24 May 2007 – Case of the Week #85

 

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We thank Dr. Ankur Sangoi, Stanford University, Stanford, California (USA) for contributing this case.  We invite you to contribute a Case of the Week by emailing info@PathologyOutlines.com with microscopic images (any size, we will shrink if necessary) in JPG or TIFF format, a clinical history, your diagnosis and any other images (gross, immunostains, etc.) that may be helpful or interesting.  We will write the discussion (unless you want to), list you as the contributor, and send you a check for $35 (US  dollars) for your time after we send out the case.  Please only send cases with a definitive diagnosis.

 

Case of the Week #85

 

Clinical History

 

A 66 year old man had a prostate biopsy showing adenocarcinoma (Gleason 3+3) in 1 of 12 cores.  He had a radical prostatectomy.

 

Micro images: image #1#2#3#4trichrome #1#2

 

What is your diagnosis?

 

 

 

 

 

 

 

 

 

 

 

 

 

  

 

 

 

 

 

 

 

 

 

Diagnosis:

 

Bilateral seminal vesicle amyloidosis

 

Discussion

 

Amyloidosis commonly occurs in the seminal vesicles of men.  The incidence increases with age, reaching 21% in men age 75 years and older (Histopathology 1993;22:173, Am J Pathol 1983;110:64).  At this site, it is usually a localized finding, and not part of a systemic process.  Although immunohistochemistry often detects lactoferrin within the deposits (Ann Pathol 2004;24:236), a recent study suggests that the amyloid derives from semenogelin I, the major secretory product of the seminal vesicles (J Lab Clin Med 2005;145:187).  Semenogelin I and II are mainly responsible for immediate gel formation of freshly ejaculated semen, and are degraded by the proteolytic action of prostate specific antigen/PSA (J Androl 1996;17:17, free full text)

 

The case contributor notes that trichrome is useful in detecting amyloid.  It stains the amyloid a dusky gray, in sharp contrast to the strong blue staining of collagen.  This is an alternate to Congo Red staining and polarization, which often does not work well.

 

 

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