Pathology · patient case question
Which oral finding in this patient is explained by the amyloid deposition?
Patient case: Bone pain, anemia and an enlarged tongue
Patient: 64-year-old man referred by his physician.
Chief complaint: His tongue feels too big for his mouth and he is exhausted.
History: Six months of back pain, fatigue and recurrent infections. Recent labs show anemia, hypercalcemia and elevated creatinine. Skull radiographs show multiple well-defined punched-out radiolucencies.
Findings: Enlarged tongue with lateral scalloping from tooth indentations. Pallor of the oral mucosa. Working diagnosis: multiple myeloma with systemic AL amyloidosis.
Show answer and explanation
Correct answer: C. Macroglossia
- A. Geographic tongue is a benign idiopathic migratory glossitis unrelated to amyloid.
- B. Median rhomboid glossitis is a candidal depapillated patch on the midline dorsum.
- C. CORRECT. Free monoclonal light chains deposit in tissue as AL amyloid. In the tongue this produces MACROGLOSSIA — a firm, enlarged tongue, often with lateral scalloping, sometimes with nodules or haemorrhagic bullae. It is one of the classic oral clues to systemic amyloidosis.
- D. Ankyloglossia is a congenital short lingual frenum.