PMC4981157_01
Electrocardiogram of the three presented cases.. Notes: In all cases, electrocardiogram showed low voltage in the limb leads. (A) Case 1: low R-wave progression was seen in the chest leads V1 to V3. (B) Case 2: the lack of R-wave was seen in the chest leads V1 to V5. (C) Case 3: low R-wave progression was seen in the chest leads V1 to V4, similar to Case 1. These abnormal R-waves were considered a pseudoinfarct pattern.
cia-11-1061Fig1.jpg
PMC4981157_03_cia-11-1061Fig1.jpg
f1-cia-11-1061
Based on echocardiogram findings similar to those seen in Cases 1 and 2, the patient was suspected to have SA (Table 1, Figures 1C, 2E, and 2F).
Echocardiography of the three presented cases.. Notes: Parasternal long-axis views (A, C, and E) and apical four-chamber views (B, D, and F) are presented. (A and B) Case 1: granular sparkling appearance was seen in the interventricular septum (IVS), which was 11.5 mm in thickness. (C and D) Case 2: granular sparkling appearance was seen in the IVS and the lateral wall. The IVS of Case 2 was less thickened (9.8 mm in thickness), but the left ventricular wall exhibited diffuse hypertrophy with diastolic dysfunction (E/e' 15.55) without valvular dysfunction. (E and F) Case 3: granular sparkling appearance was shown in the IVS and lateral wall, and the IVS was 13.0 mm in thickness.
cia-11-1061Fig2.jpg
PMC4981157_03_cia-11-1061Fig2.jpg
f2-cia-11-1061
Based on echocardiogram findings similar to those seen in Cases 1 and 2, the patient was suspected to have SA (Table 1, Figures 1C, 2E, and 2F).
Light micrograph of the subcutaneous fat tissue.. Notes: (A-C) Case 1: skin and subcutaneous fat tissue around the left posterior iliac crest was inadvertently biopsied with bone and bone marrow in Case 1. Therefore, bone marrow tissue is seen in the upper right area of the figures (A and B). Patchy amyloid deposits in dermis are stained orange red with Congo red (A). Green birefringence of the amyloid deposits can be seen under polarized light but cannot be detected in bone marrow tissue (B). Slight green birefringence of amyloid deposits is also seen in subcutaneous fat tissue adjacent to the dermis under polarized light (C). (D-F) Case 2: we could obtain only one cluster of fatty tissue after repeated aspiration from the hip in Case 2 (D). The sample was too small to slice into biopsy sections. Interstitial tissue between the adipocytes is stained orange red with Congo-red stain (E), and green birefringence of the amyloid deposits can be seen under polarized light (F). (G-I) Case 3: subcutaneous fat tissue aspirated from the hip is patchily stained orange red with Congo red (white arrows; G) and green birefringence of the patch can be seen under polarized light (H). Muscular tissue is also stained with Congo red but it is not brilliant apple green under polarized light (arrow heads). Immunohistochemistry of the subcutaneous fat tissue shows that amyloid deposits can be stained with antitransthyretin antibody (I).
cia-11-1061Fig3.jpg
PMC4981157_03_cia-11-1061Fig3.jpg
f3-cia-11-1061
Amyloid deposits in the fat tissue were revealed by Congo red staining with polarizing light exposure, as well as with transthyretin immunostaining (Figure 3G-I).
PMC4981157_02
Electrocardiogram of the three presented cases.. Notes: In all cases, electrocardiogram showed low voltage in the limb leads. (A) Case 1: low R-wave progression was seen in the chest leads V1 to V3. (B) Case 2: the lack of R-wave was seen in the chest leads V1 to V5. (C) Case 3: low R-wave progression was seen in the chest leads V1 to V4, similar to Case 1. These abnormal R-waves were considered a pseudoinfarct pattern.
cia-11-1061Fig1.jpg
PMC4981157_03_cia-11-1061Fig1.jpg
f1-cia-11-1061
Based on echocardiogram findings similar to those seen in Cases 1 and 2, the patient was suspected to have SA (Table 1, Figures 1C, 2E, and 2F).
Echocardiography of the three presented cases.. Notes: Parasternal long-axis views (A, C, and E) and apical four-chamber views (B, D, and F) are presented. (A and B) Case 1: granular sparkling appearance was seen in the interventricular septum (IVS), which was 11.5 mm in thickness. (C and D) Case 2: granular sparkling appearance was seen in the IVS and the lateral wall. The IVS of Case 2 was less thickened (9.8 mm in thickness), but the left ventricular wall exhibited diffuse hypertrophy with diastolic dysfunction (E/e' 15.55) without valvular dysfunction. (E and F) Case 3: granular sparkling appearance was shown in the IVS and lateral wall, and the IVS was 13.0 mm in thickness.
cia-11-1061Fig2.jpg
PMC4981157_03_cia-11-1061Fig2.jpg
f2-cia-11-1061
Based on echocardiogram findings similar to those seen in Cases 1 and 2, the patient was suspected to have SA (Table 1, Figures 1C, 2E, and 2F).
