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Dash S, Pandalanghat S, Kumar Y. An Unusual Case of Hoarseness of Voice and Dysphagia in Multiple Myeloma with Amyloidosis. Indian J Crit Care Med 2024; 28:175-176. [PMID: 38323258 PMCID: PMC10839925 DOI: 10.5005/jp-journals-10071-24613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2024] Open
Abstract
How to cite this article: Dash S, Pandalanghat S, Kumar Y. An Unusual Case of Hoarseness of Voice and Dysphagia in Multiple Myeloma with Amyloidosis. Indian J Crit Care Med 2024;28(2):175-176.
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Affiliation(s)
- Snehangsh Dash
- Department of Medicine, 12 Air Force Hospital, Gorakhpur, Uttar Pradesh, India
| | | | - Yogesh Kumar
- Department of Medicine, Command Hospital, Lucknow, Uttar Pradesh, India
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2
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Tavares TS, da Costa AAS, Araújo ALD, de Souza LL, Pascoaloti MIM, Bernardes VF, Aguiar MCF, Vargas PA, Fonseca FP, Pontes HAR, Lopes MA, Santos-Silva AR, da Silva TA, Caldeira PC. Oral manifestations of amyloidosis and the diagnostic applicability of oral tissue biopsy. J Oral Pathol Med 2024; 53:61-69. [PMID: 38154788 DOI: 10.1111/jop.13504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 11/14/2023] [Accepted: 12/04/2023] [Indexed: 12/30/2023]
Abstract
BACKGROUND Amyloidosis exhibits a variable spectrum of systemic signs and oral manifestations that can be difficult to diagnose. This study aimed to characterize the clinical, demographic, and microscopic features of amyloidosis in the oral cavity. METHODS This collaborative study involved three Brazilian oral pathology centers and described cases with a confirmed diagnosis of amyloidosis on available oral tissue biopsies. Clinical data were obtained from medical records. H&E, Congo-red, and immunohistochemically stained slides were analyzed. RESULTS Twenty-six oral biopsies from 23 individuals (65.2% males; mean age: 59.6 years) were included. Oral involvement was the first sign of the disease in 67.0% of cases. Two patients had no clinical manifestation in the oral mucosa, although the histological analysis confirmed amyloid deposition. Amyloid deposits were distributed in perivascular (88.0%), periacinar and periductal (80.0%), perineurial (80.0%), endoneurial (33.3%), perimuscular (88.2%), intramuscular (94.1%), and subepithelial (35.3%) sites as well as around fat cells (100.0%). Mild/moderate inflammation was found in 65.4% of cases and 23.1% had giant cells. CONCLUSIONS Amyloid deposits were consistently found in oral tissues, exhibiting distinct deposition patterns. Oral biopsy is less invasive than internal organ biopsy and enables the reliable identification of amyloid deposits even in the absence of oral manifestations. These findings corroborate the relevance of oral biopsy for the diagnosis of amyloidosis.
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Affiliation(s)
- Thalita Soares Tavares
- Department of Oral Pathology and Surgery, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | | | | | - Lucas Lacerda de Souza
- Oral Pathology Department, João de Barros Barreto University Hospital/Universidade Federal do Pará, Belém, PA, Brazil
| | - Maria Inês Mantuani Pascoaloti
- Department of Pathology, Biological Sciences Institute, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Vanessa Fátima Bernardes
- Department of Pathology, Biological Sciences Institute, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Maria Cássia Ferreira Aguiar
- Department of Oral Pathology and Surgery, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Pablo Agustin Vargas
- Oral Diagnosis Department, Piracicaba Dental School, University of Campinas, Campinas, SP, Brazil
| | - Felipe Paiva Fonseca
- Department of Oral Pathology and Surgery, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Hélder Antônio Rebelo Pontes
- Oral Pathology Department, João de Barros Barreto University Hospital/Universidade Federal do Pará, Belém, PA, Brazil
| | - Marcio Ajudarte Lopes
- Oral Diagnosis Department, Piracicaba Dental School, University of Campinas, Campinas, SP, Brazil
| | - Alan Roger Santos-Silva
- Oral Diagnosis Department, Piracicaba Dental School, University of Campinas, Campinas, SP, Brazil
| | - Tarcília Aparecida da Silva
- Department of Oral Pathology and Surgery, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Patrícia Carlos Caldeira
- Department of Oral Pathology and Surgery, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
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Abstract
Small biopsies in the larynx can make a definitive diagnosis challenging due to the sampling or tangential sectioning. The differential diagnosis can be divided into mucosal lesions (squamous papillomas, intraepithelial dysplasia, and invasive squamous cell carcinoma) or submucosal lesions (vocal cord polyps/nodules, amyloidosis, granular cell tumor, rhabdomyoma, neuroendocrine neoplasms, salivary gland tumors, and cartilaginous tumors). Diagnostic criteria (both morphologic and immunohistochemical) are reviewed to arrive at a diagnosis even on small biopsy.
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Affiliation(s)
- Abberly Lott Limbach
- Department of Pathology, E422 Doan Hall, 410W 10th Ave, Columbus, OH 43210, United States.
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Hou T, Abu-Salah A, Cummings OW, Halum S, Mesa H, Zhang D. Amyloid Deposition in the Upper Aerodigestive Tract, A Single Institute Experience. EAR, NOSE & THROAT JOURNAL 2023:1455613231189144. [PMID: 37515371 DOI: 10.1177/01455613231189144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/30/2023] Open
Abstract
Objectives: The purpose of this study is to evaluate clinical information, laboratory results, and pathologic findings of patients with amyloidosis involving larynx, oral cavity, and pharynx from our institute. Methods: A total of 39 specimens from 28 patients were retrieved from 2000 to 2020. Data collection included clinical presentation, radiographic, laboratory results, and pathologic findings. Results: A total of 12 patients had laryngeal amyloidosis and true vocal cord was the most common location. Protein electrophoresis detected monoclonal protein in 10% (1/10) of patients tested. Two patients had hematopoietic disorder (2/12, 17%) and another patient had a peptide profile consistent with amyloid transthyretin (ATTR) detected by mass spectrometry. Twelve patients showed amyloidosis in the oral cavity with 75% involving the tongue. Monoclonal protein was found in 89% of cases tested. Nine patients (9/12, 75%) had systematic involvement including 6 with hematopoietic malignancy and 3 with biopsy-confirmed systemic light chain amyloidosis. Compared to the laryngeal amyloidosis, amyloid deposition in oral cavity had a significant higher association with systematic disease (P < .01). Pharyngeal amyloidosis was seen in 7 patients. Three of 6 patients tested (3/6, 50%) were found to have biopsy-confirmed hematopoietic malignancy. Conclusions: Laryngeal amyloidosis is mostly a localized disease. Amyloidosis involving oral cavity is associated with significantly higher risk of systematic involvement which warrants a comprehensive laboratory, radiographic, and pathologic workup. There is limited data about pharynx amyloidosis. Oropharynx and hypopharynx amyloidosis appear to be more likely associated with underlying hematologic malignancy compared to nasopharynx involvement.
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Affiliation(s)
- Tieying Hou
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Asma Abu-Salah
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Oscar W Cummings
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Stacey Halum
- Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Hector Mesa
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Dongwei Zhang
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
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Upadhyaya JD, Mutalik VS. Oral Lesions Associated with Systemic Disease. Oral Maxillofac Surg Clin North Am 2023; 35:227-236. [PMID: 36805901 DOI: 10.1016/j.coms.2022.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
Oral manifestations may be the first sign of a systemic disease, or represent lesions associated with an established or recurrent disease. Oral health care providers are often the first to recognize these signs. Some lesions have characteristic features that allow for early detection and intervention. On the contrary, clinical manifestations may be diverse and require a comprehensive evaluation to establish a definitive diagnosis. This article reviews the oral manifestations of select systemic diseases to help clinicians develop a differential diagnosis that leads to early diagnosis and timely intervention.
