2012, Number 5
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Ann Hepatol 2012; 11 (5)
Primary hepatic amyloidosis: a mini literature review and five cases report
Ya-Dong W, Cai-Yan Z, Hong-Zhu Y
Language: English
References: 32
Page: 721-727
PDF size: 213.04 Kb.
ABSTRACT
Primary hepatic amyloidosis (PHA) is characterized by abnormal deposition of monoclonal immunoglobulin light chains (AL) in the liver. This rare condition is frequently undiagnosed or misdiagnosed and can be associated with poor prognosis. At present, the precise pathogenesis is not fully understood. Despite that hepatomegaly and elevated alkaline phosphatase (ALP) are present in most patients with PHA, no specific clinical markers have been identified. Staining of hepatic tissues with Congo Red is often regarded as the “gold standard”. Pharmacological therapy should aim to rapidly reduce the supply of misfolded amyloidogenic AL. High-dose intravenous melphalan (HDM) and autologous stem cell transplantation (ASCT) appear to be the most appropriate therapy but controversies still exist.
REFERENCES
Merlini G, Bellotti V. Molecular mechanisms of amyloidosis. N Engl J Med 2003: 349: 583-96.
Ebert EC, Nagar M. Gastrointestinal manifestations of amyloidosis. Am J Gastroenterol 2008: 103: 776-87.
Renzulli P, Schoepfer A, Mueller E, Candinas D. Atraumatic splenic rupture in amyloidosis. Amyloid 2009: 16: 47-53.
Gullu BE, Hatemi I, Ozbay G, Tuzuner N, Sonsuz A. A rare case of primary systemic amyloidosis presenting with hepatic failure. Turk J Gastroenterol 2011: 22: 113-4.
Stangou AJ, Rela M, Monaghan M, Mathias CJ, Mufti GJ, O’grady JG, Heaton N. Liver failure in association with hepatic amyloidosis and the role of liver transplantation; the King’s College Hospital exprience. The Liver Meeting® 2010 (AASLD) 2010: 1120.
Black RM (ed.). Amyloidosis and light-chain deposition disease. Clinical problems in nephrology. Boston: Little, Brown; 1996.
Li H, Li XW. A clinical analysis of 33 cases of primary amyloidosis (article in Chinese). Zhanghua Nei Ke Za Zhi 2003: 42: 195-6.
Cohen AD, Comenzo RL. Systemic light-chain amyloidosis: advances in diagnosis, prognosis, and therapy. Hematology Am Soc Hematol Educ Program 2010: 2010: 287-94.
Sarkar C, Chand Sharma M, Nayak A, Mercy Ralte A, Gupta V, Singh S, Behari M. Primary AL (kappa-light chain) amyloidosis manifesting as peripheral neuropathy in a young male without increase in serum and urine immunoglobulin load: a diagnostic challenge. Clin Neuropathol 2005: 24: 118-25.
Girnius S, Seldin DC, Skinner M, Finn KT, Quillen K, Doros G, Sanchorawala V. Hepatic response after high-dose melphalan and stem cell transplantation in patients with AL amyloidosis associated liver disease. Haematologica 2009; 94: 1029-32.
Park MA, Mueller PS, Kyle RA, Larson DR, Plevak MF, Gertz MA. Primary (AL) hepatic amyloidosis: clinical features and natural history in 98 patients. Medicine (Baltimore) 2003; 82: 291-8.
Falk RH, Skinner M. The systemic amyloidoses: an overview. Adv Intern Med 2000: 45: 107-37.
Sipe JD, Benson MD, Buxbaum JN, Ikeda S, Merlini G, Saraiva MJ, Westermark P. Amyloid fibril protein nomenclature: 2010 recommendations from the nomenclature committee of the International Society of Amyloidosis. Amyloid 2010;17: 101-4.
McLaurin J, Yang D, Yip CM, Fraser PE. Review: modulating factors in amyloid-beta fibril formation. J Struct Biol 2000; 130: 259-70.
Perfetti V, Casarini S, Palladini G, Vignarelli MC, Klersy C, Diegoli M, Ascari E, et al. Analysis of V(lambda)-J(lambda) expression in plasma cells from primary (AL) amyloidosis and normal bone marrow identifies 3r (lambdaIII) as a new amyloid-associated germline gene segment. Blood 2002; 100: 948-53.
