Spheroid-type transthyretin amyloidosis in the gallbladder: A possible histopathological diagnostic clue to prevent overlooking cholecystic latent amyloid deposition
Spheroid-type transthyretin amyloidosis in the gallbladder: A possible histopathological diagnostic clue to prevent overlooking cholecystic latent amyloid deposition
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胆囊球状型运甲状腺素蛋白淀粉样变性：防止忽视胆囊潜在淀粉样蛋白沉积的可能的组织病理学诊断线索
DOI：
10.1016/j.ehpc.2020.200407
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发表时间：
2020
影响因子：
--
通讯作者：
Nishida Naoki
中科院分区：
文献类型：
--
作者：
Ichimata Shojiro;Hata Yukiko;Nomoto Kazuhiro;Oshima Masahiro;Kato Yosuke;Nishida Naoki
一位83岁的女性因急性结石性胆囊炎接受了胆囊切除术。病理组织学上，胆囊壁浅层被坏死组织覆盖，深壁结构被明显的纤维化和严重的炎性细胞浸润所遮挡。在浅表区域发现许多小的、无定形的、嗜酸性的球状小体，中央有一个空洞。它们在刚果红染色呈阳性，在偏振光下呈黄绿色双折射，被确认为淀粉样沉积。在深层纤维层的血管上也发现有淀粉样物沉积。免疫组织化学显示，这些淀粉样蛋白沉积呈转甲状腺素样抗体阳性，CD34阳性细胞位于沉积中心。这些球状沉积被认为是起源于受影响的血管，形成了一种特征的沉积模式，可用作诊断胆囊中潜在的系统性淀粉样变性的征兆，否则将干扰准确的组织病理学鉴定。由于我们找不到任何其他类似的报告病例，这例球状类型的转甲状腺素衍生的胆囊性淀粉样变性似乎是第一例。
An 83-year-old woman underwent cholecystectomy for acute calculous cholecystitis. Histopathologically, the superficial area of the gallbladder was covered by necrotic tissue, and the deeper wall structure was obscured by marked fibrosis and severe inflammatory-cell infiltration. Many small, amorphous, eosinophilic spheroid bodies with a central cavity were identified in the superficial area. They were confirmed as amyloid deposits as they were positive under Congo red staining and exhibited yellow-green birefringence under polarized light. Amyloid deposition was also identified on the vessels in the deeper fibrous layer. Immunohistochemically, these amyloid deposits were positive for transthyretin antibodies, and CD34-positive cells were focally identified at the center of the deposits. These spheroid-type deposits, thought to originate from the affected vessels, formed a characteristic deposition pattern that can be used as a diagnostic sign indicating latent systemic amyloidosis in the gallbladder with severe degeneration that would otherwise interfere with accurate histopathological identification. As we were unable to find any other reported similar cases, this case report of spheroid-type transthyretin-derived amyloidosis in the gallbladder seems to be the first.
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DOI：
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