“All evil comes from people whose idea of wellbeing only includes themselves, their own family, community, race, religion or nation.” -- Sadhguru Selfishness is the cause of evil…!
2 CLINICAL PATHOLOGY The foundation of Clinical Medicine. Shashidhar Venkatesh Murthy A/Prof & Head of Pathology College of Medicine & Dentistry Amyloidosis
3 Amyloidosis: Introduction Group of disorders with extracellular deposition of fibrillary non digestible abnormal (misfolded) proteins waxy material (> 20 different proteins). “Amyloid” (starch like - Virchow) due to charged sugar molecules in the protein. Routine Microscopy shows as uniform pink deposits. Congo red stain – specifically stains amyloid – red which apear apple green under polarized microscopy. Primary, Secondary/Inflammatory*, Systemic / Local & Hereditary types. Hepatosplenomegaly, restrictive cardiomyopathy & organ failure. Glomerulus - Congo Red Stain Polarized Microscopy
4 Amyloidosis: Types & their Pathogenesis: Pathogenesis Primary Secondary Senile / Hereditary β pleated
5 Amyloidosis: Clinical Disorders Systemic Amyloidosis: (multiorgan) Primary: Plasma cell / Immunocyte disorders: Multiple myeloma. - AL Secondary: Reactive, Chronic Inflam. TB, Auto.Imm dis. – AA Hemodialysis Associated: Chronic Renal Failure – β2 microglob. Systemic Senile Amyloidosis: Ageing Transthyretin, cardiomyopathy ATTR Hereditary Amyloidosis: Many subtypes, familial: ATTR ATTR: Amyloid of TTR transporter of Thyroxin & Retinol (VitaminA) Localized Amyloidosis: (Specific tissue / organ) Senile cerebral: Alzheimer disease Aβ Endocrine: Diabetes DM2 – AIAPP Proinsulin. Cardiac Amyloidosis: atrial natriuretic factor. AANF Medullary carcinoma thyroid – ACal – Calcitonin.
“All evil comes from people whose idea of wellbeing only -- Sadhguru Think before thinking negative..…!
7 Senile Systemic Amyloidosis – Heart, Restrictive CMP Normal Previously known as Senile Cardiac Amyloidosis. Restrictive Cardiomyopathy & Arrhythmias. American Black population 4%, Transthyretin (ATTR) Familial amyloid polyneuropathy (FAP): Sweden, Japan, common.
8 Amyloidosis: Morphology Gross: Organ enlargement, pale, rubbery firm (waxy deposits) Microscopy: extracellular Pink deposits. Congo Red stain +ve. Effects: Pressure atrophy of surrounding cells, Narrowing of BV. Ischemia, infarctions, dysfunction / hypofunction. Normal Kidney Liver
“All evil comes from people whose idea of wellbeing only -- Sadhguru
10 Amyloidosis: Summary Extracellular deposition of waxy, misfolded, non digestible proteins with β pleated fibrillary structure. Leading to cellular damage & organ failure. Primary, Secondary, Systemic, Localized & Hereditary types. Secondary Amyloidosis, Commonest, chronic inflammation. SAA. Clinical: Hepatosplenomegaly, brain, kidney & Heart failure Gross: Firm, pale, waxy enlargement of organs. Microscopy: Extracellular, pink protein. Congo red stain positive, apple green under polarized microscopy. Late complication in chronic infections(TB), Inflammations, Autoimmune disorders, Ageing and B cell neoplasms like multiple myeloma. Rarely hereditary disorders.
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