{"id":2844,"date":"2021-02-19T09:12:40","date_gmt":"2021-02-19T09:12:40","guid":{"rendered":"https:\/\/www.reseau-amylose.org\/jesuissoignant\/?page_id=2844"},"modified":"2022-07-18T11:48:45","modified_gmt":"2022-07-18T09:48:45","slug":"pour-lanatomopathologiste","status":"publish","type":"page","link":"https:\/\/reseau-amylose.org\/jesuissoignant\/pour-lanatomopathologiste\/","title":{"rendered":"Pour l&rsquo;Anatomopathologiste"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"2844\" class=\"elementor elementor-2844\" data-elementor-post-type=\"page\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-1434f47d elementor-section-content-middle elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"1434f47d\" data-element_type=\"section\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-no\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-6efee34a\" data-id=\"6efee34a\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-c253fcf elementor-widget elementor-widget-heading\" data-id=\"c253fcf\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h3 class=\"elementor-heading-title elementor-size-default\">L\u2019ABC de l\u2019analyse anatomopathologique de l\u2019amylose<\/h3>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-ef6f117 elementor-widget-divider--view-line elementor-widget elementor-widget-divider\" data-id=\"ef6f117\" data-element_type=\"widget\" data-widget_type=\"divider.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-divider\">\n\t\t\t<span class=\"elementor-divider-separator\">\n\t\t\t\t\t\t<\/span>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-dd214bf elementor-widget elementor-widget-heading\" data-id=\"dd214bf\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h4 class=\"elementor-heading-title elementor-size-default\">Ce que le pathologiste doit savoir\n<\/h4>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-b5cf77c elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"b5cf77c\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-69f7e75\" data-id=\"69f7e75\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-d11b021 elementor-widget elementor-widget-text-editor\" data-id=\"d11b021\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<h5><span style=\"color: #4db8f0\">Quel tissu et pourquoi l&rsquo;analyser ?\u00a0<\/span><\/h5>\n<h6><span style=\"color: #000000\"><strong><em>La biopsie permet\u00a0: <\/em><\/strong><\/span><\/h6>\n<h6><span style=\"color: #000000\"><strong><em>1) d\u2019affirmer le diagnostic d\u2019amylose, et 2) de typer l\u2019amylose c\u2019est-\u00e0-dire de d\u00e9terminer la nature de la prot\u00e9ine amylo\u00efde d\u00e9pos\u00e9e. Ce typage est en effet indispensable pour une prise en charge th\u00e9rapeutique sp\u00e9cifique, adapt\u00e9e au type d\u2019amylose.<\/em><\/strong><\/span><\/h6>\n<h6><span style=\"color: #000000\"><strong><em>Devant une suspicion d\u2019amylose cardiaque, diff\u00e9rents tissus peuvent \u00eatre analys\u00e9s. Leur rentabilit\u00e9 est variable selon le type d\u2019amylose.<\/em><\/strong><\/span><\/h6>\n<h6><span style=\"color: #000000\"><em>\u00a0<\/em><\/span><\/h6>\n<h6><span style=\"color: #000000\"><span style=\"text-decoration: underline\"><strong>BIOPSIE DES GLANDES SALIVAIRES (BGSA) <\/strong>:<\/span> La BGSA, simple \u00e0 r\u00e9aliser, est positive dans 50% des amyloses AL et dans 30% des amyloses ATTR. Les d\u00e9p\u00f4ts peuvent \u00eatre intra-lobulaires ou extra-lobulaires, interstitiels ou vasculaires\u00a0; en cas d\u2019amylose AL, les d\u00e9p\u00f4ts peuvent \u00eatre situ\u00e9s pr\u00e9f\u00e9rentiellement dans le tissu adipeux ou le tissu musculaire.