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Affiliation(s)
- Jasbir D Upadhyaya
- Department of Applied Dental Medicine, Southern Illinois University School of Dental Medicine, 2800 College Avenue, Building 285, Alton, IL 62002, USA.
| | - Vimi Sunil Mutalik
- Department of Dental Diagnostic and Surgical Sciences, University of Manitoba Dr. Gerald Niznick College of Dentistry, 780 Bannatyne Avenue, Winnipeg, Manitoba R3E 0W2, Canada
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Lo SW, Hsu CM, Tsai YT, Tsai MS, Chang GH. Localized Amyloidosis of Bilateral Palatine Tonsils Mimicking Tonsillolithiasis. EAR, NOSE & THROAT JOURNAL 2023:1455613231154057. [PMID: 36710076 DOI: 10.1177/01455613231154057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
A rare disease called localized tonsillar amyloidosis can cause serious problems with airway patency in severe cases. This was the case with an elderly man who experienced difficulty breathing and swallowing due to enlarged palatine tonsils. The physical and imaging findings suggested tonsillolithiasis, and the patient underwent bilateral tonsillectomy. The diagnosis of amyloidosis was confirmed with histopathological examination using Congo red staining. Surgical intervention and careful follow-up care can be effective in these cases, which generally have a good prognosis.
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Affiliation(s)
- Sheng-Wei Lo
- Department of Otolaryngology, Chiayi Chang Gung Memorial Hospital, Puzi, Taiwan
| | - Cheng-Ming Hsu
- Department of Otolaryngology, Chiayi Chang Gung Memorial Hospital, Puzi, Taiwan
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Faculty of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yao-Te Tsai
- Department of Otolaryngology, Chiayi Chang Gung Memorial Hospital, Puzi, Taiwan
- Faculty of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ming-Shao Tsai
- Department of Otolaryngology, Chiayi Chang Gung Memorial Hospital, Puzi, Taiwan
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Faculty of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Geng-He Chang
- Department of Otolaryngology, Chiayi Chang Gung Memorial Hospital, Puzi, Taiwan
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Faculty of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Head and Neck Infectious Treatment Center, Chiayi Chang Gung Memorial Hospital, Puzi, Taiwan
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7
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Localized laryngeal amyloidosis: A systematic review. Am J Otolaryngol 2022; 43:103550. [DOI: 10.1016/j.amjoto.2022.103550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Accepted: 07/24/2022] [Indexed: 11/22/2022]
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Bezerra HKF, de França TRT, Prado JD, Saint-Gerons RS, de Amorim Carvalho EJ, da Cruz Perez DE. Oral localized amyloidosis. Head Neck Pathol 2022; 16:818-822. [PMID: 35296978 PMCID: PMC9424412 DOI: 10.1007/s12105-022-01436-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 02/18/2022] [Accepted: 02/21/2022] [Indexed: 11/30/2022]
Abstract
This report describes two cases of oral localized amyloidosis (LA). In case 1, a 52-year-old man appeared with painful slightly, yellowish multiple nodules located on the dorsum of the tongue, of unknown duration. Incisional biopsy was performed, and the histopathologic analysis revealed a homogeneous, eosinophilic, and extracellular material. Congo red stain showed salmon pink coloration at light microscopy and apple-green birefringence at polarized light. In case 2, a 74-year-old man presented asymptomatic nodular lesions on the labial commissures with duration of several months. An excisional biopsy was performed in both lesions, and microscopically the specimen demonstrated the same histopathologic features of the case 1. Furthermore, amyloidosis with systemic involvement was excluded after investigations for both patients. Thus, the final diagnosis for both cases was LA. The patient 1 refused the surgical excision of the residual lesion, and in both cases, no signs of clinical and systemic progression were observed after 24 and 84 months of follow up. Although it is rare, LA should be considered in the differential diagnosis of multiple or single yellowish nodules on the oral cavity.
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Affiliation(s)
- Hélen Kaline Farias Bezerra
- Department of Clinical and Preventive Dentistry, Oral Pathology Unit, Federal University of Pernambuco, Recife, Pernambuco, Brazil
| | | | - José Divaldo Prado
- Department of Stomatology, A. C. Camargo Cancer Center, São Paulo, São Paulo, Brazil
| | - Rafael Segura Saint-Gerons
- Andalusian Healthcare Service, Department of Medical and Surgical Specialties, University of Córdoba, Córdoba, Spain
| | - Elaine Judite de Amorim Carvalho
- Department of Clinical and Preventive Dentistry, Oral Pathology Unit, Federal University of Pernambuco, Recife, Pernambuco, Brazil
| | - Danyel Elias da Cruz Perez
- Department of Clinical and Preventive Dentistry, Oral Pathology Unit, Federal University of Pernambuco, Recife, Pernambuco, Brazil. .,Department of Clinical and Preventive Dentistry, Oral Pathology Unit, Universidade Federal de Pernambuco, 4ª Travessa Professor Artur de Sá, s/n, CEP: 50740-521, Recife, PE, Brazil.
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Mira C, Montalvão P, Fonseca I, Borges A. Localised laryngotracheal amyloidosis: a differential diagnosis not to forget. BMJ Case Rep 2021; 14:e237954. [PMID: 33526525 PMCID: PMC7853032 DOI: 10.1136/bcr-2020-237954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2020] [Indexed: 02/03/2023] Open
Abstract
We present a case of multifocal laryngotracheal amyloidosis (LTA) in a 43-year-old man with persistent and progressive dysphonia and dyspnoea, and a first inconclusive histology. Although laryngeal amyloidosis accounts for fewer than 1% of all benign laryngeal tumours, it is in fact the most common site of amyloid deposition in the head, neck and respiratory tract. The clinical scenario is non-specific and diagnosis depends on a high degree of suspicion and on histology. Imaging is useful in mapping lesions, which are often more extensive than they appear during laryngoscopy. Despite being a benign entity, the prognosis is variable with a high-rate and long-latency recurrences, requiring long-term follow-up.
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Affiliation(s)
- Catarina Mira
- Radiology Department, Hospital Beatriz Angelo, Loures, Portugal
| | - Pedro Montalvão
- Otorhinolaryngology Deparment, Portuguese Institute of Oncology of Lisbon, Francisco Gentil, Lisbon, Portugal
| | - Isabel Fonseca
- Pathology, Portuguese Institute of Oncology of Lisbon, Francisco Gentil, Lisboa, Portugal
| | - Alexandra Borges
- Radiology Department, Portuguese Institute of Oncology of Lisbon, Francisco Gentil, Lisboa, Portugal
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Schmid SE, Nesbitt NB, Snitchler AN, Verma PS, Grantham MD, Gallagher DJ. Localized Amyloidosis Involving Palatine Tonsils: A Case Report and Literature Review. Head Neck Pathol 2020; 14:1036-1040. [PMID: 32451875 PMCID: PMC7669982 DOI: 10.1007/s12105-020-01177-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 04/18/2020] [Accepted: 05/17/2020] [Indexed: 11/29/2022]
Abstract
Amyloidosis is a localized or systemic process where extracellular insoluble plasma protein fibers are deposited into tissues. Localized amyloidosis is rare and curable by surgical resection. While the head and neck region represents 19% of localized amyloidosis cases, only one other case of bilateral involvement of the pharyngeal tonsils has been published in the international literature. We report a case of asymptomatic amyloidosis isolated to the bilateral palatine tonsils and a cervical lymph node in a 59-year-old male. Systemic amyloidosis was ruled out through multidisciplinary consultation, and resection of the masses was performed. This represents the second reported case of bilateral tonsillar amyloidosis.
