Cytological Diagnosis of Amyloidosis From Orbital Papules.

IF 1.2 4区 医学 Q4 CELL BIOLOGY
Cytopathology Pub Date : 2025-07-01 DOI:10.1111/cyt.70007
Tarinishree Nedunchezhian, Shruthi N Ramesh, Rashmi P Joshi, Kanwalpreet Kaur, Debasis Gochhait
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引用次数: 0

Abstract

Background: Amyloidosis is the extracellular accumulation of amyloid proteins in diverse organs. While ocular and periocular involvement is rare, it can be localised or part of systemic disease. This manifestation can affect various ocular structures, including the eyelids, conjunctiva, lacrimal glands, cornea, vitreous body, extraocular muscles and ocular adnexa, leading to symptoms like ptosis. Here, we report a unique case of systemic amyloidosis presenting as papulonodules on the eyelids, diagnosed through a minimally invasive fine needle aspiration technique (FNAC).

Case presentation: A 43-year-old male presented with red to skin-coloured elevated lesions, primarily around the periocular region, persisting for 2 months. Examination revealed multiple waxy papulonodules predominantly on the eyelids, with some also in the perioral area, forehead, and neck. Additionally, the patient exhibited macroglossia with ulcers. While urine Bence Jones protein tests were negative, the urine protein creatinine ratio was elevated. Echocardiography indicated concentric left ventricular hypertrophy (LVH). FNAC from periocular papulonodules and abdominal fat pad yielded fluidy and greasy white material, respectively. The smears from eyelid lesions showed pale eosinophilic, acellular, waxy material, which was congophilic, and apple-green birefringence in polarised light. The abdominal fat pad FNAC also was positive for amyloidosis. The subsequent skin biopsies from the patient's forehead, papules, and tongue revealed eosinophilic, amorphous extracellular material deposition. Congo red staining effectively highlighted the congophilic material. These biopsy findings aligned with the earlier FNAC results, confirming the diagnosis of amyloidosis in both.

Conclusion: This case highlights the unusual presentation of systemic amyloidosis as eyelid papules and nodules, underscoring the importance of FNAC in such scenarios. FNAC is a rapid and effective diagnostic tool for accessible lesions, as demonstrated in this case. Additionally, FNAC of abdominal fat pads can provide valuable diagnostic information swiftly, making it useful in suspected amyloidosis cases.

眼眶丘疹淀粉样变的细胞学诊断。
背景:淀粉样变性是淀粉样蛋白在不同器官的细胞外积聚。虽然眼部和眼周受累是罕见的,它可以是局部或全身性疾病的一部分。这种表现可影响眼睑、结膜、泪腺、角膜、玻璃体、眼外肌、眼附件等多种眼部结构,导致上睑下垂等症状。在这里,我们报告一个独特的全身性淀粉样变性,表现为眼睑上的丘疹结节,通过微创细针穿刺技术(FNAC)诊断。病例介绍:一名43岁男性,主要在眼周区域周围出现红色至皮肤色的升高病灶,持续2个月。检查发现多发蜡状丘疹结节,主要分布在眼睑上,也见于口周区、前额和颈部。此外,患者还表现出伴溃疡的大舌缺失。虽然尿Bence Jones蛋白试验呈阴性,但尿蛋白肌酐比值升高。超声心动图提示同心性左心室肥厚(LVH)。眼周丘疹和腹部脂肪垫的FNAC分别呈液体状和油腻状白色物质。眼睑病变的涂片显示苍白的嗜酸性、脱细胞、蜡状物质,这是嗜嗜性的,在偏光下呈苹果绿色双折射。腹部脂肪垫FNAC也呈淀粉样变阳性。随后对患者前额、丘疹和舌头的皮肤活检显示嗜酸性无定形细胞外物质沉积。刚果红染色有效地突出了嗜嗜性物质。这些活检结果与早期FNAC结果一致,证实了两者淀粉样变的诊断。结论:本病例突出了不寻常的系统性淀粉样变表现为眼睑丘疹和结节,强调了FNAC在这种情况下的重要性。正如本例所示,FNAC是一种快速有效的诊断可触及病变的工具。此外,腹部脂肪垫的FNAC可以快速提供有价值的诊断信息,使其在疑似淀粉样变病例中有用。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Cytopathology
Cytopathology 生物-病理学
CiteScore
2.30
自引率
15.40%
发文量
107
审稿时长
6-12 weeks
期刊介绍: The aim of Cytopathology is to publish articles relating to those aspects of cytology which will increase our knowledge and understanding of the aetiology, diagnosis and management of human disease. It contains original articles and critical reviews on all aspects of clinical cytology in its broadest sense, including: gynaecological and non-gynaecological cytology; fine needle aspiration and screening strategy. Cytopathology welcomes papers and articles on: ultrastructural, histochemical and immunocytochemical studies of the cell; quantitative cytology and DNA hybridization as applied to cytological material.
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