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Identification of amyloidosis of the urinary tract and prostate: Opportunities for early diagnosis & intervention in systemic disease.

Authors :
Gilani SI
Dasari S
Tekin B
Hernandez LH
Cheville JC
Jimenez RE
Rech KL
Dao LN
Howard MT
Dalland JC
Chiu A
Theis JD
Vrana JA
Grogan M
Thompson RH
Leibovich BC
Karnes RJ
Boorjian SA
Dispenzieri A
McPhail ED
Gupta S
Source :
Human pathology [Hum Pathol] 2023 Dec; Vol. 142, pp. 62-67. Date of Electronic Publication: 2023 Nov 17.
Publication Year :
2023

Abstract

Objectives: To determine the prevalence of different amyloid types and frequency of associated systemic amyloidosis in the urinary tract/prostate.<br />Methods: We studied Congo red-positive prostate (n = 150) and urinary tract (n = 767) specimens typed by a proteomics-based method between 2008 and 2020. Clinical follow up was available for a subset (urinary tract, n = 111; prostate, n = 17). Amyloid types were correlated with various clinicopathologic features. For patients with clinical follow up, chart review was performed to establish localized versus systemic disease, frequency of initial diagnosis of amyloidosis on urinary tract/prostate specimens, presence of cardiac disease, and death from disease-related complications.<br />Results: The most common amyloid types were AL/AH in urinary tract (479/767, 62 %) and localized ASem1 in prostate (64/150, 43 %). Urinary tract AL/AH amyloid was usually localized, but systemic AL amyloidosis occurred in both sites (urinary tract: 5/71, 7 %; prostate: 2/2, 100 %). ATTR amyloidosis was seen in over a third of cases (urinary tract: 286/767, 37 %; prostate: 55/150, 37 %). Urinary tract/prostate was the site of the initial ATTR amyloidosis diagnosis in 44/48 patients (92 %), and 38/48 (79 %) were subsequently found to have cardiac involvement. Seminal vesicle/ejaculatory duct involvement was pathognomonic for ASem1-type amyloidosis (39/39, 100 %).<br />Conclusions: Over 40 % of patients had systemic amyloidosis, with urinary tract/prostate often the first site in which amyloid was identified. Since early recognition of systemic amyloidosis is critical for optimal patient outcomes, there should be a low threshold to perform Congo red stain. Proteomics-based amyloid typing is recommended since treatment depends on correctly identifying the amyloid type.<br /> (Copyright © 2023 Elsevier Inc. All rights reserved.)

Details

Language :
English
ISSN :
1532-8392
Volume :
142
Database :
MEDLINE
Journal :
Human pathology
Publication Type :
Academic Journal
Accession number :
37979953
Full Text :
https://doi.org/10.1016/j.humpath.2023.11.001