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Affiliation(s)
- S E Schmid
- U.S. Army Medical Center of Excellence, San Antonio, TX, USA
| | - N B Nesbitt
- Department of Otolaryngology - Head and Neck Surgery, Walter Reed National Military Medical Center, 8901 Rockville Pike, Bethesda, MD, 20889, USA.
| | - A N Snitchler
- Department of Pathology, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - P S Verma
- Department of Hematology and Oncology, Fort Belvoir Community Hospital, Fort Belvoir, VA, USA
| | - M D Grantham
- Department of Pathology, Fort Belvoir Community Hospital, Fort Belvoir, VA, USA
| | - D J Gallagher
- Department of Otolaryngology - Head and Neck Surgery, Fort Belvoir Community Hospital, Fort Belvoir, VA, USA
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Song XL, Yang JY, Lai YT, Zhou JY, Wang JJ, Sun XC, Wang DH. Localized amyloidosis affecting the lacrimal sac managed by endoscopic surgery: A case report. World J Clin Cases 2020; 8:5684-5689. [PMID: 33344561 PMCID: PMC7716319 DOI: 10.12998/wjcc.v8.i22.5684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 10/01/2020] [Accepted: 10/20/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Here we present a rare case of localized amyloidosis involving the nasolacrimal duct and lacrimal sac which was managed by endoscopic surgery.
CASE SUMMARY A 50-year-old man whose medical history included bilateral ventricular fold and vocal cord amyloidosis complained of bilateral epiphora. Magnetic resonance imaging revealed a neoplasm within the nasolacrimal sac. Characteristic positivity for Congo red staining and birefringence under a polarized microscope proved the diagnosis of amyloidosis. Dacryocystorhinostomy via an endoscope obtained a favorable result. A one-year follow-up found no recurrence.
CONCLUSION There are few reports on amyloidosis involving the lacrimal outflow system, and management and outcome are not clear. Endoscopic dacryocystorhinostomy can be a choice to relieve symptoms. Regular follow-up and monitoring of systemic diseases are highly recommended.
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Affiliation(s)
- Xiao-Le Song
- Department of Otorhinolaryngology, Eye, Ear, Nose, and Throat Hospital, Fudan University, Shanghai 200031, China
| | - Jing-Yi Yang
- Department of Otorhinolaryngology, Eye, Ear, Nose, and Throat Hospital, Fudan University, Shanghai 200031, China
| | - Yu-Ting Lai
- Department of Otorhinolaryngology, Eye, Ear, Nose, and Throat Hospital, Fudan University, Shanghai 200031, China
| | - Jia-Ying Zhou
- Department of Otorhinolaryngology, Eye, Ear, Nose, and Throat Hospital, Fudan University, Shanghai 200031, China
| | - Jing-Jing Wang
- Department of Otorhinolaryngology, Eye, Ear, Nose, and Throat Hospital, Fudan University, Shanghai 200031, China
| | - Xi-Cai Sun
- Department of Otorhinolaryngology, Eye, Ear, Nose, and Throat Hospital, Fudan University, Shanghai 200031, China
| | - De-Hui Wang
- Department of Otorhinolaryngology, Eye, Ear, Nose, and Throat Hospital, Fudan University, Shanghai 200031, China
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Hoffman JE, Dempsey NG, Sanchorawala V. Systemic Amyloidosis Caused by Monoclonal Immunoglobulins: Soft Tissue and Vascular Involvement. Hematol Oncol Clin North Am 2020; 34:1099-1113. [PMID: 33099427 DOI: 10.1016/j.hoc.2020.08.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Clinical features of soft tissue amyloid light-chain (AL) amyloidosis include macroglossia, arthropathy, muscle pseudohypertrophy, skin plaques, and carpal tunnel syndrome. Vascular manifestations of AL amyloid include periorbital ecchymosis, jaw or limb claudication, and even myocardial infarction caused by occlusion of small vessel coronary arteries. Some of these features, such as macroglossia, periorbital ecchymosis, and the so-called shoulder-pad sign, are pathognomonic for AL amyloidosis. These findings may be the initial presenting features of the disease, and the recognition of these red flag symptoms is very important for the diagnosis and early intervention on the underlying plasma cell disease.
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Affiliation(s)
- James E Hoffman
- Department of Medicine, Division of Hematology, University of Miami/Sylvester Comprehensive Cancer Center, 1475 Northwest 12th Avenue, Miami, FL 33136, USA
| | - Naomi G Dempsey
- Department of Medicine, Division of Hematology, University of Miami/Sylvester Comprehensive Cancer Center, 1475 Northwest 12th Avenue, Miami, FL 33136, USA
| | - Vaishali Sanchorawala
- Boston University School of Medicine and Boston Medical Center, 72 East Concord Street, K-503, Boston, MA 02118, USA.
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13
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Onishi T, Yasuda M, Koida A, Inui TA, Okamoto S, Hirano S. A Case of Primary Systemic Amyloidosis Involving the Sinonasal Tract. EAR, NOSE & THROAT JOURNAL 2020; 100:NP397-NP401. [PMID: 32364447 DOI: 10.1177/0145561320922719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
We present a case of primary systemic amyloidosis diagnosed by endoscopic sinus surgery. A 75-year-old woman had blurred vision in her left eye; computed tomography and magnetic resonance imaging showed shadows of the bilateral paranasal sinuses. Endoscopic sinus surgery was performed, and amyloidosis was diagnosed by histopathology. She had previously been diagnosed with amyloidosis of the stomach, and therefore, she was diagnosed with primary systemic amyloidosis. A systemic workup for additional amyloid deposits revealed no evidence of other diseases. The patient remained under follow-up without further treatment, as no further amyloid deposition or progression of the lesions was seen. Amyloidosis is a rare condition characterized by the deposition of abnormal protein filaments in the extracellular tissue. Generally, systemic amyloidosis does not involve the head and neck region, and the presence of amyloid in the nasal and paranasal sinus mucosa is more likely to be indicative of a localized process. However, in our patient, the lesions were located in both the sinonasal tract and the stomach, indicating systemic amyloidosis. To our knowledge, there have been no previous reports of systemic amyloidosis involving the sinonasal tract, and therefore, we consider this case to be extremely rare.
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Affiliation(s)
- Toshinori Onishi
- Department of Otolaryngology-Head and Neck Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Makoto Yasuda
- Department of Otolaryngology-Head and Neck Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Atsuhide Koida
- Department of Otolaryngology-Head and Neck Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Taka-Aki Inui
- Department of Otolaryngology-Head and Neck Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Shota Okamoto
- Department of Otolaryngology-Head and Neck Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Shigeru Hirano
- Department of Otolaryngology-Head and Neck Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
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Takumi K, Staziaki PV, Hito R, Nadgir RN, Berk JL, Andreu-Arasa VC, Chavez W, Sakai O. Amyloidosis in the head and neck: CT findings with clinicopathological correlation. Eur J Radiol 2020; 128:109034. [PMID: 32438260 DOI: 10.1016/j.ejrad.2020.109034] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 03/11/2020] [Accepted: 04/20/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE To characterize the CT imaging features of head and neck amyloidosis and correlate with extent of disease and clinical outcomes. MATERIALS AND METHODS This retrospective study included 80 patients with head and neck amyloidosis who underwent soft tissue neck CT imaging between November 2003 and April 2018. The CT imaging features including lesion distribution, morphology (focal, diffuse/circumferential, or combined), presence and pattern of calcification, (punctate or diffuse), and thickness of airway lesion were evaluated and compared with the extent of amyloidosis (localized or systemic), and clinical course (stable, no recurrence, or progression requiring repeated surgical treatment). RESULTS Localized disease (83.8%, 67/80) was most common with AL type (97.6%, 41/42) representing nearly all cases of head and neck amyloidosis. The larynx was the most frequently affected organ (60.0%, 48/80), specifically the glottis (43.8%, 35/80). Calcification was seen in 65.0% of cases (52/80). Non-airway or tongue lesions were significantly associated with systemic (92.3%, 12/13) as opposed to localized amyloidosis (4.5%, 3/67; P < 0.001). Repeated surgical treatment was significantly associated with laryngeal amyloidosis (35.3%, 12/34; P = 0.002) and multi-centric disease (33.3%, 10/30; P = 0.048). Airway wall thickness in patients who required repeated surgical treatment was significantly greater than in patients with stable or no recurrent disease (P = 0.016). CONCLUSION Knowledge of the imaging features of head and neck amyloidosis can aid the diagnosis, disease monitoring, and prediction of patients requiring repeated surgical intervention.
