Background: Mesenteric lymph node amyloid deposits are rare and may be seen in isolated or secondary amyloidosis. The diagnosis of mesenteric amyloidosis has conventionally relied on histopathological examination following an exploratory laparotomy or a biopsy. Case: A 72-year-old male previously diagnosed with Waldenström’s macroglobulinemia and multiple other malignancies was admitted for abdominal pain. An abdominal computed tomography (CT) scan revealed diffuse retroperitoneal and mesenteric lymphadenopathy associated with bowel wall thickening. A CT-guided fine-needle aspiration (FNA) cytology and core biopsies of mesenteric lymph nodes were performed. The FNA smears revealed irregular, waxy, basophilic clumps on a Diff-Quik stain and cyanophilic clumps of amorphous material on a Papanicolaou stain. The lymph node aspirates showed positivity for the Congo red stain, confirming it as amyloid. In situ hybridization studies revealed a predominance of λ light chains, and a diagnosis of primary amyloidosis involving mesenteric lymph nodes was made. Supplemental needle core biopsies showed positivity for Congo red and Crystal violet stains and exhibited the classic apple-green birefringence under polarized light. Conclusion: The involvement of lymph nodes in amyloidosis is not uncommon; however, the involvement of mesenteric lymph nodes in a setting of macroglobulinemia and its diagnosis by FNA cytology is novel to this case.

Keywords:
Congo red, Amyloidosis, mesenteric, Lymph node, Fine-needle aspiration, Cytology
1.
Gillmore J, Hawkins P: Drug insight: emerging therapies for amyloidosis. Nat Clin Pract Nephrol 2006;2:263–270.
2.
Gillmore J, Hawkins P: Amyloidosis and the respiratory tract. Thorax 1999;54:444–451.
3.
Dimopoulos M, Panayiotidis P, Moulopoulos L, Sfikakis P, Dalakas M: Waldenström’s macroglobulinemia: clinical features, complications, and management. J Clin Oncol 2000;18:214–226.
4.
Kahn H, Strauchen J, Gilbert H, Fuchs A: Immunoglobulin-related amyloidosis presenting as recurrent isolated lymph node involvement. Arch Pathol Lab Med 1991;115:948–950.
5.
Mohan V, Kemp J, Lewine H, Rabin M, Goldstein M, Farraye F: Diffuse mesenteric amyloidosis. Dig Dis Sci 1997;42:1079–1082.
6.
Glynn T, Kreipke D, Irons J: Amyloidosis: diffuse involvement of the retroperitoneum. Radiology 1989;170:726.
7.
Urban B, Fishman E, Goldman S, Scott WW Jr, Jones B, Humphrey R, Hruban R: CT evaluation of amyloidosis: spectrum of disease. Radiographics 1993;13:1295–1308.
8.
Hirschfield G: Amyloidosis: a clinico-pathophysiological synopsis. Semin Cell Dev Biol 2004;15:39–44.
9.
Gillmore J, Hawkins P, Pepys M: Amyloidosis: a review of recent diagnostic and therapeutic developments. Br J Haematol 1997;99:245–256.
10.
Borge M, Parker L, Mauro M: Amyloidosis: CT appearance of calcified, enlarged periaortic lymph nodes. J Comput Assist Tomogr 1991;15:855–857.
11.
Coumbaras M, Chopier J, Massiani M, Antoine M, Boudghene F, Bazot M: Diffuse mesenteric and omental infiltration by amyloidosis with omental calcification mimicking abdominal carcinomatosis. Clin Radiol 2001;56:674–676.
12.
Georgiades C, Neyman E, Barish M, Fishman E: Amyloidosis: review and CT manifestations. Radiographics 2004;24:405–416.
13.
Naschitz J, Yeshurun D, Pick A: Intrathoracic amyloid lymphadenopathy. Respiration 1986;49:73–76.
14.
Westermark P, Stenkvist B: A new method for the diagnosis of systemic amyloidosis. Arch Intern Med 1973;132:522–523.
15.
Glenner G, Terry W, Isersky C: Amyloidosis: its nature and pathogenesis. Semin Hematol 1973;10:65–86.
16.
Isobe T, Osserman E: Patterns of amyloidosis and their association with plasma-cell dyscrasia, monoclonal immunoglobulins and Bence-Jones proteins. N Engl J Med 1974;290:473–477.
17.
Hiller N, Fisher D, Shmesh O, Gottschalk-Sabag S, Dolberg M: Primary amyloidosis presenting as isolated mediastinal mass: diagnosis by fine needle biopsy. Thorax 1995;50:908–909.
18.
Gross B: Radiographic manifestations of lymph node involvement in amyloidosis. Radiology 1981;138:11–14.
19.
Takebayashi S, Ono Y, Sakai F, Tamura S, Unayama S: Computed tomography of amyloidosis involving retroperitoneal lymph nodes mimicking lymphoma. J Comput Assist Tomogr 1984;8:1025–1027.
20.
Allen H, Vick C, Messmer J, Parjer G, Allen H: Diffuse mesenteric amyloidosis: CT, sonographic and pathologic findings. J Comput Assist Tomogr 1985;9:196–198.
21.
Kaur A, Jayaram G: Thyroid tumors: cytomorphology of medullary, clinically anaplastic, and miscellaneous thyroid neoplasms. Diagn Cytopathol 1990;6:383–389.
22.
Das A, Gupta S, Banerjee A, Srinivasan R, Radotra B, Nijhawan R, Dey P, Rajwanshi A: Atypical cytologic features of medullary carcinoma of the thyroid. A review of 12 cases. Acta Cytol 1992;36:137–141.
23.
Zeppa P, Vetrani A, Marino M, Fulciniti F, Boschi R, De Rosa G, Palombini L: Fine needle aspiration cytology of medullary thyroid carcinoma; a review of 18 cases. Cytopathology 1990;1:35–34.
24.
Kyle R, Bayrd E: Amyloidosis: review of 236 cases. Medicine (Baltimore) 1975;54:271–299.
25.
Hind C, Tennent G, Evans D, Pepys M: Demonstration of amyloid A (AA) protein and amyloid P component (AP) in deposits of systemic amyloidosis associated with renal adenocarcinoma. J Pathol 1983;139:159–166.
26.
Kimball K: Amyloidosis in association with neoplastic disease: report of an unusual case and clinicopathological experience at Memorial Center for Cancer and Allied Diseases during eleven years (1948–1958). Ann Intern Med 1961;55:958–974.
27.
Vanatta P, Silva F, Taylor W, Costa J: Renal cell carcinoma and systemic amyloidosis: demonstration of AA protein and review of the literature. Hum Pathol 1983;14:195–201.
28.
Dimopoulos M, Alexanian R: Waldenström’s macroglobulinemia. Blood 1994;83:1452–1459.
29.
Gertz M, Kyle R, Noel P: Primary systemic amyloidosis: a rare complication of immunoglobulin M monoclonal gammopathies and Waldenström’s macroglobulinemia. J Clin Oncol 1993;11:914–920.
30.
Gertz M, Kyle R: Amyloidosis with IgM monoclonal gammopathies. Semin Oncol 2003;30:325–328.
31.
An T, Kaye G: Amyloid formation in insulinoma. Arch Pathol Lab Med 1978;102:227–232.
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2011
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