<\/span><\/h6>\n<h6><span style=\"color: #000000\"><strong><em>En l\u2019absence de d\u00e9p\u00f4t sur la BGSA, la biopsie d\u2019un organe cible sera envisag\u00e9e.<\/em><\/strong><\/span><\/h6>\n<h6><span style=\"color: #000000\"><span style=\"text-decoration: underline\"><strong>BIOPSIE ENDOMYOCARDIQUE : <\/strong><\/span><em>r\u00e9alis\u00e9e par voie endovasculaire par un op\u00e9rateur exp\u00e9riment\u00e9, elle pr\u00e9sente une excellente rentabilit\u00e9, proche de 100%. Elle est r\u00e9alis\u00e9e en ventricule droit en premi\u00e8re intention. Les d\u00e9p\u00f4ts peuvent \u00eatre de topographie interstitielle (nodulaires ou p\u00e9ri-myocytaires) et\/ou vasculaires.<\/em><\/span><\/h6>\n<h6><span style=\"color: #000000\"><em>\u00a0<\/em><\/span><\/h6>\n<h6><span style=\"text-decoration: underline\"><span style=\"color: #000000;text-decoration: underline\"><strong>AUTRES SITES S\u00c9LECTIFS POUR D\u00c9TECTER L\u2019AMYLOSE<\/strong><strong>\u00a0:<\/strong><\/span><\/span><\/h6>\n<h6><span style=\"color: #000000\">\u00a0 \u00a0 &#8211; Ligament transverse du carpe en cas de chirurgie du canal carpien pour l\u2019amylose ATTR<\/span><\/h6>\n<h6><span style=\"color: #000000\">\u00a0 \u00a0 &#8211; Biopsie r\u00e9nale, biopsie digestive et biopsie h\u00e9patique pour l\u2019amylose AL.<\/span><\/h6>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-c256011 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"c256011\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-50 elementor-top-column elementor-element elementor-element-fd900e4\" data-id=\"fd900e4\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-da7d01f elementor-widget elementor-widget-text-editor\" data-id=\"da7d01f\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<h5><span style=\"color: #4db8f0\">Comment techniquer le tissu en routine<\/span><\/h5>\n<h6><span style=\"color: #000000\"><strong><em>ll est souhaitable de disposer d\u2019un pr\u00e9l\u00e8vement fix\u00e9 en formol pour l\u2019\u00e9tude immunohistochimique, et d\u2019un pr\u00e9l\u00e8vement congel\u00e9 (adress\u00e9 \u00e0 l\u2019\u00e9tat frais dans une compresse imbib\u00e9e de s\u00e9rum physiologique) pour l\u2019\u00e9tude en immunofluorescence.<\/em><\/strong><\/span><\/h6>\n<h6><span style=\"text-decoration: underline\"><span style=\"color: #000000;text-decoration: underline\"><strong>AFFIRMER L\u2019AMYLOSE <\/strong><strong>: COLORATION(S) SP\u00c9CIALE(S)\u00a0: <\/strong><\/span><\/span><\/h6>\n<h6><span style=\"color: #000000\">Les d\u00e9p\u00f4ts sont extracellulaires, amorphes, anhistes, acellulaires et \u00e9osinophiles en coloration standard (HE). La conformation en feuillets \uf062\uf020pliss\u00e9s leur conf\u00e8re des propri\u00e9t\u00e9s tinctoriales particuli\u00e8res\u00a0: ils sont color\u00e9s en rouge par le rouge Congo (RC) en lumi\u00e8re blanche, et pr\u00e9sentent une bir\u00e9fringence jaune\/vert en lumi\u00e8re polaris\u00e9e. Le RC peut \u00eatre r\u00e9alis\u00e9 sur tissu fix\u00e9 ou congel\u00e9. La coloration du rouge Sirius amylose est une excellente alternative\u00a0qui colore les d\u00e9p\u00f4ts en fuchsia. Les d\u00e9p\u00f4ts sont parfois tr\u00e8s fins\u00a0; la mise au point des colorations sp\u00e9ciales doit donc \u00eatre optimale et l\u2019analyse sur niveaux de coupe multiples est parfois n\u00e9cessaire.