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Affiliation(s)
- Koji Takumi
- Department of Radiology, Boston Medical Center, Boston University School of Medicine, Boston, MA, United States; Department of Radiology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Pedro V Staziaki
- Department of Radiology, Boston Medical Center, Boston University School of Medicine, Boston, MA, United States
| | - Rania Hito
- Department of Radiology, Veteran Affairs Boston Healthcare System, Boston University School of Medicine, Boston, MA, United States
| | - Rohini N Nadgir
- Department of Radiology, Boston Medical Center, Boston University School of Medicine, Boston, MA, United States; The Russell H. Morgan Department of Radiology and Radiological Science, Division of Neuroradiology, The Johns Hopkins Medical Institutions, Baltimore, MD, United States
| | - John L Berk
- Amyloidosis Center, Boston Medical Center, Boston University School of Medicine, Boston, MA, United States
| | - V Carlota Andreu-Arasa
- Department of Radiology, Boston Medical Center, Boston University School of Medicine, Boston, MA, United States
| | - Wilson Chavez
- Department of Radiology, Boston Medical Center, Boston University School of Medicine, Boston, MA, United States
| | - Osamu Sakai
- Department of Radiology, Boston Medical Center, Boston University School of Medicine, Boston, MA, United States; Department of Otolaryngology - Head and Neck Surgery, Boston Medical Center, Boston University School of Medicine, Boston, MA, United States; Department of Radiation Oncology, Boston Medical Center, Boston University School of Medicine, Boston, MA, United States.
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15
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Adamo D, Gasparro R, Marenzi G, Mascolo M, Cervasio M, Cerciello G, De Novellis D, Mignogna MD. Amyloidoma of the Tongue: Case Report, Surgical Management, and Review of the Literature. J Oral Maxillofac Surg 2020; 78:1572-1582. [PMID: 32442425 DOI: 10.1016/j.joms.2020.04.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 04/13/2020] [Accepted: 04/13/2020] [Indexed: 12/13/2022]
Abstract
PURPOSE Localized amyloidosis of the tongue is a benign condition in which surgical management may be considered. The aim of the study was to review the current literature and report a case. MATERIALS AND METHODS We searched the PubMed database for all relevant articles reporting cases of localized tongue amyloidosis published between 1980 and February 2020. In addition, we updated 1 case diagnosed and treated in our department. RESULTS A 49-year-old male patient presented with an asymptomatic tongue nodule of the dorsum mimicking median rhomboid glossitis. The results of an incisional biopsy showed an amyloid on Congo red staining and positive findings for the κ light chain by immunohistochemical analysis. The findings of the systemic workup were negative. Therefore, a diagnosis of localized κ light-chain amyloidosis was made. The patient underwent a resection of the lesion, and no recurrence or progression was observed during a period of 18 months. The literature review showed 12 reports describing 21 patients (11 men, 52.3%) with localized tongue amyloidosis. The most common clinical presentation was nodular with a single lesion of the tongue dorsum (15 patients, 71.4%). All cases showed positive findings on Congo red staining. Immunohistochemical analysis findings were available for only 9 patients (42.8%) and showed light-chain amyloidosis. No case showed any systemic involvement or the development of systemic disease. Surgical excision was performed in 9 cases, with recurrence at the site of operation in 2 cases. CONCLUSIONS Localized amyloidosis of the tongue is a rare disease in which surgical excision may be therapeutic when a multidisciplinary evaluation does not show any systemic disease. We recommend an excision when the lesion is persistent or shows an enlargement or when discomfort is reported. In the case of any further local recurrence, resection may be repeated.
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Affiliation(s)
- Daniela Adamo
- Clinical Assistant, Oral Medicine Unit, Department of Neuroscience, Reproductive Sciences and Dentistry, University of Naples Federico II, Naples, Italy
| | - Roberta Gasparro
- Resident, Oral Surgery Unit, Department of Neuroscience, Reproductive Sciences and Dentistry, University of Naples Federico II, Naples, Italy.
| | - Gaetano Marenzi
- Researcher, Oral Surgery Unit, Department of Neuroscience, Reproductive Sciences and Dentistry, University of Naples Federico II, Naples, Italy
| | - Massimo Mascolo
- Associate Professor, Advanced Biomedical Sciences Department, University of Naples Federico II, Naples, Italy
| | - Mariarosaria Cervasio
- Resident, Advanced Biomedical Sciences Department, University of Naples Federico II, Naples, Italy
| | - Giuseppe Cerciello
- Clinical Assistant, Haematology Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Danilo De Novellis
- Resident, Haematology Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Michele Davide Mignogna
- Full Professor and Department Head, Oral Medicine Unit, Department of Neuroscience, Reproductive Sciences and Dentistry, University of Naples Federico II, Naples, Italy
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Crosetti E, Manca A, Maldi E, Succo G. A Rare Nasopharyngeal Presentation of Amyloidosis. EAR, NOSE & THROAT JOURNAL 2020; 100:562-565. [PMID: 32228034 DOI: 10.1177/0145561320914432] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Amyloidosis is a heterogeneous group of diseases characterized by the extracellular deposition of insoluble proteins whose pathogenesis is not yet fully understood. The deposition of amyloid proteins can be systemic or localized, idiopathic or related to systemic diseases, mostly multiple myeloma or chronic inflammatory diseases. Localized head and neck amyloidosis is a rare entity, mainly involving the larynx. Given the rarity of the disease and the absence of a lasting follow-up protocol, there is no standard treatment defined for localized amyloidosis. We report a rare case of localized nasopharyngeal amyloidosis, treated with complete transoral resection and confirmed by histological examination.
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Affiliation(s)
- Erika Crosetti
- Head and Neck Oncology Unit, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Torino, Italy
| | - Andrea Manca
- Head and Neck Oncology Unit, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Torino, Italy
| | - Elena Maldi
- Pathology Unit, Candiolo Cancer Institute, FPO - IRCCS, Candiolo, Torino, Italy
| | - Giovanni Succo
- Head and Neck Oncology Unit, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Torino, Italy.,Department of Oncology, University of Turin, Orbassano, Torino, Italy
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Singh A, Haq M, Gautam P, Gautam D, Handa AC, Handa KK. Clinical Profile of Patients with Head and Neck Amyloidosis: A Single-Institution Retrospective Chart Review. Int Arch Otorhinolaryngol 2020; 24:e450-e456. [PMID: 33101510 PMCID: PMC7575368 DOI: 10.1055/s-0039-3402494] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 11/11/2019] [Indexed: 11/24/2022] Open
Abstract
Introduction
Isolated amyloidosis involving the head and neck is a rare entity. The pathophysiology of the localized disease appears to be distinct from that of the systemic counterpart. Systemic progression of the localized disease is unusual, and the prognosis of the localized form is excellent.
