Secondary amyloidosis diagnostic study of choice: Difference between revisions

Jump to navigation Jump to search
VisualWikitext
(Created page with "__NOTOC__ {{CMG}} {{Sahar}} ==Overview== The diagnostic study of choice in amyloidosis is tissue biopsy of the affected organ...")
 
No edit summary
Line 5: Line 5:
The [[diagnostic]] study of choice in amyloidosis is [[Tissue (biology)|tissue]] [[biopsy]] of the affected [[Organ (anatomy)|organ]]. [[Urinary]] protein measurement followed by [[renal]] [[biopsy]] is the gold standard of the [[diagnosis]].
The [[diagnostic]] study of choice in amyloidosis is [[Tissue (biology)|tissue]] [[biopsy]] of the affected [[Organ (anatomy)|organ]]. [[Urinary]] protein measurement followed by [[renal]] [[biopsy]] is the gold standard of the [[diagnosis]].
==Diagnostic Study of Choice==
==Diagnostic Study of Choice==
* Since AA amyloidosis is a [[condition]] that occurred due to another [[illness]], the [[diagnostic]] study of choice varies according to the primary [[disorder]].<ref name="LachmannGoodman2007">{{cite journal|last1=Lachmann|first1=Helen J.|last2=Goodman|first2=Hugh J.B.|last3=Gilbertson|first3=Janet A.|last4=Gallimore|first4=J. Ruth|last5=Sabin|first5=Caroline A.|last6=Gillmore|first6=Julian D.|last7=Hawkins|first7=Philip N.|title=Natural History and Outcome in Systemic AA Amyloidosis|journal=New England Journal of Medicine|volume=356|issue=23|year=2007|pages=2361–2371|issn=0028-4793|doi=10.1056/NEJMoa070265}}</ref>
* Since AA amyloidosis is a [[condition]] that occurred due to another [[illness]], the [[diagnostic]] study of choice varies according to the primary [[disorder]].
* However, the amyloidosis itself should be confirmed through [[histologic]] examination of the affected organs.  
* However, the amyloidosis itself should be confirmed through [[histologic]] examination of the affected organs.  
* A [[Tissue (biology)|tissue]] [[biopsy]] of the affected organ is the [[Gold standard (test)|gold standard test]] for amyloidosis. Particular stains can determine the subtype of amyloidosis.
* A [[Tissue (biology)|tissue]] [[biopsy]] of the affected organ is the [[Gold standard (test)|gold standard test]] for amyloidosis. Particular stains can determine the subtype of amyloidosis.
* [[Kidney]] is affected to a greater extent compared to other [[organs]]. The 24-hour urine collection with the assessment of urinary [[protein]] may be useful and in the case of [[renal]] involvement, a kidney biopsy is required.  
* [[Kidney]] is affected to a greater extent compared to other [[organs]]. The 24-hour urine collection with the assessment of urinary [[protein]] may be useful and in the case of [[renal]] involvement, a kidney biopsy is required.  
* Staining the tissue sample with [[antibodies]] that are specific for AA amyloidosis will confirm the final [[diagnosis]].
* Staining the tissue sample with [[antibodies]] that are specific for AA amyloidosis will confirm the final [[diagnosis]].
*'''Organ-specific labs''': If a particular [[Organ (biology)|organ]] is affected, laboratory measurements that are specific to that organ can be measured. For example, if there is liver involvement, [[liver function tests]] (such as [[Aspartate transaminase|AST]], [[Alanine transaminase|ALT]], [[Bilirubin|total bilirubin]], and [[alkaline phosphatase]]) should be measured.<ref name="pmid24497558">{{cite journal| author=Mahmood S, Palladini G, Sanchorawala V, Wechalekar A| title=Update on treatment of light chain amyloidosis. | journal=Haematologica | year= 2014 | volume= 99 | issue= 2 | pages= 209-21 | pmid=24497558 | doi=10.3324/haematol.2013.087619 | pmc=3912950 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24497558  }} </ref>
*'''Organ-specific labs''': If a particular [[Organ (biology)|organ]] is affected, laboratory measurements that are specific to that organ can be measured. For example, if there is liver involvement, [[liver function tests]] (such as [[Aspartate transaminase|AST]], [[Alanine transaminase|ALT]], [[Bilirubin|total bilirubin]], and [[alkaline phosphatase]]) should be measured.
===Diagnostic Criteria===
===Diagnostic Criteria===
* Following diagnostic criteria has been used for AL amyloidosis. However, it may be applicable for AA amyloidosis as well.
* Following diagnostic criteria has been used for AL amyloidosis. However, it may be applicable for AA amyloidosis as well.
{| class="wikitable"
{| class="wikitable"
|+
|+
| colspan="4" style="background:#4479BA; color: #FFFFFF;" align="center" ! + |'''Primary tumor (T)'''
| colspan="3" |Diagnostic Criteria
|-
|-
| rowspan="2" style="background: #DCDCDC; padding: 5px; text-align: center;" |'''Stage'''
| style="background: #DCDCDC; padding: 5px; text-align: left;" |Organ
| colspan="3" style="background: #DCDCDC; padding: 5px; text-align: left;" |'''Finding'''
| style="background: #DCDCDC; padding: 5px; text-align: left;" |
| style="background: #DCDCDC; padding: 5px; text-align: left;" |
|-
|-
|style="background: #DCDCDC; padding: 5px; text-align: left;" |'''Spine'''
|style="background: #DCDCDC; padding: 5px; text-align: left;" |'''Pelvis'''
|style="background: #DCDCDC; padding: 5px; text-align: left;" |'''Appendicular skeleton, trunk, skull, and facial bones'''
|-
|'''Tx'''
|
|
* Cannot be assessed
*  
|
|
* Cannot be assessed
*  
|
|
* Cannot be assessed
*  
|-
|-
| |'''T0'''
|
|
* No evidence of primary [[tumor]]
*  
|
|
* No evidence of primary [[tumor]]
*  
|
|
* No evidence of primary [[tumor]]
*  
|-
|-
|'''T1'''
|
|
* Confined to one [[vertebral]] segment or two adjacent [[vertebral]] segments
*  
|
|
* Confined to one [[pelvic]] segment with no extraosseous extension
*  
|
|
* [[Tumor]] ≤8 cm in greatest dimension
*  
*  
*  
|-
|-
|'''T2'''
|
|
* Confined to three adjacent [[vertebral]] segments
*  
|
|
* Confined to one [[pelvic]] segment with extraosseous extension or two segments without extraosseous extension
*  
|
|
* [[Tumor]] >8 cm in greatest dimension
*  


