Cardiac amyloidosis: A review of its causes and the morphologic spectrum found at forensic autopsy

Objective: To present a discussion of the histological appearance, morphologic patterns, and underlying causes of various forms of cardiac amyloidosis, followed by guide to the autopsy diagnosis of this pathologic condition. Methods: Review of all autopsies conducted by the author in the last nine years, with subsequent analysis of those with a diagnosis of cardiac amyloidosis. Results: Four cases of cardiac amyloidosis among 1128 autopsies were identified, two with age-related amyloidosis, and two with primary amyloidosis, one each due to multiple myeloma and a plasma cell dyscrasia, and one of these with a rare morphologic variant of pronounced involvement of the intramyocardial coronary arterial branches. Conclusions: Cardiac amyloidosis is an uncommon pathologic condition coming to the attention of forensic pathologists because of its ability to induce dysrhythmias, and cause sudden death. It has a variety of morphologic appearances, and with the aid of supplemental histologic stains, as well as serologic and genetic testing, the underlying protein type responsible for the accumulation can be identified.