Bladder Amylodosis

• 27 Dec 2020 11:02:46 PM
• |Onco Urology

1. How do you confirm it’s primary bladder amylodisis ?

Comments(2)

• 

  Venugopal P

  01 Jan 2021 10:41:26 AM

  Dear All,

  Nitesh has posted a case of Amyloidosis Bladder.

  Pr Amyloidosis of Urinary Tract Frequently mimics Neoplasia. Within the genitourinary system, the Prostate and Seminal Vesicles are most commonly involved by localized amyloidosis and are usu­ally asymptomatic incidental findings in pros­tate specimens. Localized Urinary Tract Amy­loidosis (UTA) other than prostate and seminal vesicles is very rare and is of interest to physi­cians of various specialties, including radiolo­gists, urologists and pathologists, because it mimics urothelial cell carcinoma clinically, cys­toscopically, and radiologically. Though there are several reports published, most are case Reports with few being case series.

  The amyloid was first described by Virchow in 1854. The first case of isolated urinary bladder amyloidosis was described by Solomin in 1897. There are ~200 cases reported in the literature.

  Oltita Tirzaman et al (2000, Mayo Clinic Proceedings) have analyzed 31 Cases of Pr Localized Amyloidosis of Urinary Bladder (probably the largest series till to date), found Multiple Bladder areas were involved in 65%, a single area was involved in 26%, and diffuse involvement was present in 10%. Amyloid deposition is found predominantly in the posterior bladder wall (68%), followed by in the trigone (26%).

  Majority of patients had immunoglobulin light chain, and 3 had Transthyretin-related amyloid. Local Recurrences were common making Cystoscopic follow ups necessary. However, repeated work-ups for systemic amyloidosis are unnecessary for patients with light chain related amyloidosis of the urinary bladder.

  I am providing Few Links from which more information on Amyloidosis of Urinary Bladder can be had.

  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5849876/pdf/main.pdf

  https://www.urologyannals.com/temp/UrolAnn54309-1145185_031051.pdf

  http://sgpgivdrc.nmcn.in:8080/jspui/bitstream/1/9713/1/Localized%20amyloidosis%20of%20urinary%20bladder.pdf

  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3955294/pdf/num-05-994.pdf

  Though a rare condition, it is often mistaken for Urothelial Neoplasia and Immunohistochemistry is often needed to arrive at a diagnosis

  With Warm Regards,

  Venu

   

• 

  Nitesh Jain

  02 Jan 2021 08:31:50 AM

  Thank you sir for your expert comments, few things I would like add about amylodosis are 

  
  

  #amylodosis

  
  

  1. Need to differentiate between primary and systemic 

  
  

  2. Ambominal fat pad biopsy or rectal mucosa biopsy needed when systemic amylodosis is suspected and the target organ biopsy is difficult like heart 

  
  

  3. Once biopsy is there need not repeat the biopsy, the preliminary confirmation is apple green bisfringens with Congo red and amporphous eosinophillic appearance with hematoxylin eosin stain 

  
  

  4. Systemic is secondary to malignancy , myeloma , or Chronic diseases like RA 

  
  

  6. Imaging like PET SCAN can help in idetifying the systemic disease - it was normal in this case 

  
  

  7. Light and heavy chain protein needs to be seen - they can raise many fold in systemic disease , it was near normal in this case 

  
  

  8. IHC - helps in confirmation 

  
  

  9. Localised bladder amylodosis - TURBT OR complete resection can achieve cure but patients needs to be under monitoring 

  
  

  10. DMSO - there are few studies which says some usefulness can be tried