Localized amyloidosis involving lacrimal gland and conjunctiva in Sjogren syndrome
Purpose
To report localized amyloidosis involving the lacrimal gland and conjunctiva in a patient with Sjogren syndrome (SS).
Methods
A 56-year-old female had SS from twenty years ago. The patient suffered from upper eyelid swelling in her left eye for five months. She was referred for managements of a mass OS observed in a nearby clinic in October 2018. Her visual acuity was 20/20 OS with a normal intraocular pressure. Superficial punctate keratopathy (SPK) was seen at the lower part in both eyes, and Schirmer’s test was positive (R=2mm, L=3mm). We conducted an insertion of lacrimal plug. Orbital computed tomography (CT) showed a mild enlargement of the left lacrimal gland. We conducted an excisional biopsy of the lacrimal gland mass after informed consent was obtained.
Results
Histopathologic examination showed the deposition of amorphous eosinophilic substance not only in the lacrimal gland but also beneath the conjunctival epithelium that demonstrated birefringence of apple-green color on Direct Fast Scarlet (DFS) staining, suggestive of amyloid under a polarizing microscope. The patient referred to the department for additional evaluation for amyloidosis, and was diagnosed with localized secondary amyloidosis of the lacrimal gland.
Conclusion
Physicians should be aware of the existence of amyloidosis in a case of upper eyelid swelling with SS.
Conflict of interest
No
Author 1
Last name
ITO
Initials of first name(s)
T
Department
Ophthalmology, Hokkaido University
City
Sapporo
Country
Japan
Author 2
Last name
Kase
Initials of first name(s)
S
Department
Ophthalmology, Hokkaido University
City
Sapporo
Country
Japan
Author 3
Last name
Ishijima
Initials of first name(s)
K
Department
Ophthalmology, Hokkaido University
City
Sapporo
Country
Japan
Author 4
Last name
Suimon
Initials of first name(s)
Y
Department
Ophthalmology, Hokkaido University
City
Sapporo
Country
Japan
Author 5
Last name
Takakuwa
Initials of first name(s)
E
Department
Pathology, Hokkaido University
City
Sapporo
Country
Japan
Author 6
Last name
Ishida
Initials of first name(s)
S
Department
Ophthalmology, Hokkaido University
City
Sapporo
Country
Japan
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