Skeletal Radiology

, Volume 48, Issue 2, pp 301–306 | Cite as

Progression of dialysis-related amyloidoma towards pathologic fracture

  • Joe D. Baal
  • Andrew E. Horvai
  • Thomas M. LinkEmail author
Case Report


Amyloidosis is the extracellular deposition of amyloid protein fibrils, and this condition may be hereditary or acquired. Patients undergoing long-term hemodialysis are particularly at risk for developing acquired amyloidosis. A rare form of amyloidosis is an amyloidoma or amyloid tumor, which occurs when amyloid focally deposits in a section of the musculoskeletal system, most commonly in the osteoarticular system. Here, we present a case of a hemodialysis-related amyloidoma of the left femoral neck in an 80-year-old woman with end-stage renal disease on hemodialysis for 8 years. The purpose of this report is to provide an account of the unique clinical, imaging, and histopathologic manifestation of a dialysis-related amyloidoma that progressively enlarges over a 2-year period. This report also highlights some prophylactic measures that may reduce the risk of developing an associated pathologic fracture.


Amyloidoma Pathologic fracture Dialysis 


Compliance with ethical standards


This publication was supported by the National Center for Advancing Translational Sciences, National Institutes of Health, through UCSF-CTSI Grant Number TL1 TR001871. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the NIH.

Conflict of interest

The authors have no conflicts of interest regarding this study.


  1. 1.
    Ross LV, Ross GJ, Mesgarzadeh M, Edmonds PR, Bonakdarpour A. Hemodialysis-related amyloidomas of bone. Radiology. 1991;178(1):263–5.CrossRefGoogle Scholar
  2. 2.
    Kuntz D, Naveau B, Bardin T, Drueke T, Treves R, Dryll A. Destructive spondyloarthropathy in hemodialyzed patients. A new syndrome. Arthritis Rheum. 1984;27(4):369–75.CrossRefGoogle Scholar
  3. 3.
    Danesh F, Ho LT. Dialysis-related amyloidosis: history and clinical manifestations. Semin Dial. 2001;14(2):80–5.CrossRefGoogle Scholar
  4. 4.
    Floege J. Ketteler M. beta2-microglobulin-derived amyloidosis: an update. Kidney Int Suppl. 2001;78:S164–71.CrossRefGoogle Scholar
  5. 5.
    Kiss E, Keusch G, Zanetti M, et al. Dialysis-related amyloidosis revisited. AJR Am J Roentgenol. 2005;185(6):1460–7.CrossRefGoogle Scholar
  6. 6.
    Alshehri F. Hemodialysis-induced amyloid arthropathy of hip presenting as pathological fracture—a case report and literature review. J Clin Diagn Res. 2014;8(10):RD01–2.PubMedPubMedCentralGoogle Scholar
  7. 7.
    Casey TT, Stone WJ, Diraimondo CR, et al. Tumoral amyloidosis of bone of beta 2-microglobulin origin in association with long-term hemodialysis: a new type of amyloid disease. Hum Pathol. 1986;17(7):731–8.CrossRefGoogle Scholar
  8. 8.
    Giorgetti S, Rossi A, Mangione P, et al. Beta2-microglobulin isoforms display an heterogeneous affinity for type I collagen. Protein Sci. 2005;14(3):696–702.CrossRefGoogle Scholar
  9. 9.
    Jadoul M, Garbar C, Noël H, et al. Histological prevalence of beta 2-microglobulin amyloidosis in hemodialysis: a prospective post-mortem study. Kidney Int. 1997;51(6):1928–32.CrossRefGoogle Scholar
  10. 10.
    Hipp JA, Springfield DS, Hayes WC. Predicting pathologic fracture risk in the management of metastatic bone defects. Clin Orthop Relat Res. 1995;312:120–35.Google Scholar
  11. 11.
    Piccioli A, Spinelli MS, Maccauro G. Impending fracture: a difficult diagnosis. Injury. 2014;45(Suppl 6):S138–41.CrossRefGoogle Scholar
  12. 12.
    Jawad MU, Scully SP. In brief: classifications in brief: Mirels' classification: metastatic disease in long bones and impending pathologic fracture. Clin Orthop Relat Res. 2010;468(10):2825–7.CrossRefGoogle Scholar
  13. 13.
    Kreul SM, Sorger JI, Rajamanickam VP, Heiner JP. Updated outcomes of prophylactic femoral fixation. Orthopedics. 2016;39(2):e346–52.CrossRefGoogle Scholar
  14. 14.
    Lin JS, Santiago-torres JE, Everhart JS, Zayan NE, Mayerson JL, Scharschmidt TJ. When is hemiarthroplasty preferable to intramedullary prophylactic fixation of malignant lesions of the proximal femur? J Surg Oncol. 2017;116(8):1132–40.CrossRefGoogle Scholar
  15. 15.
    Hartmann J, Fricke H, Schiffl H. Biocompatible membranes preserve residual renal function in patients undergoing regular hemodialysis. Am J Kidney Dis. 1997;30(3):366–73.CrossRefGoogle Scholar
  16. 16.
    Scarpioni R, Ricardi M, Albertazzi V, De Amicis S, Rastelli F, Zerbini L. Dialysis-related amyloidosis: challenges and solutions. Int J Nephrol Renov Dis. 2016;9:319–28.CrossRefGoogle Scholar
  17. 17.
    Tan SY, Pepys MB, Hawkins PN. Treatment of amyloidosis. Am J Kidney Dis. 1995;26(2):267–85.CrossRefGoogle Scholar

Copyright information

© ISS 2018

Authors and Affiliations

  • Joe D. Baal
    • 1
    • 2
  • Andrew E. Horvai
    • 1
    • 3
  • Thomas M. Link
    • 1
    • 2
    Email author
  1. 1.School of MedicineUniversity of California, San FranciscoSan FranciscoUSA
  2. 2.Department of Radiology and Biomedical ImagingUniversity of California, San FranciscoSan FranciscoUSA
  3. 3.Department of PathologyUniversity of California, San FranciscoSan FranciscoUSA

Personalised recommendations