<\/span><\/h6>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-50 elementor-top-column elementor-element elementor-element-a92e5d2\" data-id=\"a92e5d2\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-601f594 elementor-widget elementor-widget-text-editor\" data-id=\"601f594\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p>\u00a0<\/p><p>\u00a0<\/p><p>\u00a0<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-74048aa elementor-widget elementor-widget-image\" data-id=\"74048aa\" data-element_type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t\t\t\t<figure class=\"wp-caption\">\n\t\t\t\t\t\t\t\t\t\t<img fetchpriority=\"high\" decoding=\"async\" width=\"1024\" height=\"330\" src=\"https:\/\/reseau-amylose.org\/jesuissoignant\/wp-content\/uploads\/sites\/5\/2021\/12\/Capture-de\u0301cran-2021-12-03-a\u0300-07.46.57-1024x330.png\" class=\"attachment-large size-large wp-image-4528\" alt=\"\" srcset=\"https:\/\/reseau-amylose.org\/jesuissoignant\/wp-content\/uploads\/sites\/5\/2021\/12\/Capture-de\u0301cran-2021-12-03-a\u0300-07.46.57-1024x330.png 1024w, https:\/\/reseau-amylose.org\/jesuissoignant\/wp-content\/uploads\/sites\/5\/2021\/12\/Capture-de\u0301cran-2021-12-03-a\u0300-07.46.57-300x97.png 300w, https:\/\/reseau-amylose.org\/jesuissoignant\/wp-content\/uploads\/sites\/5\/2021\/12\/Capture-de\u0301cran-2021-12-03-a\u0300-07.46.57-768x247.png 768w, https:\/\/reseau-amylose.org\/jesuissoignant\/wp-content\/uploads\/sites\/5\/2021\/12\/Capture-de\u0301cran-2021-12-03-a\u0300-07.46.57.png 1310w\" sizes=\"(max-width: 1024px) 100vw, 1024px\" \/>\t\t\t\t\t\t\t\t\t\t\t<figcaption class=\"widget-image-caption wp-caption-text\">BGSA et biopsie cardiaque - d\u00e9p\u00f4ts interstitiels d\u2019amylose coloration RC (x200)<\/figcaption>\n\t\t\t\t\t\t\t\t\t\t<\/figure>\n\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-1da6529 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"1da6529\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-50 elementor-top-column elementor-element elementor-element-e01506a\" data-id=\"e01506a\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-4a19168 elementor-widget elementor-widget-text-editor\" data-id=\"4a19168\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<h6><span style=\"text-decoration: underline\"><span style=\"color: #000000;text-decoration: underline\"><strong>TYPER L\u2019AMYLOSE <\/strong><strong>: \u00c9TUDE IMMUNOISTOCHIMIQUE (IHC) ET IMMUNOFLUORESCENCE (IF)\u00a0<\/strong><\/span><\/span><\/h6><h6><span style=\"color: #000000\"><strong><em>IHC <\/em><\/strong>: Le panel standard associe les anticorps (AC) dirig\u00e9s contre les principales amyloses c\u2019est \u00e0 dire la transthyr\u00e9tine (TTR), les cha\u00eenes l\u00e9g\u00e8res kappa et lambda et la prot\u00e9ine SAA. L\u2019interpr\u00e9tation n\u2019est pas toujours ais\u00e9e avec en particulier, un bruit de fond diffus avec les AC anti-cha\u00eenes l\u00e9g\u00e8res et un accrochage non sp\u00e9cifique des d\u00e9p\u00f4ts avec l\u2019AC anti-TTR.<\/span><\/h6><h6><span style=\"color: #000000\"><strong><em>IF <\/em><\/strong>: Les cha\u00eenes l\u00e9g\u00e8res kappa et lambda sont d\u00e9tect\u00e9es de mani\u00e8re beaucoup plus fiable en IF. Les faux n\u00e9gatifs sont possibles.