Objective
To describe the demographic and clinicopathological characteristics of patients presenting with localized head and neck subsite amyloidosis.
Methods
A retrospective chart review of the patients with head and neck amyloidosis identified by the electronic search of the electronic database of the Departments of Pathology and Otorhinolaryngology was performed. The various demographic and clinical data were tabulated.
Results
In total, seven patients (four females, three males) with localized head and neck amyloidosis (three supraglottic, three lingual and one sinonasal) were identified. Six patients had AL-amyloid deposits, and one patient had AA-amyloid deposits. Supraglottic involvement and that of the base of the tongue were treated surgically using CO2 laser, and these patients were disease-free at the last follow-up. The patient with sinonasal amyloidosis experienced symptom recurrence after six months of the functional endoscopic sinus surgery. All of the patients were screened for systemic amyloidosis with abdominal fat pad biopsy, and were found to be free of systemic spread.
Conclusion
Isolated head and neck amyloidosis, as opposed to systemic amyloidosis, has an excellent prognosis in terms of survival. Therefore, systemic amyloidosis should be excluded in all cases. The treatment of choice remains surgical excision; however, watchful waiting may be a suitable strategy for mild symptoms or for cases in which the disease was discovered incidentally.
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Affiliation(s)
- Anup Singh
- Department of Otorhinolaryngology and Head and Neck Surgery, Medanta - The Medicity, Gurugram, Haryana, India
| | - Mubashshirul Haq
- Department of Otorhinolaryngology and Head and Neck Surgery, Medanta - The Medicity, Gurugram, Haryana, India
| | - Poonam Gautam
- Department of Otorhinolaryngology and Head and Neck Surgery, Medanta - The Medicity, Gurugram, Haryana, India
| | - Dheeraj Gautam
- Department of Pathology, Medanta - The Medicity, Gurugram, Haryana, India
| | - Aru C Handa
- Department of Otorhinolaryngology and Head and Neck Surgery, Medanta - The Medicity, Gurugram, Haryana, India
| | - Kumud K Handa
- Department of Otorhinolaryngology and Head and Neck Surgery, Medanta - The Medicity, Gurugram, Haryana, India
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19
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Chow K, Kaul VF, Iacob CE, Cosetti MK. Amyloidosis Presenting as a Mass Abutting the Tympanic Membrane. EAR, NOSE & THROAT JOURNAL 2019; 100:337-339. [PMID: 31569979 DOI: 10.1177/0145561319868453] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Kevin Chow
- 12339McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Vivian F Kaul
- Department of Otolaryngology-Head and Neck Surgery, 5925Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Codrin E Iacob
- Department of Pathology and Laboratory Medicine, 22526New York Eye and Ear Infirmary of Mount Sinai, New York, NY, USA
| | - Maura K Cosetti
- Department of Otolaryngology-Head and Neck Surgery, 5925Icahn School of Medicine at Mount Sinai, New York, NY, USA
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20
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Coyle P, Tan N, Jonas N. Sleep disordered breathing and dysphonia in a pediatric patient - Laryngeal amyloidosis as an unusual diagnosis. Int J Pediatr Otorhinolaryngol 2019; 122:44-46. [PMID: 30959336 DOI: 10.1016/j.ijporl.2019.03.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 03/21/2019] [Accepted: 03/22/2019] [Indexed: 11/30/2022]
Abstract
Primary laryngeal amyloidosis is an uncommon condition, and cases in the pediatric population are even rarer. We present a case of a nine year old female patient who presented with sleep disordered breathing and dysphonia to our outpatient clinic. The patient underwent Microlaryngoscopy and Bronchoscopy for diagnosis which identified a large soft tissue mass in the supraglottis. After Histological diagnosis was made, she had subtotal debridement of the mass and has maintained a good exercise tolerance with no airway compromise.
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Affiliation(s)
- P Coyle
- Department of Pediatric ENT, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QQ, UK
| | - N Tan
- Department of Pediatric ENT, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QQ, UK
| | - N Jonas
- Department of Pediatric ENT, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QQ, UK.
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21
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Systemic amyloidosis presenting in the lateral pharyngeal band of Waldeyer's ring: A case report. OTOLARYNGOLOGY CASE REPORTS 2018. [DOI: 10.1016/j.xocr.2018.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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22
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Amyloidosis of the Upper Aerodigestive Tract: Management of a Rare Disease and Review of the Literature. Dysphagia 2018; 34:179-191. [DOI: 10.1007/s00455-018-9956-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 10/20/2018] [Indexed: 01/23/2023]
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23
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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 2018; 25:670-675. [PMID: 29667278 DOI: 10.1111/odi.12870] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 03/21/2018] [Accepted: 04/07/2018] [Indexed: 11/29/2022]
Affiliation(s)
- J Deng
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral DiseasesWest China Hospital of StomatologySichuan University Chengdu China
| | - Q Chen
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral DiseasesWest China Hospital of StomatologySichuan University Chengdu China
| | - P Ji
- College of StomatologyChongqing Medical University Chongqing China
- Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences Chongqing China
- Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education Chongqing China
| | - X Zeng
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral DiseasesWest China Hospital of StomatologySichuan University Chengdu China
| | - X Jin
- College of StomatologyChongqing Medical University Chongqing China
- Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences Chongqing China
- Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education Chongqing China
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Abstract
Amyloidomas are rare tumor-like depositions of abnormally folded, insoluble proteins that may be seen in the setting of systemic amyloidosis or as isolated tumoral deposits. Focal, isolated amyloidomas carry an excellent prognosis whereas systemic amyloidoses do not. The ability to identify or suggest amyloidoma on imaging studies may help direct laboratory testing and eventual diagnosis. Amyloidomas involving the head and neck have been variably described from homogeneously T2 hypointense to iso-slightly hyperintense relative to skeletal muscle. Herein we present two patients with pharyngeal submucosal amyloidomas of differing sizes and imaging characteristics to emphasize their potential widely variable imaging appearance and broaden our knowledge of these rare lesions.
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Affiliation(s)
| | - Q Zhai
- Mayo Clinic Jacksonville, USA
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25
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Reiter R, Hoffmann TK, Pickhard A, Brosch S. Hoarseness-causes and treatments. DEUTSCHES ARZTEBLATT INTERNATIONAL 2016; 112:329-37. [PMID: 26043420 DOI: 10.3238/arztebl.2015.0329] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Revised: 03/03/2015] [Accepted: 03/03/2015] [Indexed: 01/03/2023]
Abstract
BACKGROUND Hoarseness (dysphonia) is the reason for about 1% of all consultations in primary care. It has many causes, ranging from self-limited laryngitis to malignant tumors of the vocal cords. METHODS This review is based on literature retrieved by a selective search in PubMed employing the terms "hoarseness," "hoarse voice," and "dysphonia," on the relevant guideline of the American Academy of Otolaryngology -Head and Neck Surgery, and on Cochrane reviews. RESULTS Hoarseness can be caused by acute (42.1%) and chronic laryngitis (9.7%), functional vocal disturbances (30%), and benign (10.7-31%) and malignant tumors (2.2-3%), as well as by neurogenic disturbances such as vocal cord paresis (2.8-8%), physiologic aging of the voice (2%), and psychogenic factors (2-2.2 %). Hoarseness is very rarely a manifestation of internal medical illness. The treatment of hoarseness has been studied in only a few randomized controlled trials, all of which were on a small scale. Voice therapy is often successful in the treatment of functional and organic vocal disturbances (level 1a evidence). Surgery on the vocal cords is indicated to treat tumors and inadequate vocal cord closure. The only entity causing hoarseness that can be treated pharmacologically is chronic laryngitis associated with gastro-esophageal reflux, which responds to treatment of the reflux disorder. The empirical treatment of hoarseness with antibiotics or corticosteroids is not recommended. CONCLUSION Voice therapy, vocal cord surgery, and drug therapy for appropriate groups of patients with hoarseness are well documented as effective by the available evidence. In patients with risk factors, especially smokers, hoarseness should be immediately evaluated by laryngos - copy.
