A 56-year-old male, with diabetes mellitus type II under insulin treatment, who underwent myopia and cataract surgery.
She came to our clinic for preputial craurosis that prevents foreskin retraction.
A painful nodule about three centimeters is located under the foreskin at the level of the glans and is very consistent.
With the suspicion of penile carcinoma, it is performed with local anesthesia preputial incision in which we find a nodule four centimeters in diameter, located lateral redact glans, rough on face t
A deep wedge was taken from the nodule and sent for pathological study.
It was decided not to perform circumcision or excision of the nodule pending the outcome.
Although with the preputial incision the glans could be exteriorized and perform proper hygiene.
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The histological result is reported as nodular amyloidosis.
It is curious to note that in the time elapsed until the histological result was expected, when adequate hygiene was performed, the appearance of the nodule improved.
Complete circumcision and excision of the nodule were performed, confirming this second histological study that was an amyloidotic nodule.
Potassium permanganate staining was used to differentiate AA from AL amyloid, the latter characteristic of the primary form and not sensitive to permanganate.
The tissue sample was stained with Rojo Congo and examined with polarized light typical bi-rigency green.
After the amyloid was identified, proteins and immunohistochemistry were performed.
The amyloid component was the AL type, characteristic of primary amyloidosis and local amyloidosis.
This flar component is characterized by a higher deposit of immunoglobulins Kappa or lambda.
Patient was screened for generalized amyloidosis consisting of complete blood count, biochemistry, proteinogram, PSA, chest X-ray, abdominal ultrasound and rectal mucosa biopsy.
The patient did not present nephrotic syndrome so we did not believe appropriate to perform renal biopsy.
She also had no arthritis, heart failure, hypotension or neuropathy.
All tests showed normal results and generalized amyloidosis was ruled out.
Two years later, the lesion has not recurred and the patient has not developed generalized amyloidosis.