<\/span><\/h6>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-50 elementor-top-column elementor-element elementor-element-c022847\" data-id=\"c022847\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-02652aa elementor-widget elementor-widget-image\" data-id=\"02652aa\" data-element_type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t\t\t\t<figure class=\"wp-caption\">\n\t\t\t\t\t\t\t\t\t\t<img decoding=\"async\" width=\"1024\" height=\"309\" src=\"https:\/\/reseau-amylose.org\/jesuissoignant\/wp-content\/uploads\/sites\/5\/2021\/12\/Capture-de\u0301cran-2021-12-03-a\u0300-07.47.11-1024x309.png\" class=\"attachment-large size-large wp-image-4529\" alt=\"\" srcset=\"https:\/\/reseau-amylose.org\/jesuissoignant\/wp-content\/uploads\/sites\/5\/2021\/12\/Capture-de\u0301cran-2021-12-03-a\u0300-07.47.11-1024x309.png 1024w, https:\/\/reseau-amylose.org\/jesuissoignant\/wp-content\/uploads\/sites\/5\/2021\/12\/Capture-de\u0301cran-2021-12-03-a\u0300-07.47.11-300x90.png 300w, https:\/\/reseau-amylose.org\/jesuissoignant\/wp-content\/uploads\/sites\/5\/2021\/12\/Capture-de\u0301cran-2021-12-03-a\u0300-07.47.11-768x231.png 768w, https:\/\/reseau-amylose.org\/jesuissoignant\/wp-content\/uploads\/sites\/5\/2021\/12\/Capture-de\u0301cran-2021-12-03-a\u0300-07.47.11.png 1168w\" sizes=\"(max-width: 1024px) 100vw, 1024px\" \/>\t\t\t\t\t\t\t\t\t\t\t<figcaption class=\"widget-image-caption wp-caption-text\">BGSA : d\u00e9p\u00f4ts d\u2019amylose (coloration RC) positifs pour l\u2019AC anti-transthyr\u00e9tine (x200).<\/figcaption>\n\t\t\t\t\t\t\t\t\t\t<\/figure>\n\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-4fd1e04 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"4fd1e04\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-50 elementor-top-column elementor-element elementor-element-c8d8f53\" data-id=\"c8d8f53\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-28be6a2 elementor-widget elementor-widget-text-editor\" data-id=\"28be6a2\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<h5><span style=\"color: #4db8f0\">Autres techniques<\/span><\/h5><h6><span style=\"color: #000000\"><strong><em>Le recours \u00e0 des techniques plus sp\u00e9cialis\u00e9es est parfois n\u00e9cessaire. <\/em><\/strong><strong><em>Seuls quelques centres en France r\u00e9alisent ces techniques.<\/em><\/strong><\/span><\/h6><h6><span style=\"color: #000000\"><strong><span style=\"text-decoration: underline\">SPECTROM\u00c9TRIE DE MASSE<\/span> <\/strong>: En cas de typage par IHC\/IF non concluant, on peut avoir recours \u00e0 une analyse par spectrom\u00e9trie de masse apr\u00e8s microdissection laser. Cette technique est r\u00e9alis\u00e9e \u00e0 partir du bloc de paraffine. Contrairement \u00e0 l\u2019IHC\/IF, elle permet en un seul test de rechercher toutes les prot\u00e9ines amylog\u00e8nes\u00a0: TTR, cha\u00eenes l\u00e9g\u00e8res, SAA et d\u2019autres beaucoup plus rares comme les apolipoprot\u00e9ines. Le succ\u00e8s de typage est excellent, sup\u00e9rieur \u00e0 95% pour les BGSA et proche de 100% pour les biopsies endomyocardiques.<\/span><\/h6><h6><span style=\"color: #000000\"><span style=\"text-decoration: underline\"><strong>MICROSCOPIE \u00c9LECTRONIQUE <\/strong>:<\/span> Elle permet de confirmer la nature amylo\u00efde des d\u00e9p\u00f4ts en montrant des fibrilles de 8 \u00e0 10 nm de diam\u00e8tre. Elle requiert une fixation en glutarald\u00e9hyde d\u00e8s la r\u00e9alisation du pr\u00e9l\u00e8vement. Outre la d\u00e9tection des d\u00e9p\u00f4ts, un typage par immunogold est possible.<\/span><\/h6>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-50 elementor-top-column elementor-element elementor-element-f45d76e\" data-id=\"f45d76e\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-973c55a elementor-widget elementor-widget-image\" data-id=\"973c55a\" data-element_type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t\t\t\t<figure class=\"wp-caption\">\n\t\t\t\t\t\t\t\t\t\t<img decoding=\"async\" width=\"768\" height=\"811\" src=\"https:\/\/reseau-amylose.org\/jesuissoignant\/wp-content\/uploads\/sites\/5\/2021\/12\/Capture-de\u0301cran-2021-12-03-a\u0300-08.00.28-768x811.png\" class=\"attachment-medium_large