Excessive Tongue Amyloidosis as the Diagnostic Sign of Multiple Myeloma: a Case Report

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Stylianos Dalampiras1 / 2 / Ioannis Kostopoulos3 / Florentia Stylianou4 / Ioannis Papadiochos1 / Athanasios Poulopoulos2

1School of Dentistry, Department of Oral and Maxillofacial Surgery, Aristotle University, Thessaloniki, Greece
2School of Dentistry, Department of Oral Medicine and Pathology, Aristotle University, Thessaloniki, Greece
3School of Medicine, Department of Histopathology, Aristotle University, Thessaloniki, Greece
4School of Dentistry, student, Aristotle University, Thessaloniki, Greece
5“Evangelismos” General Hospital, School of Dentistry, Athens, Greece


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.

Keywords: Oral Amyloidosis; Macroglossia; Multiple Myeloma


  1. Petersson T, Konttinen YT. Amyloidosis-Recent Developments. Semin Arthritis Rheum, 2010; 39(5):356-358. [Crossref] [Web of Science]
  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. [Crossref]
  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. [Crossref]
  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. [PubMed]
  8. Kyle RA, Greipp PR. Amyloidosis (AL) clinical and laboratory features in 229 cases. Mayo Clin Proc, 1983; 58:665.
  9. Khan MF, Falk RH. Amyloidosis. Postgrad Med J, 2001; 7:686-693. [Crossref]
  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. [Crossref]
  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 [Crossref]
  12. Kyle RA, Gertz MA. Primary systemic amyloidosis: clinical and laboratory features in 474 cases. Semin Hematol, 1995; 32:45-59.
Citation Information: Balkan Journal of Dental Medicine. Volume 19, Issue 1, Pages 50–52, ISSN (Online) 2335-0245, DOI: https://doi.org/10.1515/bjdm-2015-0034, July 2015