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Affiliation(s)
- Rudolf Reiter
- Division of Phoniatrics and Pediatric Audiology, Department of Otorhinolaryngology, Head and Neck Surgery, Ulm University Hospital, Ulm, Department of Otorhinolaryngology, Head and Neck Surgery, Ulm University Hospital, Ulm, Department of Otorhinolaryngology, University Hospital Klinikum rechts der Isar, Technische Universität München, Munich
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26
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Figueiredo M, Trierveiler M, Ortega KL. Image Gallery: Amyloidosis of the tongue associated with haemodialysis. Br J Dermatol 2016; 175:e114. [PMID: 27632972 DOI: 10.1111/bjd.14857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2016] [Indexed: 11/30/2022]
Affiliation(s)
- M Figueiredo
- Special Care Dentistry Center, School of Dentistry, University of Sao Paulo, Sao Paulo, Brazil
| | - M Trierveiler
- Department of Oral Pathology, School of Dentistry, University of Sao Paulo, Sao Paulo, Brazil
| | - K L Ortega
- Special Care Dentistry Center, School of Dentistry, University of Sao Paulo, Sao Paulo, Brazil. .,Department of Oral Pathology, School of Dentistry, University of Sao Paulo, Sao Paulo, Brazil.
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Scivetti M, Favia G, Fatone L, Maiorano E, Crincoli V. Concomitant use of Congo red staining and confocal laser scanning microscopy to detect amyloidosis in oral biopsy: A clinicopathological study of 16 patients. Ultrastruct Pathol 2016; 40:86-91. [DOI: 10.3109/01913123.2016.1152339] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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28
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Kumar B, Pant B, Kumar V, Negi M. Sinonasal Globular Amyloidosis Simulating Malignancy: A Rare Presentation. Head Neck Pathol 2016; 10:379-83. [PMID: 26780770 PMCID: PMC4972754 DOI: 10.1007/s12105-016-0681-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Accepted: 01/02/2016] [Indexed: 01/17/2023]
Abstract
Primary localized amyloidosis in the head and neck region is a rare entity. The most commonly involved organ is larynx. Primary amyloidosis localized to the sinonasal tract is extremely rare. We report one such case along with a brief review of the associated literature. The aim of reporting this case is to emphasize the fact that sometimes nasal amyloidosis can also present with signs and symptoms of nasal and nasopharyngeal malignancy. The definitive diagnosis in such cases depends upon histopathology and further confirmed by immunohistochemistry. A 55-year old male presented with recurrent episodes of nasal bleed, bilateral nasal obstruction, and bilateral hearing loss from last 7 years. On clinical examination a mass was found in the nasal cavity on both sides reaching up to the nasopharynx. Contrast enhanced CT scan revealed that the mass was extending up to the skull base and destroying bony landmarks of the nasal cavity and paranasal sinuses. Mass was proved to be amyloidosis after histopathological examination. It showed multiple blotches of globular submucosal deposit of amyloid, on staining with Congo red. Immunohistochemistry confirmed AL amyloidosis with expression of mixed kappa and lambda light chain immunoglobulin (κ > λ). No evidence of systemic amyloidosis was found after proper work up. It was managed by conservative surgery.
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Affiliation(s)
- Binay Kumar
- Department of Pathology, Government Medical College, Haldwani-Nainital, Uttarakhand India
| | - Bhawna Pant
- Department of ENT, Government Medical College, Haldwani-Nainital, Uttarakhand India
| | - Vikrant Kumar
- Department of ENT, Government Medical College, Haldwani-Nainital, Uttarakhand India
| | - Meghna Negi
- Department of Pathology, Government Medical College, Haldwani-Nainital, Uttarakhand India
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Matsuo FS, Barbosa de Paulo LF, Servato JPS, 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 2015; 20:1913-1920. [PMID: 26556575 DOI: 10.1007/s00784-015-1649-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Accepted: 11/02/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Amyloidosis is a term used to describe a group of diseases in which there is an extracellular deposition of amorphous fibrillar proteins known as amyloid. The aim of this study was to present clinicopathological data from eight oral amyloidosis-affected patients and a deep review of the literature about the disease. MATERIALS AND METHODS A retrospective study was conducted based on the records of oral amyloidosis-affected patients diagnosed in our institution between 1978 and 2012. The clinicopathological features and immunohistochemical (IHC) staining with anti-kappa and anti-lambda light chain antibodies were carried out and analyzed. RESULTS Eight patients were diagnosed with the disease; the tongue and women in their sixth decade of life were mostly affected. All lesions demonstrated apple-green birefringence and immunoreactivity for kappa-light chain, and four cases also showed lambda positivity. According to our series, four cases were diagnosed with localized amyloidosis and four with systemic amyloidosis. Prognosis for the systemic ones was gloomy, but good for the localized ones, which was characterized by a slow pattern of deposition without evolution to systemic involvement. CONCLUSIONS This study reinforces our knowledge about predilections, outcomes, and the importance of making a correct and quick diagnosis of oral amyloidosis and shows the necessity of more studies detailing oral amyloidosis predilection on a global scale. The importance and utility of IHC in the typing of the biochemical nature of amyloid deposits are becoming increasingly necessary for proper management of the patient. Correct classification of the type of amyloid is important for treatment consequences. CLINICAL RELEVANCE This article highlights the clinicopathological data of patients with amyloidosis affecting oral tissues and compare these new findings with other worldwide descriptions. Because of its rarity, such data are often unfamiliar to most clinicians and pathologists.
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Thorbury L, Ryan K, Martin L, Hunter K, Hegarty AM. Amyloidosis presenting in the head and neck: a report of two cases. Br J Hosp Med (Lond) 2015; 76:600-1. [PMID: 26457943 DOI: 10.12968/hmed.2015.76.10.600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Laura Thorbury
- Dental Core Trainee in Oral Medicine and Oral & Maxillofacial Pathology
| | - Kevin Ryan
- Specialist Registrar in Oral Medicine in the Oral Medicine Unit
| | - Lisette Martin
- Specialist Registrar in Oral Medicine in the Unit of Oral & Maxillofacial Pathology, Charles Clifford Dental Hospital, Sheffield
| | - Keith Hunter
- Reader and Honorary Consultant in the Academic Unit of Oral & Maxillofacial Pathology, University of Sheffield, Sheffield
| | - Anne M Hegarty
- Consultant in Oral Medicine in the Oral Medicine Unit, Charles Clifford Dental Hospital, Sheffield S10 2SZ
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Sjögren's syndrome with marked swelling of major salivary glands related to localized AL amyloidosis: A case report and literature review. JOURNAL OF ORAL AND MAXILLOFACIAL SURGERY, MEDICINE, AND PATHOLOGY 2015. [DOI: 10.1016/j.ajoms.2014.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Gaffney PM, Imai DM, Clifford DL, Ghassemian M, Sasik R, Chang AN, O’Brien TD, Coppinger J, Trejo M, Masliah E, Munson L, Sigurdson C. Proteomic analysis of highly prevalent amyloid A amyloidosis endemic to endangered island foxes. PLoS One 2014; 9:e113765. [PMID: 25429466 PMCID: PMC4245998 DOI: 10.1371/journal.pone.0113765] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Accepted: 10/29/2014] [Indexed: 11/18/2022] Open
Abstract
Amyloid A (AA) amyloidosis is a debilitating, often fatal, systemic amyloid disease associated with chronic inflammation and persistently elevated serum amyloid A (SAA). Elevated SAA is necessary but not sufficient to cause disease and the risk factors for AA amyloidosis remain poorly understood. Here we identify an extraordinarily high prevalence of AA amyloidosis (34%) in a genetically isolated population of island foxes (Urocyon littoralis) with concurrent chronic inflammatory diseases. Amyloid deposits were most common in kidney (76%), spleen (58%), oral cavity (45%), and vasculature (44%) and were composed of unbranching, 10 nm in diameter fibrils. Peptide sequencing by mass spectrometry revealed that SAA peptides were dominant in amyloid-laden kidney, together with high levels of apolipoprotein E, apolipoprotein A-IV, fibrinogen-α chain, and complement C3 and C4 (false discovery rate ≤ 0.05). Reassembled peptide sequences showed island fox SAA as an 111 amino acid protein, most similar to dog and artic fox, with 5 unique amino acid variants among carnivores. SAA peptides extended to the last two C-terminal amino acids in 5 of 9 samples, indicating that near full length SAA was often present in amyloid aggregates. These studies define a remarkably prevalent AA amyloidosis in island foxes with widespread systemic amyloid deposition, a unique SAA sequence, and the co-occurrence of AA with apolipoproteins.
