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157:Persistent Tongue Lesions Due To Light-Chain Amyloidosis In A Patient With Multiple Myeloma In Remission[AAOM2021]
Poster Title: 157:Persistent Tongue Lesions Due To Light-Chain Amyloidosis In A Patient With Multiple Myeloma In Remission[AAOM2021]
Submitted on 29 Mar 2021
Author(s): Jason Solensky, Hiba Qari, Juan Bugueno
Affiliations: West Virginia University School of Dentistry, United States of America
This poster was presented at 2021 American Academy of Oral Medicine Virtual Conference
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Poster Information
Abstract: Amyloidosis represents disorders characterized by extracellular deposition of insoluble fibrils of amyloid protein in organs and tissues. Oral amyloidosis could affect the buccal mucosa, tongue and gingiva, and might severely impact the quality of a patient’s life.

A 91-year-old Caucasian female was referred to the Oral Medicine Clinic, West Virginia University SOD, for evaluation of an ulcer on the posterior left lateral border of the tongue that had been present for about three weeks. She complained of pain, during eating and swallowing. Patient’s medical history included hypertension, hypercholesterolemia, GERD, spinal stenosis, and multiple myeloma diagnosed in 2017, treated with chemotherapy, but not on current maintenance. Her medications were Aspirin, Amlodipine, Denosumab, Pantoprazole, Rosuvastatin, and Tramadol. Patient reported no allergies and denied current use of tobacco, alcohol and recreational drugs. Physical assessment revealed a well-nourished woman in no apparent distress. Extraoral examination was within normal limits. Intraoral exam revealed a well-defined single ulceration, approximately 1.5 x 0.5 cm, shallow surrounded by a raised rolled border of fibrous tissue, non-indurated and slightly painful to palpation. Tooth # 18 was in close relation with ulceration. Differential diagnosis included traumatic ulcer, and traumatic ulcerative granuloma with stromal eosinophilia. Her dentist smoothed lingual cusps of tooth # 18, but the ulcer did not improve. Incisional biopsy was performed revealing inflamed pseudoepitheliomatous hyperplasia with reactive atypia. No diagnostic features of invasion were reported. Treatment consisted of topical steroids, antifungals and soft occlusal guard with mild improvement of the ulcer. Later, she reported severe dyspnea on exertion and her cardiologist indicated an endomyocardial biopsy, which showed light chain cardiac amyloidosis. Currently, patient is having further evaluations by cardiologist, pulmonologist and oncologist. Recently, white, elliptical, nodular areas, sessile, and non-indurated developed in the dorsum of her tongue. A histopathology examination of one of the nodules, stained with Congo red-stain demonstrated subtle apple-green birefringence, which confirmed the presence of amyloid.

Recognition of amyloidosis-associated orofacial changes is extremely important for clinicians, as the oral cavity may be the initial site of presentation and enable the detection as well as the surveillance of underlying diseases, therefore improving outcomes for these patients.
Summary: Amyloidosis represents disorders characterized by the extracellular deposition of amorphous, fibrillar proteins known as amyloid in different organs and tissues (1-5). There are more than 30 amyloid subtypes, which mainly include immunoglobulin light chain amyloidosis (AL), amyloid A amyloidosis (AA), β2 microglobulin amyloidosis (Aβ2M) and transthyretin amyloidosis (ATTR) (4).

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References: 1. Angiero F, Seramondi R, Magistro S, et al. Amyloid deposition in the tongue: Clinical and histopathological profile. Anticancer Res. 2010;30(7):3009-3014.
2. Viggor SF, Frezzini C, Farthing PM, Freeman CO, Yeoman CM, Thornhill MH. Amyloidosis: An unusual case of persistent oral ulceration. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009;108(5):e46-50.
3. Matsuo FS, Barbosa de Paulo LF, Servato JP, de Faria PR, Cardoso SV, Loyola AM. Involvement of oral tissues by AL amyloidosis: A literature review and report of eight new cases. Clin Oral Investig. 2016;20(8):1913-1920.
4. Deng J, Chen Q, Ji P, Zeng X, Jin X. Oral amyloidosis: A strategy to differentiate systemic amyloidosis involving the oral cavity and localized amyloidosis. Oral Dis. 2019;25(3):670-675.
5. Liu X, Zhou P, Hua H. Characteristics of orofacial amyloidosis: A case series. Ann Clin Case Rep. 2016;1:1133.
6. Dissanayaka DWVN, Bandara HMMR, Sabesan T, Mohomed YS, Siriwardena BSMS. Case report:
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