title: Localized amyloidosis at the site of repeated insulin injection in a diabetic patient.
abstract: A 60-year-old woman diabetic patient presented with a subcutaneous mass in right lower abdominal quadrant where recombinant human insulin or insulin analogue had been injected for 16 years. Her diabetes has been insulin resistant with insufficient blood glucose control. The mass was extirpated under the suspicion of neoplasm but it was found to consist of diffuse deposition of eosinophilic amorphous materials mixed with inflammatory change. Congo-red staining demonstrated positive red color and yielded green birefringence by polarized microscopy. Pre-digestion with potassium permanganate was incomplete to quench positive Congo-red stains. Immunostains with insulin antibody were positive for this deposition but not so with amylin or AA or AL amyloid. Thus, the mass was considered to be localized amyloidosis composed of iatrogenic A-Ins type amyloid. Thus, the case suggested that her insulin resistance, i.e. refractoriness of insulin treatment, may be ascribed to poor penetration of injected insulin and human insulin itself or its analogue is amyloidogenic to form a local mass.
authors.affiliation: Department of Pathology and Molecular Medicine, Hirosaki University Graduate School of Medicine.
authors.forename: Yasuyoshi
authors.initials: Y
authors.lastname: Shikama
authors.forename: Jun-Ichi
authors.initials: J
authors.lastname: Kitazawa
authors.forename: Nobuo
authors.initials: N
authors.lastname: Yagihashi
authors.forename: Osamu
authors.initials: O
authors.lastname: Uehara
authors.forename: Yuuji
authors.initials: Y
authors.lastname: Murata
authors.forename: Nobuhisa
authors.initials: N
authors.lastname: Yajima
authors.forename: Ryuichi
authors.initials: R
authors.lastname: Wada
authors.forename: Soroku
authors.initials: S
authors.lastname: Yagihashi
mesh_terms: D000005:Abdomen; D000682:Amyloid / Q000378:metabolism; D000686:Amyloidosis / Q000175:diagnosis* / Q000209:etiology* / Q000378:metabolism; D001786:Blood Glucose / Q000378:metabolism; D003920:Diabetes Mellitus / Q000097:blood / Q000188:drug therapy* / Q000503:physiopathology; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000627:therapeutic use; D007279:Injections, Subcutaneous / Q000009:adverse effects*; D007328:Insulin / Q000008:administration & dosage* / Q000627:therapeutic use*; D007333:Insulin Resistance / Q000502:physiology; D008875:Middle Aged
chemical_list: D000682:Amyloid; D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin