features
Normal histology of Liver

Normal section of Liver by H & E

Receiving biopsy to histopathology Laboratory
 Specimens :
ue cut biopsy
 Fixation :
zen section is
t choice for
earches and
d Formal saline
h florescent
chnique
 Processing
How to Demonstrate
1. Heamatoxlein & eosin.
2. Congo red technique .
3. Immunofleurecent technique .
4. Iodine technique .
5. Metacromasia technique .
6. Immunohistochemistry ( IHC )
H & E stain in liver for amyloid

1. Nucleus Blue
2. Amyloid pale pink
Congo Red
Aim
.To demonstrate the amyloid
principle
Congo red form non polar hydrogen bond
with amyloid, opposed to electrostatic
bond with most other tissue component,
this binding depend on the largely β
.pleat sheath configuration
Type Of Congo Red
1. Highman’s Congo red technique .

2. Alkaline Congo red technique .

3. Sirius red technique .

 Preparation Of Heighman’s 
Congo red technique
Solution A :
1. 0.5 % Congo Red (powder) .
2. In 50 % Alcohol .
 Solution B :
1. 0.2 % Potassium Hydroxide .
2. In 80% Alcohol .
 Liver with Amyloidosis

1. Amyloid orange
2. Background pale blue
Liver
1

1. Amyloid Red .
2. Background Blue .
 Immunohistochemistry
Demonstration of liver amyloidosis by immunohistochemistry.

 Marker: anti-amyloid precursor protein antibody .

 Visualized by DAB chromagen .
Cases
A 53 years old male patient presented
with progressive anasarca over 2
months. His evaluation revealed as cites
with high serum-as cites albumin
gradient. Liver imaging suggested mild
hepatomegaly with nodular liver and
splenomegaly with patent hepatic and
portal veins. After thorough blood tests,
the patient was labelled as cryptogenic
cirrhosis and started on diuretics.
Treatment
No treatment just drug to reduce
amyloid protein and easier patient's life
and reduce deposition of amyloid
1. Chemotherapy .
2. Hereditary amyloidosis Liver
transplantation (factory) .
3. Dialysis-related amyloidosis. changing
mode of dialysis kidney transplant .
Other locations by
congo red
Kidneys

Congo Red Stain of the Kidneys showing

amyloid deposition .
 Heart

1. Amyloid deposition throughout the myocardium .

2. Deposition in the wall of the blood vessel .
Spleen

Spleen By Congo Red

Thyroid gland

According to PH make it very red .

 Brain

Deposition in amyloid in brain by Congo red stain .

THE END
Dr-Motasem Sirag Mohammed
Dr-Latefa Ghassan Salem
Dr-Lobna Mohammed Al-hassan
Dr-Hajer Mohammed Godby
Dr-Safa Abdalgafar
Dr-Maab Faisal Mohammed
Dr-Namarig Abd Alateif
Dr-Saeed Salah Alsmany
Dr-Sahar Abd Alhi
Dr-Reem Salah Aldin Altayeb