Background: Deposition of amyloid in oral mucosa may be related to systemic disorders, including immune-related diseases and malignancies.
Clinical Presentation: We describe a case of 76-year-old patient with excessive, painless, multi-nodular tongue enlargement, and petechiae on the vermilion border and perioral skin that appeared 2 months ago. The biopsy detected subepithelial, Congo’s Red positive amyloid depositions. Consequent laboratory investigation and bone marrow biopsy confirmed the diagnosis of multiple myeloma stage 2 (International Prognostic Index - IPI).
Conclusion: Multi-nodular excessive tongue enlargement could be of high significance as initial sign of undiagnosed, underlying systemic disease including severe malignancy like multiple myeloma.
2. Robbins J. Diseases of immunity. In: Cortan RS Kumar V Collins T (eds). Pathologic basis of disease. 6th ed. Philadelphia: Saunders Co 1999; pp 188-259.
3. Stoopler ET Sollecito TP Chen SY. Amyloid deposition in the oral cavity: a retrospective study and review of the literature. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2003; 95(6):674-680.
4. Eisen D Lynch DP. Oral manifestations of systemic diseases. In: Eisen D Lynch DP (eds). The mouth. Diagnosis and treatment. St Louis: Mosby 1998; pp 212-236.
5. Van der Waal RIF van de Scheur MR Huijgens PC Starink TM van der Waal I. Amyloidosis of the tongue as a paraneoplastic marker of plasma cell dyscrasia. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2002; 94:444-447.
6. Salisbury PL Jr Jacoway JR. Oral amyloidosis: A late complication of multiple myeloma. Oral Surg 1983; 56:48-50.
7. Angiero F Seramondi R Magistro S Crippa R Benedicenti S Rizzardi C Cattoretti G. Amyloid Deposition in the Tongue: Clinical and Histopathological Profile. Anticancer Res 2010; 30:3009-3014.
8. Kyle RA Greipp PR. Amyloidosis (AL) clinical and laboratory features in 229 cases. Mayo Clin Proc 1983; 58:665.
10. Cengiz MI Wang HL Yildiz L. Oral involvement in a case of AA amyloidosis: a case report. J Med Case Rep 2010; 4:200.
11. Durie BG Kyle RA Belch A Bensinger W Blade J Boccadoro M Child JA Comenzo R Djulbegovic B Fantl D Gahrton G Harousseau JL Hungria V Joshua D Ludwig H Mehta J Morales AR Morgan G Nouel A Oken M Powles R Roodman D San Miguel J Shimizu K Singhal S Sirohi B Sonneveld P Tricot G Van Ness B. Myeloma management guidelines. A consensus report from the scientific advisors of the International Myeloma Foundation. Hematol J 2003; 4:279-298
12. Kyle RA Gertz MA. Primary systemic amyloidosis: clinical and laboratory features in 474 cases. Semin Hematol 1995; 32:45-59.