The document discusses amyloidosis, a group of disorders involving the deposition of abnormal proteins outside cells. There are different types including primary, secondary, systemic, localized, and hereditary amyloidosis. Secondary amyloidosis is the most common type and is caused by chronic inflammation. Clinically, amyloidosis can lead to organ enlargement and failure of the liver, kidneys, brain, and heart. Under the microscope, amyloid deposits appear as extracellular pink proteins that stain positive with Congo red and appear apple green under polarized microscopy.

1. “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…!

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CLINICAL PATHOLOGY
The foundation of Clinical Medicine.
Shashidhar Venkatesh Murthy
A/Prof & Head of Pathology
College of Medicine & Dentistry
Amyloidosis

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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.
Glomerulus - Congo Red Stain
Polarized Microscopy
 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.

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Amyloidosis: Types & their Pathogenesis:
Primary Secondary
Senile / Hereditary
Pathogenesis
β pleated

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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.

6. “All evil comes from
people whose idea of
wellbeing only -- Sadhguru
Think before thinking negative..…!

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Senile Systemic Amyloidosis – Heart, Restrictive CMP
 Previously known as Senile Cardiac Amyloidosis.
 Restrictive Cardiomyopathy & Arrhythmias.
 American Black population 4%, Transthyretin (ATTR)
 Familial amyloid polyneuropathy (FAP): Sweden, Japan, common.
Normal

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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.
Kidney
Liver
Normal

9. “All evil comes from people whose
idea of wellbeing only -- Sadhguru

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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.

11. “No doubt knowledge is valuable,
but above it is Character”
Knowledge without character is dangerous!