Prokaeva T, Spencer B, Kaut M, Ozonoff A, Doros G, Connors LH, Skinner M, et al. Soft tissue, joint, and bone manifestations of AL amyloidosis: clinical presentation, molecular features, and survival. Arthritis Rheum 2007; 56: 3858-68.
Hung HH, Huang DF, Tzeng CH, Su CH, Su TP, Chen HC, Tsay SH, et al. Systemic amyloidosis manifesting as a rare cause of hepatic failure. J Chin Med Assoc 2010; 73: 161-5.
Bandyopadhyay SK, Bandyopadhyay R, Dutta A. Primary amyloidosis presenting as intrahepatic cholestasis. Indian J Pathol Microbiol 2006; 49: 557-9.
Bradwell AR, Carr-Smith HD, Mead GP, Tang LX, Showell PJ, Drayson MT, Drew R. Highly sensitive, automated immunoassay for immunoglobulin free light chains in serum and urine. Clin Chem 2001; 47: 673-80.
Kim SH, Han JK, Lee KH, Won HJ, Kim KW, Kim JS, Park CH, et al. Abdominal amyloidosis: spectrum of radiological findings. Clin Radiol 2003; 58: 610-20.
Monzawa S, Tsukamoto T, Omata K, Hosoda K, Araki T, Sugimura K. A case with primary amyloidosis of the liver and spleen: radiologic findings. Eur J Radiol 2002; 41: 237-41.
Shin YM. Hepatic amyloidosis. Korean J Hepatol 2011; 17: 80-3.
Loustaud-Ratti VR, Cypierre A, Rousseau A, Yagoubi F, Abraham J, Fauchais AL, et al. Non-invasive detection of hepatic amyloidosis: FibroScan, a new tool. Amyloid 2011; 18: 19-24.
Chee CE, Lacy MQ, Dogan A, Zeldenrust SR, Gertz MA. Pitfalls in the diagnosis of primary amyloidosis. Clin Lymphoma Myeloma Leuk 2010; 10: 177-80.
Gertz MA. Immunoglobulin light chain amyloidosis: 2011 update on diagnosis, risk-stratification, and management. Am J Hematol 2011; 86: 180-6.
Gertz MA, Zeldenrust SR. Treatment of immunoglobulin light chain amyloidosis. Curr Hematol Malig Rep 2009; 4: 91-8.
Palladini G, Perfetti V, Obici L, Caccialanza R, Semino A, Adami F, Cavallero G, et al. Association of melphalan and high-dose dexamethasone is effective and well tolerated in patients with AL (primary) amyloidosis who are ineligible for stem cell transplantation. Blood 2004; 103: 2936-8.
Jaccard A, Moreau P, Leblond V, Leleu X, Benboubker L, Hermine O, Recher C, et al. High-dose melphalan versus melphalan plus dexamethasone for AL amyloidosis. N Engl J Med 2007; 357: 1083-93.
Ohno S, Yoshimoto M, Honda S, Miyachi S, Ishida T, Itoh F, Endo T, et al. The antisense approach in amyloid light chain amyloidosis: identification of monoclonal Ig and inhibition of its production by antisense oligonucleotides in in vitro and in vivo models. J Immunol 2002; 169: 4039-45.
Kumar SK, Gertz MA, Lacy MQ, Dingli D, Hayman SR, Buadi FK, Short-Detweiler K, et al. Recent improvements in survival in primary systemic amyloidosis and the importance of an early mortality risk score. Mayo Clin Proc 2011; 86: 12-8.
Kumar SK, Dispenzieri A, Lacy MQ, Hayman SR, Buadi FK, Zeldenrust SR, Tan T, et al. Changes in serum-free light chain rather than intact monoclonal immunoglobulin levels predicts outcome following therapy in primary amyloidosis. Am J Hematol 2011; 86: 251-5.
Gertz MA, Comenzo R, Falk RH, Fermand JP, Hazenberg BP, Hawkins PN, et al. Definition of organ involvement and treatment response in immunoglobulin light chain amyloidosis (AL): a consensus opinion from the 10th International Symposium on Amyloid and Amyloidosis, Tours, France, 18-22 April 2004. Am J Hematol 2005; 79: 319-28.