*  
*  
Line 61: Line 54:
*  
*  
|-
|-
|'''T3'''
|
|
* Confined to four or more adjacent [[vertebral]] segments, or any nonadjacent [[vertebral]] segments
*  
|
|
* Spanning two [[pelvic]] segments with extraosseous extension
*  
|
|
* Discontinuous [[tumors]] in the primary [[bone]] site
*  


*  
*  
Line 73: Line 65:
*  
*  
|-
|-
|'''T4'''
|
|
* Extension into the [[spinal canal]] or great [[vessels]]
*  
|
|
* Spanning three [[pelvic]] segments or crossing the [[sacroiliac joint]]
*  
|_
|_


Line 85: Line 76:
|+
|+


! colspan="4" style="background:#4479BA; color: #FFFFFF;" align="center" + |'''Regional lymph nodes (N)'''
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''Stage'''
| colspan="3" style="background: #DCDCDC; padding: 5px; text-align: left;" |'''Finding'''
|-
!Nx
| colspan="3" |
* cannot be assessed
*
|-
!N0
| colspan="3" |
* No regional [[lymph node]] [[metastasis]]
*
|-
!N1
| colspan="3" |
* Regional [[lymph node]] [[metastasis]]
|-
|-
|+
|+


! colspan="4" style="background:#4479BA; color: #FFFFFF;" align="center" + |Distant metastasis (M)
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''Stage'''
| colspan="3" style="background: #DCDCDC; padding: 5px; text-align: left;" |'''Finding'''
|-
!M0
| colspan="3" |
* No distant [[metastasis]]
*
|-
!M1
| colspan="3" |
* Distant [[metastasis]]
*
*
|-
!M1a
| colspan="3" |
* Distant [[metastasis]] to [[lung]]
*
*
|-
!M1b
| colspan="3" |
* Distant [[metastasis]] to [[bone]] or other distant sites
*
*
|-
| colspan="4" style="background:#4479BA; color: #FFFFFF;" align="center" + |'''Histologic grade (G)'''
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''Stage'''
| colspan="3" style="background: #DCDCDC; padding: 5px; text-align: left;" |'''Finding'''
|-
!Gx
| colspan="3" |
* cannot be assessed
*
|-
!G1
| colspan="3" |
* Low grade
*
|-
!G2
| colspan="3" |
* High grade (moderately differentiated)
*
|-
!G3
| colspan="3" |
* High grade (poorly differentiated)
|-
|-
|-
!G4
| colspan="3" |
* Undifferentiated
|-
|-
|}
|}
<references />

Revision as of 21:05, 29 October 2019

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Sahar Memar Montazerin, M.D.[2]

Overview

The diagnostic study of choice in amyloidosis is tissue biopsy of the affected organ. Urinary protein measurement followed by renal biopsy is the gold standard of the diagnosis.

Diagnostic Study of Choice

  • Since AA amyloidosis is a condition that occurred due to another illness, the diagnostic study of choice varies according to the primary disorder.
  • However, the amyloidosis itself should be confirmed through histologic examination of the affected organs.
  • A tissue biopsy of the affected organ is the gold standard test for amyloidosis. Particular stains can determine the subtype of amyloidosis.
  • Kidney is affected to a greater extent compared to other organs. The 24-hour urine collection with the assessment of urinary protein may be useful and in the case of renal involvement, a kidney biopsy is required.
  • Staining the tissue sample with antibodies that are specific for AA amyloidosis will confirm the final diagnosis.
  • Organ-specific labs: If a particular organ is affected, laboratory measurements that are specific to that organ can be measured. For example, if there is liver involvement, liver function tests (such as AST, ALT, total bilirubin, and alkaline phosphatase) should be measured.

Diagnostic Criteria

  • Following diagnostic criteria has been used for AL amyloidosis. However, it may be applicable for AA amyloidosis as well.
Diagnostic Criteria
Organ
_
Retrieved from "https://www.wikidoc.org/index.php?title=Secondary_amyloidosis_diagnostic_study_of_choice&oldid=1586848"