TONSILOGENIC AMYLOIDOSIS

Abstract

In connection with the report that amyloid is a functional antimicrobial substance, possibly a part of innate immunity, we suggested that amyloid may form in the palatine tonsils in chronic tonsillitis. Thirty-two patients aged 19 to 52 years underwent surgical treatment for clinically proven chronic tonsillitis. The aim of the study was to detect the fact of amyloid tonsillar lesions formation in chronic tonsillitis. We performed histological examination of tonsillo-ectomized material fixed in 10% formalin solution and filled in paraffin on 4-micron histological sections: 1) according to the conventional technique, stained with hematoxylin-eosin, 2) Congo red staining and 3) using our own original trichromatic method (two-hour incubation of paraffin sections in acidin-pepsin, sequential staining with picro-fuchsin according to Van Gieson, Сaracсi hematoxylin, Congo red according to H. H. Benhold, picro-indigocarmine). All 32 patients showed a clinical presentation of chronic tonsillitis without exacerbation with stroma sclerosis and atrophy of the lymphatic glandular system. Local amyloidosis of the tonsils was detected in 10 out of 32 cases. As a result of trichromatic staining, unchanged connective tissue fibers stained green, changed tissues (hyalinosis or amyloidosis) stained in various shades from yellow, yellow-orange to red, in addition, lymphocytes, neutrophils and mast cells were clearly detected in the tissues of the amygdala. For comparison, a section of the palatine tonsil was taken from a 49-year-old man who committed suicide by hanging, who had no chronic tonsillitis. Forensic diagnosis: mechanical asphyxia by hanging. Macroscopically: the tonsils are not enlarged, folded, the size of one of them together with the soft tissues was 2.5×1.5×1 cm. Nevertheless, a Congo-positive substance was found in the sections of the suicider's tonsils. It is concluded that a significant number of amyloidosis cases that did not lead to severe damage to the vital organs remain unaccounted for due to the lack of specialists' awareness and, as a result, recommendations for screening for the presence of amyloidosis. At least 30% of patients with chronic tonsillitis are observed to have at least local tonsillar amyloidosis. Amyloid damage to the tonsils can be seen even in clinically unchanged tonsils.