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Case Study: March 2016
History
A 45-year-old female notices a slight discmofort and lump in the right eye.
On examination a yellow nodule is present in the right supero-temporal conjunctival fornix. The clinical interpretation is of possible fat prolapse. A biopsy is performed.
Questions
1. What do figures 1 and 2 demonstrate?
2. Which histological stain has been used in Fig 3.
3. What does Fig 4 show?
4. What is the diagnosis?
5. What is the next clinical step to take?
6. Which further investigations can be done on the histological material?
1. Mostly perivascular deposits of eosinophilic amorphous material.
2. Congo Red
3. Apple green birifringence under polarised light.
4. This is amyloid deposition in the conjunctiva.
5. To establish whether this is primary or secondary amyloid. Under most circumstances it is primary, AL type amyloid.
6. Mass spectometry can be done on the material to type the amyloid.
References
Gilbertson JA, Theis JD, Vrana JA, Lachmann H, Wechalekar A, Whelan C, Hawkins PN, Dogan A, Gillmore JD. A comparison of immunohistochemistry and mass spectrometry for determining the amyloid fibril protein from formalin-fixed biopsy tissue. J Clin Pathol. 2015 Apr;68(4):314-7