Light micrograph of the subcutaneous fat tissue.. Notes: (A-C) Case 1: skin and subcutaneous fat tissue around the left posterior iliac crest was inadvertently biopsied with bone and bone marrow in Case 1. Therefore, bone marrow tissue is seen in the upper right area of the figures (A and B). Patchy amyloid deposits in dermis are stained orange red with Congo red (A). Green birefringence of the amyloid deposits can be seen under polarized light but cannot be detected in bone marrow tissue (B). Slight green birefringence of amyloid deposits is also seen in subcutaneous fat tissue adjacent to the dermis under polarized light (C). (D-F) Case 2: we could obtain only one cluster of fatty tissue after repeated aspiration from the hip in Case 2 (D). The sample was too small to slice into biopsy sections. Interstitial tissue between the adipocytes is stained orange red with Congo-red stain (E), and green birefringence of the amyloid deposits can be seen under polarized light (F). (G-I) Case 3: subcutaneous fat tissue aspirated from the hip is patchily stained orange red with Congo red (white arrows; G) and green birefringence of the patch can be seen under polarized light (H). Muscular tissue is also stained with Congo red but it is not brilliant apple green under polarized light (arrow heads). Immunohistochemistry of the subcutaneous fat tissue shows that amyloid deposits can be stained with antitransthyretin antibody (I).
cia-11-1061Fig3.jpg
PMC4981157_03_cia-11-1061Fig3.jpg
f3-cia-11-1061
Amyloid deposits in the fat tissue were revealed by Congo red staining with polarizing light exposure, as well as with transthyretin immunostaining (Figure 3G-I).
PMC4981157_03
Electrocardiogram of the three presented cases.. Notes: In all cases, electrocardiogram showed low voltage in the limb leads. (A) Case 1: low R-wave progression was seen in the chest leads V1 to V3. (B) Case 2: the lack of R-wave was seen in the chest leads V1 to V5. (C) Case 3: low R-wave progression was seen in the chest leads V1 to V4, similar to Case 1. These abnormal R-waves were considered a pseudoinfarct pattern.
cia-11-1061Fig1.jpg
PMC4981157_03_cia-11-1061Fig1.jpg
f1-cia-11-1061
Based on echocardiogram findings similar to those seen in Cases 1 and 2, the patient was suspected to have SA (Table 1, Figures 1C, 2E, and 2F).
Echocardiography of the three presented cases.. Notes: Parasternal long-axis views (A, C, and E) and apical four-chamber views (B, D, and F) are presented. (A and B) Case 1: granular sparkling appearance was seen in the interventricular septum (IVS), which was 11.5 mm in thickness. (C and D) Case 2: granular sparkling appearance was seen in the IVS and the lateral wall. The IVS of Case 2 was less thickened (9.8 mm in thickness), but the left ventricular wall exhibited diffuse hypertrophy with diastolic dysfunction (E/e' 15.55) without valvular dysfunction. (E and F) Case 3: granular sparkling appearance was shown in the IVS and lateral wall, and the IVS was 13.0 mm in thickness.
cia-11-1061Fig2.jpg
PMC4981157_03_cia-11-1061Fig2.jpg
f2-cia-11-1061
Based on echocardiogram findings similar to those seen in Cases 1 and 2, the patient was suspected to have SA (Table 1, Figures 1C, 2E, and 2F).
Light micrograph of the subcutaneous fat tissue.. Notes: (A-C) Case 1: skin and subcutaneous fat tissue around the left posterior iliac crest was inadvertently biopsied with bone and bone marrow in Case 1. Therefore, bone marrow tissue is seen in the upper right area of the figures (A and B). Patchy amyloid deposits in dermis are stained orange red with Congo red (A). Green birefringence of the amyloid deposits can be seen under polarized light but cannot be detected in bone marrow tissue (B). Slight green birefringence of amyloid deposits is also seen in subcutaneous fat tissue adjacent to the dermis under polarized light (C). (D-F) Case 2: we could obtain only one cluster of fatty tissue after repeated aspiration from the hip in Case 2 (D). The sample was too small to slice into biopsy sections. Interstitial tissue between the adipocytes is stained orange red with Congo-red stain (E), and green birefringence of the amyloid deposits can be seen under polarized light (F). (G-I) Case 3: subcutaneous fat tissue aspirated from the hip is patchily stained orange red with Congo red (white arrows; G) and green birefringence of the patch can be seen under polarized light (H). Muscular tissue is also stained with Congo red but it is not brilliant apple green under polarized light (arrow heads). Immunohistochemistry of the subcutaneous fat tissue shows that amyloid deposits can be stained with antitransthyretin antibody (I).
cia-11-1061Fig3.jpg
PMC4981157_03_cia-11-1061Fig3.jpg
f3-cia-11-1061
Amyloid deposits in the fat tissue were revealed by Congo red staining with polarizing light exposure, as well as with transthyretin immunostaining (Figure 3G-I).
The abdominal computerized tomography of Case 3.. Notes: The abdominal wall around the navel was ~3-5 mm in thickness, where FNAB-AFP is usually performed. The white arrow indicates where FNAB of the hip was performed.. Abbreviations: AFP, abdominal fat pad; FNAB, fine-needle aspiration biopsy.
cia-11-1061Fig4.jpg
PMC4981157_03_cia-11-1061Fig4.jpg
f4-cia-11-1061
We could not perform FNAB-AFP because her abdominal wall was too thin to apply centesis safely (Figure 4) and she could not remain still during the FNAB procedure because of stroke-induced cognitive impairment.