Diagnosis of Minimal Amyloid Deposits by Congo Red Fluorescence and Amyloid Type-Specific Immunohistochemistry: A Review

  • Reinhold P. LinkeEmail author
Part of the Current Clinical Pathology book series (CCPATH)


The diagnosis of amyloidosis on tissue sections containing minute amounts of amyloid poses the severe problem of making an incorrect diagnosis, due to the low sensitivity of the classical Congo red procedure. Increasing the sensitivity by using amyloid antibodies advanced the diagnosis by more than 2 years, according to a retrospective study. Even more sensitive is the application of Congo red fluorescence by means of which the missing of amyloid deposits rarely occurs. Nevertheless, diagnosis of amyloid is not trivial. To arrive at a flawless diagnosis, the awareness of the many pitfalls and if possible their remedies is mandatory, in particular those concerning sampling errors. The goal for the patient is to get the diagnosis of amyloid at the earliest clinical stages, concomitant with the clinician’s first suspicion, in order to get an early typing of amyloid and a suitable respective therapy before organ damage can occur, thus giving the chance of improving the course of the otherwise fatal disease. By using these expert methods, in tissue samples (evaluated as amyloid negative by the classical Congo red method or even by electron microscopy), amyloid could nevertheless be detected and thus diagnosis of amyloidosis could be made.


Amyloidosis Preclinical amyloid Very early amyloid Quality of tissue Minute amyloid deposits Formalin-fixed paraffin sections Congo red Quality of staining Polarization microscopy Congo red fluorescence Light microscopy Electron microscopy Diagnosing amyloid Immunohistochemistry (IHC) of high quality Double staining Congo red and immunohistochemistry Triple illumination Pitfalls and remedies Sampling error Polarization shadow Quality of equipment Inconclusiveness of negative results Expert opinion Quality of evaluation and interpretation Expert evaluation 



For technical assistance, I thank Mrs. A. Meinel; for secretarial help, Mrs. A. Feix, both Martinsried/Germany; and for artwork, I thank Ms. A.K.M. Linke, Essen/Germany.


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Copyright information

© Springer International Publishing Switzerland 2015

Authors and Affiliations

  1. 1.Reference Center of Amyloid Diseases amYmed, Innovation Center of BiotechnologyMartinsriedGermany

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