Answer B

Immunofluorescence and immunohistochemical microscopy for SAA is typically positive in AA amyloidosis.9 Absence of staining for lambda or kappa light chains distinguishes AA amyloidosis from AL amyloidosis.6 Amino acid sequencing and mass spectroscopy of amyloid deposits can be done to identify which precursor protein is involved in amyloid pathogenesis. Serum paraproteins are typically found in amyloid light-chain (primary) amyloidosis.11  Beta-2 microglobulin accumulation in kidney glomeruli is indicative of dialysis-related AA amyloidosis and is usually seen in patients with end-stage renal disease receiving hemodialysis.7

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References

 

1.      Eisenberg D, Jucker M. The amyloid state of proteins in human diseases. Cell. 2012; 148:1188.

2.       Kyle RA. Amyloidosis: a convoluted story. Br J Haematol 2001; 114:529.

3.       Westermark GT, Fändrich M, Westermark P. AA amyloidosis: pathogenesis and targeted therapy. Annu Rev Pathol 2015; 10:321.

4.       Gratacos J, Orellana C, Sanmarti R, et al. Secondary amyloidosis in ankylosing spondylitis. A systematic survey of 137 patients using abdominal fat aspiration. J Rheumatol 1997; 24:912.

5.       Kisilevsky R, Manley PN. Acute-phase serum amyloid A: perspectives on its physiological and pathological roles. Amyloid. 2012; 19:5.

6.       Lachmann HJ, Booth DR, Booth SE, et al. Misdiagnosis of hereditary amyloidosis as AL (primary) amyloidosis. N Engl J Med. 2002; 346:1786.

7.       Dervisoglu E, Anik Y, Erdogan S, Akansel G, Yilmaz A. Beta2-microglobulin amyloidosis in hemodialysis and peritoneal dialysis patients. Ther Apher Dial. 2008;12(4):306-10.

8.       Devata S, Hari P, Markelova N, Li R, Komorowski R, Shidham VB. Detection of amyloid in abdominal fat pad aspirates in early amyloidosis: Role of electron microscopy and Congo red stained cell block sections. Cytojournal. 2011;8:11.

9.       Schönland SO, Hegenbart U, Bochtler T, et al. Immunohistochemistry in the classification of systemic forms of amyloidosis: a systematic investigation of 117 patients. Blood. 2012; 119:488.

10.     Whittier WL. Complications of the percutaneous kidney biopsy. Adv Chronic Kidney Dis. 2012;19(3):179-87.

11.      Real de Asúa D, Costa R, Galván JM, Filigheddu MT, Trujillo D, Cadiñanos J. Systemic AA amyloidosis: epidemiology, diagnosis, and management. Clin Epidemiol. 2014;6:369-377.