IMAGES IN CYTOLOGYSection Editor: Shahla Masood, M.D.

Follow-Up Findings on AspirationCytology of Amyloid FromVitreous FluidRaj K. Gupta, M.D., F.I.A.C.,1,2* T. Halliwell, F.R.C.S., F.R.A.C.O.,1Sarla Naran, B.Sc., C.F.I.A.C.,1 Sharda Lallu, B.SC., C.F.I.A.C.,1and Robert Fauck, C.T. (I.A.C.)

1

In a recent communication from this laboratory, we reportedon the cytodiagnosis of amyloid from an aspiration sampleof the vitreous in a 36-year-old female with a history offamilial amyloidosis in whom a left pars plana vitrectomywas done. The patient is now 38 years old, and for the lastfew months has had progressive deterioration of the visionin the right side. On examination, extensive opacification ofthe vitreous was found with a visual acuity of 6/18. Thevision in the left side, however, has remained well and is 6/5unaided. The right retina was difficult to visualize due todense opacities. To improve the vision, a right-sided parsplana vitrectomy was performed. The intraoperative find-ings showed dense vitreous opacities, posterior vitreousdetachment, and clumps of sheet-like and fibrillar opacitieson posterior vitreous surface, and fluffy cotton wool-likeopacities arising from retinal vessels. An aspirate sample ofvitreous was obtained and collected directly in a cytologycontainer in which 30% ethyl alcohol in physiologic salinewas present. From half of the material, filter preparationswere made on size 3 micron Schleicher and Schuell mem-brane filters and stained by Papanicolaou method while theremainder of the sample was spun and from sediment a cellblock was made; sections were cut and stained with hema-toxylin-eosin and Congo red stain. For electronmicroscopy(EM), a portion of cell block was divided into 1 mm cubes,fixed in glutaraldehyde, postfixed in osmium tetroxide,passed through graded alcohols, embedded, sectioned, andstained with uranyl acetate and lead citrate.

Papanicolaou-stained filter preparations and hematox-ylin-eosin-stained sections of cell blocks showed abun-dant amorphous, dense pink globular excrescences indic-

1Department of Cytology, Ophthalmology, Wellington Hospital andSchool of Medicine, Wellington, New Zealand

2Valley Diagnostic Laboratories Ltd., Lower Hutt, New Zealand*Correspondence to: Raj K. Gupta, M.D., F.I.A.C., Valley Diagnostic

Laboratories Ltd., 22-Kings crescent, P.O. Box 30044, Lower Hutt, NewZealand. E-mail: raj.gupta@xtra.co.nz

Received 25 August 2003; Accepted 21 January 2004DOI 10.1002/dc.20089Published online in Wiley InterScience (www.interscience.wiley.com).

Figs. C-1–C-2. Fig. C-1. Papanicolaou-stained filter preparation fromaspirate showing amyloid as amorphous globules (original magnification,�160). Fig. C-2. Congo red-stained section of cell block exhibiting bire-fringence under polarized light (original magnification, �100).

© 2004 WILEY-LISS, INC. Diagnostic Cytopathology, Vol 31, No 5 319

ative of amyloid (Fig. C-1) and they stained positivelywith congo red and exhibited yellowish green birefrin-gence with polarized light (Fig. C-2). On electronmicros-copy, three-dimensional interlacing meshwork of elec-tron-dense fibers 8 –10 nm in diameter and of varyinglength with appearance typical of amyloid was present. Inour recent study on the subject of the diagnosis of amy-loid in vitreous fluid,1 we have discussed in detail thevarious views of the etiopathogenesis of this rare condi-

tion. In this presentation, the cytodiagnosis of amyloidfrom the vitreous aspirate sample from the contralateraleye appeared to be of interest to present the follow-upfindings of this rare entity.

Reference1. Gupta RK, Wakefield SG, Halliwell T, Foo K, Lallu S, Naran S, Fauck

R. Aspiration cytodiagnosis of amyloid from vitreous fluid. DiagnCytopathol 2002;26:294–296.

GUPTA ET AL.

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