Hepatic amyloid, when identified, is usually located in the sinusoids, portal tracts, and arterioles. We report 14 cases of hepatic amyloidosis where eosinophilic globules having the histochemical and electron microscopic features of classic amyloid were found. The globules were round to oval, 5 to 40 pm in diameter, and were found within the space of Disse as well as aggregated within the portal tracts. There were no distinctive clinical or laboratory features distinguishing this type of amyloidosis from classic hepatic amyloidosis. However, there were no cases of multiple myeloma and only one of benign monoclonal gammopathy. All seven patients who were studied at postmortem examination had systemic (nonglobular) amyloidosis. This form of hepatic amyloidosis is probably not an early form of the disease but is an original but rare presentation of hepatic amyloid deposition.
Amyloid is an amorphous eosinophilic substance usually found in the liver in patients with systemic amyloidosis (1-5). When the diagnosis of amyloidosis is made on liver biopsy, it is usually incidental to a liver biopsy performed for other reasons. Its morphologic presentation is characteristic and, when foci of amyloid are suspected, its identity can be easily confirmed by histochemical methods and polarization microscopy (6-8). We report 14 cases of hepatic amyloidosis with a uniquely different morphologic pattern, having round, homogeneously eosinophilic globules in portal areas and hepatic parenchyma. Globular hepatic amyloid is not widely recognized. We feel that a detailed clinico-pathologic report is important as general awareness will undoubtedly result in increased diagnosis of this form of hepatic amyloid. From April, 1967, through December, 1980,14 cases of atypical globular hepatic amyloid were identified. Slides of liver tissue of six patients were received in consultation: liver biopsy, 3, postmortem tissue, 2, and liver biopsy
MATERIALS AND METHODS