We report on a case of a patient with laryngo-tracheobronchial amyloidosis who complained of cough, sputum, and hoarseness. A chest X-ray showed consolidation in the right middle lobe. A chest CT scan showed diffuse, irregular narrowing of the tracheobronchial tree and atelectasis of the right middle lobe, with calcification of bronchial wall. Bronchoscopic findings were multinodular submucosal thickening of the right vocal cord, and yellowish multinodular submucosal thickening from the lower trachea through both main bronchi, as well as the lingular division of the left upper lobe, the right middle lobe, and the right lower lobe. The right middle lobe bronchus was nearly obstructed. The diagnosis of amyloidosis was made by multiple bronchoscopic biopsies on the right vocal cord and both bronchi. Pathologic findings were characteristic apple-green birefringence under polarized microscopy with Congo-red stain. The patient had no evidence of systemic amyloidosis. The patient is under conservative symptomatic treatment.
Amyloidosis ; Biopsy ; Birefringence ; Bronchi ; Cough ; Hoarseness ; Humans ; Microscopy ; Pulmonary Atelectasis ; Sputum ; Thorax ; Trachea ; Vocal Cords

Amyloid may involve the conjunctiva without deposits of the skin of the eyelid in primary localized amyloidosis, but extremely rare in primary systemic amyloidosis. We describe the clinicopathologic features of a case of primary systemic amyloidosis which invloved the conjunctiva and larynx. A 58-years-old woman presented a conjuctival mass of the left eye. Slit lamp microscopy showed a pinkish, flat elevated mass on the bulbar conjunctiva, fornix, and upper tarsal conjunctiva. There was no history of antecedent ocular or systemic diseases. She had undergone total laryngectomy for laryngeal amyloidosis. Microscopically, a pale amorphous eosinophilic material was deposited in the subcojunctival tissue. The deposit showed metachromasia with crystal violet, and dichroism and birefringence in polarized light following Congo red staining. Electron microscopically amyloid was comprised of linear add non-branching fibrils, which were about 11nm in width.
Amyloid ; Amyloidosis* ; Birefringence ; Congo Red ; Conjunctiva* ; Eosinophils ; Eyelids ; Female ; Gentian Violet ; Humans ; Laryngectomy ; Larynx ; Microscopy ; Skin

A 38-year-old male patient visited our clinic complaining of three skin lesions on the scalp. There were yellowish to brownish, waxy, non-tender, walnut-sized nodules. Hematoxylin and eosin staining revealed amorphous pinkish material deposits in the dermis. The Congo red stain and Dylon stain under polarizing microscopy showed yellow-green birefringence and the immunoglobulin-lambda light chain stain showed a positive reaction. An electron microscopic examination revealed filaments with uniform diameter(6 to 10nm) that were straight and neither branched nor anastomosed. Based on the clinical, histopathological, immunohistochemical and electron microscopical findings, the skin lesions were diagnosed as nodular amyloidosis.
Adult ; Amyloidosis* ; Birefringence ; Congo Red ; Dermis ; Eosine Yellowish-(YS) ; Hematoxylin ; Humans ; Male ; Microscopy ; Scalp ; Skin

Primary nodular cutaneous amyloidosis is a very rare type of amyloidosis, it must excluded the secondary nodular deposition of systemic amyloidosis. We report herein 47-year-old male with a erythematous waxy nodule on his parietal scalp for one year. Histopathologic examination showed homogenous amorphous eosinophilic deposition in the dermis with nodular fashion. In Congo red, amyloid material stained positively and showed apple-green birefringence with polarized light. On electron microscopic examination, extensive deposit of amyloid with typical 6-10 nm filament was confirmed. He had neither clinical nor laboratory evidence of systemic amyloidosis. We reviewed previously reported nodular amyloidosis in Korea.
Amyloid ; Amyloidosis* ; Birefringence ; Congo Red ; Dermis ; Eosinophils ; Humans ; Korea ; Male ; Middle Aged ; Rabeprazole ; Scalp

OBJECTIVE: Osteoarthritis is a disorder or group of disorders affecting synovial joint, characterized at the tissue level by degenerative, regenerative and reparative structural changes in cartilage, synovium and bone. The histopathological understanding of osteoarthritis would help to clear the pathogenesis and evaluate the activity and progression of the disease. We studied the histochemical distribution of collagen in the search for and accurate morphometric m~rker for osteoarthritic progression. METHODS: The immunohistochemical analysis by monoclonal antibodies to type I, II and III collagen, the Masson's trichrome stain and the Picrosirius stain and polarization microscopy were performed in 10 osteoarthritis cartilages and 1 normal control cartilage. RESULTS: 1)By the immunohistochemical analysis, type II collagen was diffusely expressed in both normal and osteoarthritis cartilage but the expression of type I and III collagen was only shown around chondrocytes in the osteoarthritis cartilage. 2) There was no difference in Masson's trichrome stain of the normal and osteoarthritis cartilage. 3) By the Picrosirius stain and polarization microscopy, there was less diffuse birefringence of collagen and increased perichondronal birefringence in the osteoarthritis cartilage in comparison to normal cartilage. CONCLUSIONS: The Picrosirius-polarization method may be considered one of the useful morphometriic methods for the progression of osteoarthrits.
Antibodies, Monoclonal ; Birefringence ; Cartilage* ; Chondrocytes ; Collagen Type II ; Collagen* ; Humans* ; Joints ; Microscopy, Polarization ; Osteoarthritis ; Synovial Membrane

The Amyloidosis represent a heterogeneous group of disorders characterized by abnormal extracellular and endothelial accumulation of insoluble proteins. This disorder displays variable clinical symptoms depending upon the involved organ and a diagnosis is rendered through a biopsy of the affected organ, follwed by staining using Congo-red which reveals an apple-green birefringence. We report a case of secondary amyloidosis diagnosed incidentally by endoscopic gastric and sigmoid colon mucosal biopsy in a patient who had history of bronchiectasis and recurrent pneumonia, pseudomembranous colitis and paralytic ileus.
Amyloidosis* ; Biopsy ; Birefringence ; Bronchiectasis* ; Colon, Sigmoid ; Diagnosis ; Enterocolitis, Pseudomembranous ; Humans ; Intestinal Pseudo-Obstruction ; Pneumonia

AA amyloidosis is one of the most significant complications of rheumatoid arthritis characterized by the deposition of amyloid A (AA) in multiple organs and tissues in the body. This disorder displays variable clinical symptoms depending upon the involved organ and a diagnosis is rendered through a biopsy of the affected organ, followed by staining using Congo-red which reveals an apple-green birefringence. Fundamental disease control is critical in the treatment of AA amyloidosis. Anti-tumor necrosis factor alpha (anti TNF-alpha) agents are promising in inducing clinical remission by suppressing systemic inflammation in AA amyloidosis. We report a case of AA amyloidosis in a 71 year old woman with rheumatoid arthritis that responded well to infliximab therapy.
Amyloid ; Amyloidosis ; Antibodies, Monoclonal ; Arthritis, Rheumatoid ; Biopsy ; Birefringence ; Female ; Humans ; Inflammation ; Necrosis ; Infliximab

PURPOSE: To report a case of vitreous amyloidosis. METHODS: A 51-year old male presented with bilateral floater and decreased visual acuity of 3 months duration. Small white dots attached to the posterior lens surface were observed on slit lamp examination. The vitreous opacity, which connected with the small white dots to the posterior lens surface, were observed on funduscopic examination, and multiple hyperechoic plaques in the vitreous cavity on B-scan. The pars plana vitrectomy was performed. RESULTS: The aspirate of the pars plana vitrectomy was stained with Congo red and observed with light microscope, and polarized light. Electron microscopy was also performed. The vitreous smear stained with Congo red showed greenish dichroism and birefringent nature with polarized light and fine fibrillar nature of amyloid material was noted on electron microscopy. CONCLUSIONS: To our knowledge, this is the first Korean report of vitreous amyloidosis. The authors diagnosed vitreous amyloidosis that developed in a 51-year-old male patient. The diagnosis was confirmed by light microscope, polarized light and electron microscope.
Amyloid ; Amyloidosis* ; Birefringence ; Congo Red ; Diagnosis ; Humans ; Male ; Microscopy, Electron ; Middle Aged ; Visual Acuity ; Vitrectomy

Deposition of monosodium urate crystal in joints and periarticular soft tissue is regarded as one of the characteristics of chronic gouty arthritis. In spine, however, only nineteen cases of tophaceous deposits have been reported to date suggesting the rarity of clinical symptoms secondary to involvement of spine. Authors report a case of spinal stenosis due to hypertrophy of ligament flavum with monosodium urate deposits. The patient was 65 years of age with chronic gouty arthritis who underwent a decompressive laminectomy at L4-5. At surgery, hypertrophied ligament flavum that was covered with chalky amorphous materials was noted without any evidence of radiologic features. Microscopically, a portion of ligament flavum had been focally destoryed by amorphous material deposits that were surrounded by a thin layer of mononuclear and giant cells along with occasional sprinkling of chronic inflammatory cells and negative birefringence on polarizing microscopy.
Arthritis, Gouty ; Birefringence ; Giant Cells ; Humans ; Hypertrophy* ; Joints ; Laminectomy ; Ligaments* ; Microscopy ; Spinal Stenosis* ; Spine ; Uric Acid*

Synovial fluid (SF) aspiration cytology is a useful diagnostic tool. For patients with gouty arthritis, the diagnosis is confirmed by the presence of monosodium uric acid (MSU) crystals in the SF, and these crystals are long, pointed ended and needle-shaped and they show strongly negative birefringence. Sometimes, it is difficult to diagnosis between gouty arthritis and other type of inflammatory arthritis. We experienced two unusual cases of gouty arthritis that we performed SF analysis for. The first patient was a 35 year old male who presented with relatively typical clinical symptoms with hyperuricemia, but the SF showed acute inflammatory cells without crystals on light microscopy. Only a few suspected crystals of MSU were identified on polarizing microscopy. The second patient was a 45 year old male who presented with atypical symptoms and pain and swelling of the left ankle and knee joint for 3 weeks. The uric acid level in the serum and urine was increased, but not over the normal limit. However, on light and polarizing microscopy, there were numerous MSU crystals in the SF. Conclusively, in some cases of gouty arthritis, the crystals are not identified on light microscopy or the uric acid level is not dramatically increased. So, the polarizing microscopy, the clinical information and the laboratory findings are all included in the work-up when evaluating the SF cytology of arthritis patients.
Animals ; Ankle ; Arthritis ; Arthritis, Gouty ; Birefringence ; Gout ; Humans ; Hyperuricemia ; Knee Joint ; Light ; Male ; Microscopy ; Synovial Fluid ; Uric Acid