PMC5748320_01
Physical examination of the affected area: two subcutaneous masses were present, each measuring 50 mm, in the left and right subumbilical regions, with minor subcutaneous hemorrhage and tenderness (indicated by broken-lined ovals).
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The masses had smooth surfaces, partly with subcutaneous hemorrhage and tenderness (Figure 1).
Contrast-enhanced CT of the abdomen (equilibrium phase): in the left and right subumbilical regions, subcutaneous masses with irregular margins are observed, each measuring approximately 60 mm. The density is heterogeneous and higher than that of the surrounding adipose tissue, without contrast-enhancement effect (indicated by arrows).
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Contrast-enhanced CT of the abdomen (Figure 2) demonstrated subcutaneous masses with irregular margins, each measuring approximately 60 mm, in the left and right subumbilical regions, with the density higher than that of the surrounding adipose tissue, and without contrast-enhancement effect.
Comparison of preoperative abdominal ultrasound findings (a) and Congo red-stained histopathological findings (b). The high magnification figures (x200) of Congo red staining (c) and its green birefringence (d). (a) On ultrasonography, the subcutaneous mass is shown as a somewhat heterogeneous, hypoechoic area under the dermis. (b) Congo red-stained section of the mass shows diffuse, irregular, lumpy amyloid deposition (indicated by broken-lined ovals). When the material was stained with Congo red staining (c) and seen with polarized light, we saw green birefringence (d), diagnostic of amyloid.
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Ultrasonography showed a poorly defined heterogeneous hypoechoic mass, measuring 66 (height) x 85 (width) x 20 mm (depth), in the subcutaneous fat layer in the left subumbilical region (Figure 3(a)) and another mass with similar findings on the other side as well. The histopathological picture (Congo red staining) is shown in Figure 3(b), with the high magnification figures of Congo red staining (Figure 3(c)) and its green birefringence (Figure 3(d)).