Light chain amyloidosis of the urinary bladder. A site restricted deposition of an externally produced immunoglobulin

A Livneh¹, S Shtrasburg¹, B M Martin², J Baniel³, R Gal⁴ and M Pras¹

¹ Heller Institute of Medical Research, Sheba Medical Center, Tel-Hashomer 52621, Israel
² Clinical Neurosciences Branch, National Institute of Mental Health, National Institute of Health, Bethesda, MD, 20892-4405 USA
³ Department of Urology, Belinson Campus, Rabin Medical Center, Petach-Tiqva, 49100 Israel
⁴ Department of Pathology, Golda Campus, Rabin Medical Center, Petach-Tiqva, 49372 Israel

Correspondence to:
Professor Livneh alivneh{at}post.tau.ac.il

Aims—To identify the amyloid protein in a patient with amyloidosis localised to the urinary bladder, and to see whether subtyping of the protein by sequence analysis increases the understanding of the selection of the urinary bladder as the site of amyloid deposition.

Methods—A patient with gross haematuria and a congophilic mass in his urinary bladder was evaluated further. Characterisation of the amyloid protein was performed using conventional histological and immunohistochemical methods. Determination of the N-terminal amino acid sequence of the amyloid protein was performed using protein sequencers.

Results—The patient's history, physical examination, and laboratory evaluation excluded the involvement of other organs, justifying a diagnosis of amyloidosis localised to the urinary bladder. Histological and immunological studies showed that the amyloid protein deposited in the urinary bladder of the patient was probably of the amyloid light chain type. No plasma cells or lymphocytes were seen in sections of the urinary bladder and lower ureter adjacent to the amyloid deposits. Molecular analysis showed the sequence NFMLTQPHSISGSPG, which assigned the amyloid protein to either the V_I or the V_VI immunoglobulin (Ig) light chain families.

Conclusions—The findings suggest that the amyloid protein in this patient originated outside the urinary bladder. The heterogeneity of the Ig proteins in known cases of amyloidosis of the lower urinary tract suggests that the amino acid residues, which determine the V subtyping, have no major role in restricting the deposited protein to the urinary bladder.

Key Words: primary amyloidosis • urinary bladder • light chain • amino acid sequence

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