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Affiliation(s)
- Patricia M. Gaffney
- Departments of Pathology and Medicine, University of California San Diego, La Jolla, California, United States of America
- Department of Pathology, Immunology, and Microbiology, University of California Davis, Davis, California, United States of America
| | - Denise M. Imai
- Department of Pathology, Immunology, and Microbiology, University of California Davis, Davis, California, United States of America
| | - Deana L. Clifford
- Wildlife Investigations Laboratory, California Department of Fish and Wildlife, Rancho Cordova, California, United States of America
- Department of Veterinary Medicine and Epidemiology, University of California Davis, Davis, California, United States of America
| | - Majid Ghassemian
- Department of Chemistry and Biochemistry, University of California San Diego, La Jolla, California, United States of America
| | - Roman Sasik
- Center for Computational Biology, Institute for Genomic Medicine, University of California San Diego, La Jolla, California, United States of America
| | - Aaron N. Chang
- Center for Computational Biology, Institute for Genomic Medicine, University of California San Diego, La Jolla, California, United States of America
| | - Timothy D. O’Brien
- Veterinary Population Medicine Department, Veterinary Diagnostic Laboratory, University of Minnesota, St. Paul, Minnesota, United States of America
| | - Judith Coppinger
- Departments of Pathology and Medicine, University of California San Diego, La Jolla, California, United States of America
| | - Margarita Trejo
- Departments of Pathology and Neuroscience, University of California San Diego, La Jolla, California, United States of America
| | - Eliezer Masliah
- Departments of Pathology and Neuroscience, University of California San Diego, La Jolla, California, United States of America
| | - Linda Munson
- Department of Pathology, Immunology, and Microbiology, University of California Davis, Davis, California, United States of America
| | - Christina Sigurdson
- Departments of Pathology and Medicine, University of California San Diego, La Jolla, California, United States of America
- Department of Pathology, Immunology, and Microbiology, University of California Davis, Davis, California, United States of America
- * E-mail:
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Pietruszewska W, Wągrowska-Danilewicz M, Klatka J. Amyloidosis of the head and neck: a clinicopathological study of cases with long-term follow-up. Arch Med Sci 2014; 10:846-52. [PMID: 25276173 PMCID: PMC4175762 DOI: 10.5114/aoms.2013.39206] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2012] [Revised: 05/18/2012] [Accepted: 06/17/2012] [Indexed: 11/17/2022] Open
Affiliation(s)
- Wioletta Pietruszewska
- Department of Otolaryngology and Laryngological Oncology, Medical University
of Lodz, Poland
| | | | - Janusz Klatka
- Department of Otolaryngology and Laryngological Oncology, Medical University
of Lublin, Poland
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34
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Soft masses occurring simultaneously in the upper and lower lips. Oral Surg Oral Med Oral Pathol Oral Radiol 2014; 117:147-52. [DOI: 10.1016/j.oooo.2012.11.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2012] [Revised: 11/07/2012] [Accepted: 11/13/2012] [Indexed: 02/06/2023]
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Celenk F, Durucu C, Baysal E, Karatas ZA, Polat M, Bakir K, Mumbuc S, Kanlikama M. Management of Upper Aerodigestive Tract Amyloidosis. Ann Otol Rhinol Laryngol 2013; 122:535-40. [DOI: 10.1177/000348941312200810] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives: The aim of this study was to discuss the treatment options for upper aerodigestive tract amyloidosis. Methods: Four patients with histologically confirmed amyloidosis were included in the study. All patients underwent surgical treatment. Three patients had laryngeal amyloidosis, and 1 patient had tonsillar amyloidosis. Results: Two of the cases of laryngeal amyloidosis were successfully treated with a combination of surgery and radiation therapy. One case of laryngeal amyloidosis was treated with surgery alone. The tonsillar amyloidosis was removed by tonsillectomy. None of the cases showed systemic involvement. Long-term follow-up of the patients showed no recurrence or evidence of systemic disease. Conclusions: Surgical resection is the primary treatment for patients with upper aerodigestive tract amyloidosis. Radiation therapy is especially effective in cases of recurrent amyloidosis with submucosal involvement. Pedunculated polypoid lesions may be treated with surgery alone, and in cases of recurrence, irradiation following the surgical removal should be considered. Tonsillectomy is usually sufficient for treating tonsillar amyloidosis.
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Abstract
Objective Review Mayo Clinic experience of localized tongue amyloidosis. Study Design Case series with retrospective chart review. Setting Academic medical center. Subjects and Methods Cases of localized tongue amyloidosis were identified from the dysproteinemia database at the Mayo Clinic in Rochester, Minnesota. Electronic records were reviewed with focus on presenting symptoms, laboratory results (ie, serum or urine immunoelectrophoresis, bone marrow biopsy, and fat aspirate analysis), treatment modality, and status of disease at follow-up. Results Six cases of localized tongue amyloidosis presented to the Mayo Clinic between 1969 and 2011. Mean patient age was 69 years (range, 43-90). Patients presented with asymptomatic tongue mass(es). Biopsy of the tongue mass in all patients showed amyloid on Congo red stains. Work-up for systemic amyloidosis, including bone marrow biopsy, fat aspiration, and serum and urine protein immunoelectrophoresis, was negative for all 6 patients, nor was there other organ involvement. Two patients underwent resection of the lesions, and the remaining patients elected for observation. Recurrence requiring repeat excision occurred in 1 of the patients that underwent resection. Repeat evaluation for systemic involvement was performed in 3 patients 1 to 3 years after the initial diagnosis. None of these patients went on to develop systemic involvement. Conclusions Localized tongue amyloidosis remains a rare diagnosis and requires exclusion of systemic involvement. Localized lesions may be observed or resected; however, recurrence may occur with resection. Patients with localized tongue amyloidosis do not appear to be at increased risk of developing systemic involvement.
