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Performing and processing FNA of anterior fat pad for amyloid. J Vis Exp 2010 Oct 30(44) PMID: 21085098 PMCID: PMC3185617

Pubmed ID

21085098

Abstract

Historically, heart, liver, and kidney biopsies were performed to demonstrate amyloid deposits in amyloidosis. Since the clinical presentation of this disease is so variable and non-specific, the associated risks of these biopsies are too great for the diagnostic yield. Other sites that have a lower biopsy risk, such as skin or gingival, are also relatively invasive and expensive. In addition, these biopsies may not always have sufficient amyloid deposits to establish a diagnosis. Fat pad aspiration has demonstrated good clinical correlation with low cost and minimal morbidity. However, there are no standardized protocols for performing this procedure or processing the aspirated specimen, which leads to variable and nonreproducible results. The most frequently utilized modality for detecting amyloid in tissue is an apple-green birefringence on Congo red stained sections using a polarizing microscope. This technique requires cell block preparation of aspirated material. Unfortunately, patients presenting in early stage of amyloidosis have minimal amounts of amyloid which greatly reduces the sensitivity of Congo red stained cell block sections of fat pad aspirates. Therefore, ultrastructural evaluation of fat pad aspirates by electron microscopy should be utilized, given its increased sensitivity for amyloid detection. This article demonstrates a simple and reproducible procedure for performing anterior fat pad aspiration for the detection of amyloid utilizing both Congo red staining of cell block sections and electron microscopy for ultrastructural identification.

Author List

Shidham VB, Hunt B, Jardeh SS, Barboi AC, Devata S, Hari P

Author

Parameswaran Hari MD Chief, Professor in the Medicine department at Medical College of Wisconsin




Scopus

2-s2.0-80355133732   5 Citations

MESH terms used to index this publication - Major topics in bold

Abdominal Fat
Adipose Tissue
Amyloid
Amyloidosis
Biopsy, Fine-Needle
Coloring Agents
Congo Red
Humans
Microscopy, Electron
jenkins-FCD Prod-299 9ef562391eceb2b8f95265c767fbba1ce5a52fd6