PMC5340654_01
Abdominal CT showing an enlarged liver with patent hepatic and portal veins.
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F1
There was no evidence of retroperitoneal or mesenteric lymphadenopathy (Figure 1).
Liver biopsy showing near complete effacement of acinar architecture by sinusoidal and portal deposits of congophilic, extracellular, pale eosinophilic, hyaline, amorphous, acellular material. Hepatocytes showed pressure atrophy and focal presence of canalicular bile was noted. Portal tracts showed no significant inflammation. There was no significant fibrosis. Hematoxylin and eosin stain.
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F2
Portal tracts showed no significant inflammation with F1 fibrosis (Figure 2).
(A and B) lambda and kappa staining revealed that the amyloid deposits consisted largely of light chains, lambda being stronger than kappa (magnification 40x).
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F3
Immunohistochemistry revealed that the amyloid deposits consisted largely of light chains, with lambda being stronger than kappa (Figure 3).
(A) Hematoxylin and eosin staining of rectal biopsy showing focal deposit of acellular eosinophilic amorphous material in the wall of blood vessels in submucosa. (B) Congo red staining under polarized light showing apple green birefringence on rectal biopsy, confirming extrahepatic amyloid deposits.
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F4
This confirmed extrahepatic deposition of amyloid (Figure 4).