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Diagnose This (February 22, 2021)

Joel Murphy, MD
By Joel Murphy, MD

Feb 23, 2021

amyloidosis, Amyloid Spicules on Jones Silver Stain, amyloid spicules with eyelashes, renal pathology

What is your leading diagnosis when seeing this finding along the glomerular capillary loops?

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Answer: The light microscopic image of a Jones silver stain shows a glomerulus with demonstrates numerous elongated, fine spicules which some regard as the “eyelash sign”. This finding is classically seen with amyloidosis. Other glomeruli, in this case, demonstrated areas of PAS-weak to negative staining of mesangial areas which is another feature that should raise suspicion for possible amyloidosis. By electron microscopy, this case demonstrated numerous, randomly arranged fibrils that measured ~10 nm characteristic of amyloid fibrils within mesangial areas with extension into numerous capillary loops. Congo red stain was positive in glomeruli.

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