size-medium_large wp-image-4542\" alt=\"\" srcset=\"https:\/\/reseau-amylose.org\/jesuissoignant\/wp-content\/uploads\/sites\/5\/2021\/12\/Capture-de\u0301cran-2021-12-03-a\u0300-08.00.28-768x811.png 768w, https:\/\/reseau-amylose.org\/jesuissoignant\/wp-content\/uploads\/sites\/5\/2021\/12\/Capture-de\u0301cran-2021-12-03-a\u0300-08.00.28-284x300.png 284w, https:\/\/reseau-amylose.org\/jesuissoignant\/wp-content\/uploads\/sites\/5\/2021\/12\/Capture-de\u0301cran-2021-12-03-a\u0300-08.00.28-969x1024.png 969w, https:\/\/reseau-amylose.org\/jesuissoignant\/wp-content\/uploads\/sites\/5\/2021\/12\/Capture-de\u0301cran-2021-12-03-a\u0300-08.00.28.png 994w\" sizes=\"(max-width: 768px) 100vw, 768px\" \/>\t\t\t\t\t\t\t\t\t\t\t<figcaption class=\"widget-image-caption wp-caption-text\">Biopsie : Comment et pourquoi ? <\/figcaption>\n\t\t\t\t\t\t\t\t\t\t<\/figure>\n\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-f8c8693 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"f8c8693\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-0422480\" data-id=\"0422480\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-f9c5700 elementor-widget elementor-widget-text-editor\" data-id=\"f9c5700\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<h6><span style=\"color: #000000\"><strong><em>La prise en charge th\u00e9rapeutique sp\u00e9cifique n\u2019est possible qu\u2019en cas de typage de l\u2019amylose. <\/em><\/strong><\/span><\/h6><h6><span style=\"color: #000000\"><strong><em>Les amyloses \u00e0 transthyr\u00e9tine (ATTR) et \u00e0 cha\u00eenes l\u00e9g\u00e8res (AL) repr\u00e9sentent &gt;90% des amyloses cardiaques. Les amyloses ATTR sont les plus fr\u00e9quentes.<\/em><\/strong><\/span><span style=\"color: #000000\"><strong><em>\u00a0<\/em><\/strong><\/span><\/h6><h6><span style=\"text-decoration: underline\"><span style=\"color: #000000\"><strong>AMYLOSE TTR\u00a0: <\/strong><\/span><\/span><\/h6><h6><span style=\"color: #000000\">L\u2019atteinte est principalement cardiaque en cas d\u2019amylose \u00ab\u00a0s\u00e9nile\u00a0\u00bb (ATTR-wt), neurologique et cardiaque en cas d\u2019amylose ATTR mut\u00e9e (ATTR-v). \u00a0Sur le plan anatomo-pathologique, il n\u2019est pas possible de diff\u00e9rencier ces 2 sous-types d\u2019amylose ATTR. Seule la recherche d\u2019une mutation du g\u00e8ne de la TTR permettra d\u2019affirmer le diagnostic d\u2019ATTR-v, avec d\u00e9clenchement<strong> d\u2019un conseil <\/strong>g\u00e9n\u00e9tique<em> (p\u00e9n\u00e9trance variable et incompl\u00e8te)<strong>. <\/strong><\/em>Les traitements <strong>stabiliseurs de t\u00e9tram\u00e8res\u00a0<\/strong>emp\u00eachent la dissociation sous forme de monom\u00e8res, \u00e9tape premi\u00e8re de la formation des d\u00e9p\u00f4ts d\u2019ATTR. Le Tafamidis \uf0d2 a prouv\u00e9 son efficacit\u00e9 pour am\u00e9liorer la survie dans les atteintes cardiaques.<\/span><\/h6><h6><span style=\"text-decoration: underline\"><span style=\"color: #000000;text-decoration: underline\"><strong>AMYLOSE AL <\/strong>:<\/span><\/span><\/h6><h6><span style=\"color: #000000\">Les amyloses AL sont li\u00e9es \u00e0 une prolif\u00e9ration monoclonale B, gammapathie monoclonale de signification ind\u00e9termin\u00e9e (MGUS) ou my\u00e9lome (le plus souvent indolent), ou \u00e9ventuel lymphome B \u00e0 petites cellules (dont lymphome lympho-plasmocytaire\/maladie de Waldenstr\u00f6m IgM). Les d\u00e9p\u00f4ts peuvent se d\u00e9poser dans de nombreux organes, le c\u0153ur et le rein sont les plus fr\u00e9quemment touch\u00e9s (pr\u00e8s de 50% des cas), puis le foie (16%), ou bien encore le tube digestif (10%). La classification de la Mayo Clinic est bas\u00e9e sur les dosages de NT-proBNP (seuil de 332 ng\/mL) et troponine (seuil de 0,035 ng\/mL). Il s\u2019agit d\u2019un indicateur de s\u00e9v\u00e9rit\u00e9 de l\u2019atteinte cardiaque initiale. Il d\u00e9finit 3 stades (I \u00e0 III) selon l\u2019\u00e9l\u00e9vation d\u2019aucun, 1 ou 2 biomarqueurs. Les survies m\u00e9dianes sont de 26,4 mois pour le stade I, 10,5 mois pour le stade II et de 3,5 mois pour le stade III. Le diagnostic d\u2019amylose cardiaque AL est donc relativement urgent \u00e0 porter. La prise en charge est discut\u00e9e en r\u00e9union de concertation pluridisciplinaire rassemblant h\u00e9matologues et cardiologues.<\/span><\/h6>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-faeac1d elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"faeac1d\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-25 elementor-top-column elementor-element elementor-element-a8a8001\" data-id=\"a8a8001\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap\">\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-50 elementor-top-column elementor-element elementor-element-5cfff01\" data-id=\"5cfff01\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-46a05eb elementor-widget elementor-widget-button\" data-id=\"46a05eb\" data-element_type=\"widget\" data-widget_type=\"button.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<div class=\"elementor-button-wrapper\">\n\t\t\t\t\t<a class=\"elementor-button elementor-button-link elementor-size-md\" href=\"https:\/\/reseau-amylose.org\/jesuissoignant\/documentation\/triptyques-du-centre-de-reference-des-amyloses-cardiaques-chu-henri-mondor\/\">\n\t\t\t\t\t\t<span class=\"elementor-button-content-wrapper\">\n\t\t\t\t\t\t\t\t\t<span class=\"elementor-button-text\">T\u00e9l\u00e9chargez le triptyque \"L'ABC de l'amylose pour l'anatomopathologiste\"<\/span>\n\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/a>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-25 elementor-top-column elementor-element elementor-element-46a90f6\" data-id=\"46a90f6\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap\">\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>L\u2019ABC de l\u2019analyse anatomopathologique de l\u2019amylose Ce que le pathologiste doit savoir Quel tissu et pourquoi l&rsquo;analyser ?&nbsp; La biopsie permet&nbsp;: 1) d\u2019affirmer le diagnostic d\u2019amylose, et 2) de typer l\u2019amylose c\u2019est-\u00e0-dire de d\u00e9terminer la nature de la prot\u00e9ine amylo\u00efde d\u00e9pos\u00e9e. Ce typage est en effet indispensable pour une prise en charge th\u00e9rapeutique sp\u00e9cifique, adapt\u00e9e [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"footnotes":""},"categories":[],"tags":[],"class_list":["post-2844","page","type-page","status-publish","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v25.5 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Pour l&#039;Anatomopathologiste - R\u00e9seau Amylose<\/title>\n<meta name=\"description\" content=\"L\u2019ABC de l\u2019analyse anatomopathologique de l\u2019amylose : quel tissu, comment techniquer - visionnez les vid\u00e9os, t\u00e9l\u00e9chargez les documents\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/reseau-amylose.org\/jesuissoignant\/pour-lanatomopathologiste\/\" \/>\n<meta property=\"og:locale\" content=\"fr_FR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Pour l&#039;Anatomopathologiste - 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