LIVER AMYLOIDOSIS

The tissue specimen is blue-violet, because of methyl-violet staining with

metachromatic properties. Large roundish light purple areas (ie metachromatic)
can be observed. Hollow structures include a large branch of the portal vein, an
artery and a bile duct with the high epithelium, that is a portal field nearby the
hepatic hilum. The surrounding tissue consists of ortho-chromatically stained
hepatocytes separated by dilated/engorged sinusoids, dilated. Hepatocytes have
a poorly stained nucleus and sometime contain a large optically empty round
vacuole, a tell-tale of moderate degree of steatosis. The metachromatic areas
appear, even at high magnification, homogeneous, due to the presence of
amyloid substance, which accumulates, typically in the extracellular
compartment, such as the sub-endothelial space of Disse and in vasa-vasorum of
large vases. The peri-vascular distribution of amyloid is typical of systemic
amyloidosis, in which the precursor of the amyloid substance is a circulating
protein.
Amyloidosis in portal fields

*
Amyloidosis in the Disse space

ENDOTHELIUM

KUPFFER CELL

STEATOSIS
Amyloidosis in the
perivascular space
LIVER AMYLOIDOSIS
A large portal field (white area) shows its classic features:) a vein (blue) an artery (red)
and a bile duct green). Metachromatic purple areas are highlighted (white arrows)
STEATOSI MODERATA

Higher magnification of a portal field (white area) a vein (blue) an artery (red)
and a bile duct green). Meta-chromatic areas are located inside the walls of the
artery and vein. Moderates steatosis can be observed (presence of empty
spaces in hepatocytes) (white arrow, yellow area)
portal field (white area) a vein (blue) an artery (red) and a bile duct (green)
Drop-like meta-chromatic areas (are located inside the arterial and vein walls).
In the lower part of the specimen we observe a large build in of amyloid which
disrupts the liver architecture.
At higher magnification dilated sinusoids are evident (white arrows).
Amyloid deposition in the Disse space is highlighted (yellow arrows)
Drops of amyloid substance in a wall of the vein vessel (white arrow)
Deposition of amyloid in Disse spaces are also evident (black arrow).
Steatosis is present (yellow arrow). In the lower part of the picture, a large amyloid
accrual is also evident (orange area)