ORAL AMYLOIDOSIS SECONDARY TO MULTIPLE MYELOMA

An 85-year-old Caucasian female presented with a 3-year history of tongue enlargement associated with serious difficulties with swallowing and speech. Her medical history of relevance was hypertension and anxiety. Physical examination revealed multiple asymptomatic multisized nodules of fibrous consistency spread throughout the skin and oral mucosa. A truly remarkable sign observed was the prompt development of ecchymosis during manipulation of oral tissues. Histopathologic examination of her tongue biopsy revealed the presence of homogeneous, eosinophilic material within connective tissue and around capillaries. This amorphous extra-cellular material stained positively with Congo red and appeared apple-green when viewed under polarized light, confirming the amyloid nature of the deposits. The patient was referred for medical evaluation. A bone marrow biopsy revealed multiple myeloma as the primary cause of amyloidosis. A combination of melphalan, thalidomide, and prednisone was the treatment of choice. The patient passed away after 2 weeks of treatment.