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Amyloid Involving the Seminal Vesicles

      A man in his 30s presented with hematospermia. Imaging studies revealed hypoenhancement of the seminal vesicles on magnetic resonance imaging. This patient subsequently underwent bilateral seminal vesiculectomy.
      Representative hematoxylin and eosin–stained images of the seminal vesicles show deposition of an eosinophilic acellular material (Figure 1A, B). Staining with Congo red showed a pink-red staining pattern on light microscopy (Figure 1C) and apple-green birefringence on polarization (Figure 1D).
      Liquid chromatography–tandem mass spectrometry performed on Congo red–positive areas detected a peptide profile consistent with ASem1 (semenogelin 1)–type amyloid deposition.
      Are these findings consistent with systemic amyloidosis?
      • a.
        No. ASem1 (semenogelin 1)–type amyloid deposition is associated with localized amyloidosis.
      • b.
        Yes. ASem1 (semenogelin 1)–type amyloid deposition is associated with systemic amyloidosis.
      Answer: a. No. ASem1 (semenogelin 1)–type amyloid deposition is associated with localized amyloidosis.
      It is estimated that 1% to 5% of radical prostatectomy specimens show amyloid involving seminal vesicles, vas deferens, and ejaculatory ducts.
      • Kee K.H.
      • Lee M.J.
      • Shen S.S.
      • et al.
      Amyloidosis of seminal vesicles and ejaculatory ducts: a histologic analysis of 21 cases among 447 prostatectomy specimens.
      ,
      • Harvey I.
      • Tetu B.
      [Amyloidosis of the seminal vesicles: a local condition with no systemic impact].
      In these cases, localized amyloid deposition (occurring in a subepithelial pattern) typically involves seminal vesicles bilaterally.
      • Kee K.H.
      • Lee M.J.
      • Shen S.S.
      • et al.
      Amyloidosis of seminal vesicles and ejaculatory ducts: a histologic analysis of 21 cases among 447 prostatectomy specimens.
      This pattern of localized amyloid is generally not associated with systemic amyloidosis.
      • Kee K.H.
      • Lee M.J.
      • Shen S.S.
      • et al.
      Amyloidosis of seminal vesicles and ejaculatory ducts: a histologic analysis of 21 cases among 447 prostatectomy specimens.
      ,
      • Yang Z.
      • Laird A.
      • Monaghan A.
      • Seywright M.
      • Ahmad I.
      • Leung H.Y.
      Incidental seminal vesicle amyloidosis observed in diagnostic prostate biopsies—are routine investigations for systemic amyloidosis warranted?.
      In rare instances, localized prostatic amyloid is associated with hematospermia.
      • Schaeffer E.M.
      • Epstein J.I.
      • Walsh P.C.
      Amyloidosis of the seminal vesicle and hematospermia.
      Mass spectrometric analysis has shown that localized seminal vesicle amyloid is predominantly composed of semenogelin 1.
      • Linke R.P.
      • Joswig R.
      • Murphy C.L.
      • et al.
      Senile seminal vesicle amyloid is derived from semenogelin I.
      In a study of amyloid typing by mass spectrometry of more than 16,000 specimens, ASem1 (semenogelin 1)–type amyloid deposition was exclusively identified in amyloid deposits in prostate specimens.
      • Dasari S.
      • Theis J.D.
      • Vrana J.A.
      • et al.
      Amyloid typing by mass spectrometry in clinical practice: a comprehensive review of 16,175 samples.
      In contrast, amyloid deposition is occasionally identified around blood vessels in prostate biopsy specimens (Figure 2, arrow indicates perivascular amyloid deposition). This pattern of amyloid deposition is often associated with systemic amyloidosis. In a single study of amyloid typing by mass spectrometry in 77 prostate specimens, approximately 50% were associated with systemic amyloidosis (ATTR, 33.8%; AL, 16.9%).
      • Dasari S.
      • Theis J.D.
      • Vrana J.A.
      • et al.
      Amyloid typing by mass spectrometry in clinical practice: a comprehensive review of 16,175 samples.

      References

        • Kee K.H.
        • Lee M.J.
        • Shen S.S.
        • et al.
        Amyloidosis of seminal vesicles and ejaculatory ducts: a histologic analysis of 21 cases among 447 prostatectomy specimens.
        Ann Diagn Pathol. 2008; 12: 235-238
        • Harvey I.
        • Tetu B.
        [Amyloidosis of the seminal vesicles: a local condition with no systemic impact].
        Ann Pathol. 2004; 24 (quiz 227): 236-240
        • Yang Z.
        • Laird A.
        • Monaghan A.
        • Seywright M.
        • Ahmad I.
        • Leung H.Y.
        Incidental seminal vesicle amyloidosis observed in diagnostic prostate biopsies—are routine investigations for systemic amyloidosis warranted?.
        Asian J Androl. 2013; 15: 149-151
        • Schaeffer E.M.
        • Epstein J.I.
        • Walsh P.C.
        Amyloidosis of the seminal vesicle and hematospermia.
        J Urol. 2004; 171: 2382
        • Linke R.P.
        • Joswig R.
        • Murphy C.L.
        • et al.
        Senile seminal vesicle amyloid is derived from semenogelin I.
        J Lab Clin Med. 2005; 145: 187-193
        • Dasari S.
        • Theis J.D.
        • Vrana J.A.
        • et al.
        Amyloid typing by mass spectrometry in clinical practice: a comprehensive review of 16,175 samples.
        Mayo Clin Proc. 2020; 95: 1852-1864