Differential Diagnosis of Amyloid Deposits by Light, Polarization and Electron Microscopy

This book is about the differential diagnosis of amyloid deposits observed by light, polarization and electron microscopy. The main types of systemic (AA, AL or AL , ATTRwt, A 2M) and isolated (A , AL or AL , A 2M, AANF, IAPP, etc.) amyloidosis are discussed according to their histologic, histochemical, immunohistochemical, and electron microscopic charcteristics. Systemic amyloidosis is related to the cardiovascular system and the precursor becomes generalized via the bloodstream; the vessel walls are always involved with or without extravascular deposition of amyloid. Isolated amyloidosis is limited to an organ or tissue, and is an extravascular phenomenon; its precursors are not connected to the systemic circulation, and the vessel walls remain spared, the process is localized without involvement of the blood vessels. With simple immunohistochemical methods the most important types of systemic and isolated amyloid deposits may be differentiated. The immunohistochemical analysis of various amyloid deposits may be difficult especially in case of minimal deposits with extensive background staining. This book discusses and demonstrates histochemical methods to differentiate the most important systemic and isolated types of amyloidosis. The histochemical methods are recommended for general use in laboratories where electronmicroscopy, genomic DNA sequence analysis or amino acid sequence identification techniques are not available. Present study and documentation is based on biopsy and autopsy material of the Department of Pathology of the National Institute of Rheumatology, as well as on material sent in consultation over a time span of more than thirty years. The most important applied methods are summarized in the Appendix. The applied methods are easy to apply and are available worldwide in basic diagnostic laboratories. The results are well documented and illustrated with figures and microphotographs. The book is recommended to all clinicians and pathologists who are working with or are interested in amyloidosis. The style of the text is easily understandable by rheumatologists as well as general practitioners.