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Affiliation(s)
- Ashley O’Reilly
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota, USA
| | - Anita D’Souza
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - John Lust
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Daniel Price
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota, USA
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Ferreira L, Efebera Y, Allen C. Clinical Pathologic Conference Case 2: A Diffuse Swelling of the Neck. Oral Surg Oral Med Oral Pathol Oral Radiol 2013; 115:e36-40. [DOI: 10.1016/j.oooo.2013.01.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Loyo M, Baras A, Akst LM. Plasmacytoma of the larynx. Am J Otolaryngol 2013; 34:172-5. [PMID: 23312735 DOI: 10.1016/j.amjoto.2012.11.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2012] [Accepted: 11/05/2012] [Indexed: 10/27/2022]
Abstract
Amyloid is an extracellular proteinaceous low-molecular-weight fibril. In the larynx, amyloid deposits usually represent a benign localized disease. Although laryngeal amyloidosis is an indolent lesion, amyloid deposition in the larynx may actually result from a lymphoproliferative disorder and not isolated amyloidosis. In this case report, we describe a patient referred for laryngeal amyloidosis who was subsequently diagnosed with extramedullary plasmacytoma of the larynx. The report discusses the presentation, diagnosis, and treatment provided. The importance of systemic workup and accurate tissue diagnosis in differentiating primary amyloidosis and secondary amyloid deposition will be highlighted.
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Wierzbicka M, Budzyński D, Piwowarczyk K, Bartochowska A, Marszałek A, Szyfter W. How to deal with laryngeal amyloidosis? Experience based on 16 cases. Amyloid 2012; 19:177-81. [PMID: 22998523 DOI: 10.3109/13506129.2012.723073] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Amyloidosis is characterized by the deposition of amorphous fibrillar protein (amyloid) in the intercellular or intracellular space. Localized amyloidosis is rare in the head and neck area. In Polish literature of the last decade it has been the subject of case studies. AIM The goal of the study was to carry out a retrospective analysis of patients treated for amyloidosis in the Department of Otolaryngology and Head and Neck Surgery of the Poznań University of Medical Sciences in the period from 2000 to 2009. Based on the collected clinical material, the authors made an attempt to determine the most frequent anatomical location of amyloid deposits and the most frequently affected organs, the type and duration of symptoms, the therapeutic approach, further diagnostic measures taken and the final outcome of the treatment. The next goal was to assess the number of microlaryngoscopies performed in patients with amyloidosis affecting the larynx as compared to the overall number of such procedures. MATERIAL The detailed analysis included 16 patients with laryngeal amyloidosis. RESULTS Amyloidosis of the larynx was found in only 0.52% of patients undergoing microlaryngoscopies in the period from 2000 to 2009. In the vast majority of patients (11 of 16), there was no suspicion of amyloidosis in the initial diagnosis. Only the histopathological assessment definitely confirmed the nature of pathological changes in the larynx. Glottis was the most common location of amyloid deposits in the study group. In all cases, additional studies and long-term monitoring of the postoperative course excluded generalized amyloidosis. CONCLUSIONS Laryngeal amyloidosis is very rare, however it should be considered in the differential diagnosis in patients with laryngeal dysfunction. Surgery remains the treatment of choice in most patients, although the attempts of radiotherapy are undertaken. Preserving the normal function of the organ remains the priority.
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Affiliation(s)
- Małgorzata Wierzbicka
- Department of Otolaryngology, Head and Neck Surgery, Poznań University of Medical Sciences, Poland.
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Li Y, Liu N, Xu Y, Wang J, Wu L, Zhou Y, Zhu X, Jin X, Chen Q, Zeng X, Zeng X. Widespread purple bulla-like masses of the oral mucosa. Oral Surg Oral Med Oral Pathol Oral Radiol 2012; 114:552-7. [DOI: 10.1016/j.oooo.2011.11.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2011] [Revised: 10/30/2011] [Accepted: 11/08/2011] [Indexed: 12/13/2022]
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Abstract
Amyloidosis is a rare group of diseases characterized by deposition of amyloid fibrils in soft tissues. More than 28 types of amyloid have been identified. They all share common ultrastructural and chemical characteristics. Treatments are available for many types but are type specific. Therefore, confirmation and typing of amyloid are essential before initiating treatment. Monoclonal protein studies should be performed on suspected cases, but the diagnosis requires a tissue biopsy. Congo red stain and electron microscopy are helpful to discriminate between amyloid and other pathologic fibrils. Once amyloid is confirmed, typing should be performed. Immunofluorescence and immunohistochemistry are frequently used and are helpful, but this approach has limitations, such as availability, specificity and sensitivity of commercial antibodies. Genetic mutational analysis is vital for ruling in and out hereditary amyloidoses but is unhelpful in nonmutated forms. The most advanced technique of amyloid typing is laser microdissection followed by mass spectrometry. Using proteomics, laser microdissection followed by mass spectrometry can directly identify proteins with or without mutations. Finally, imaging studies, such as cardiac MRI with gadolinium and (123)I-labeled SAP scintigraphy not only assist in evaluation of patients with known amyloidosis but cardiac MRI has detected amyloid in patients previously unsuspected of the disease.
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Abstract
Benign and malignant lesions of the larynx and hypopharynx present an interesting and diverse spectrum of diagnostic entities, which may be infrequently encountered in routine surgical pathology practice. This article places emphasis on illustrating the classical pathologic characteristics, differential diagnosis, clinical significance, and presentation of common lesions unique to these sites. The initial diagnosis of these lesions is via small endoscopic biopsy. Many of the entities have overlapping histologic features which necessitate optimizing the information available in a small sample. The focus of this article is to provide useful criteria to enable separating the more common types of lesions encountered in these sites.
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Affiliation(s)
- Joaquín J García
- Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, 200 First Street Southwest, Rochester, MN 55905, USA
| | - Mary S Richardson
- Medical University of South Carolina, 171 Ashley Avenue, MSC 908, Charleston, SC 29425, USA
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Gouvêa AF, Ribeiro ACP, León JE, Carlos R, de Almeida OP, Lopes MA. Head and neck amyloidosis: clinicopathological features and immunohistochemical analysis of 14 cases. J Oral Pathol Med 2011; 41:178-85. [PMID: 21883489 DOI: 10.1111/j.1600-0714.2011.01073.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Amyloidosis is associated with or caused by amyloid deposition. These fibrillar proteins may be deposited extracellularly causing tissue damage or impairment. OBJECTIVES The aim of the study was to retrospectively review pathology archives in two oral diagnostic centers for cases fulfilling criteria of amyloidosis and to differentiate AA and AL types of amyloidosis. METHODS The clinicopathological features, alkaline Congo red staining, with and without pretreatment with potassium permanganate, and immunohistochemical (IHC) staining with anti-AA, anti-kappa (κ), and anti-lambda (λ) light chain antibodies were carried out and analyzed. RESULTS The search identified 14 cases. Ten patients were women and four were men, with a mean age of 58 years. Eleven patients had systemic involvement by amyloidosis (associated either with multiple myeloma or plasma cell dyscrasia/monoclonal gammopathies), while three presented the localized type, one of them associated with plasmacytoma. All cases showed positivity for κ or λ light chains (AL-amyloid) and presented resistance to the potassium permanganate pretreatment. CONCLUSIONS Our results show that the head and neck region is preferentially affected by systemic AL-amyloidosis, usually associated with plasma cell dyscrasia. Interestingly, two cases affected by inflammatory rheumatic diseases presented AL-amyloid deposition. Moreover, even after pretreatment with potassium permanganate, which was helpful in highlighting the presence of AL-amyloid, in agreement with the IHC findings, clinical classifications should be carefully made in systemic amyloidosis.
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Affiliation(s)
- Adriele Ferreira Gouvêa
- Department of Oral Diagnosis - Oral Semiology and Oral Pathology Sections, Piracicaba Dental School - State University of Campinas, Piracicaba, Sao Paulo, Brazil.
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Thibault I, Vallières I. Macroglossia due to Systemic Amyloidosis: Is There a Role for Radiotherapy? Case Rep Oncol 2011; 4:392-9. [PMID: 21941488 PMCID: PMC3177795 DOI: 10.1159/000330238] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background Macroglossia due to amyloid depositions can cause cosmetic problems and functional disability, and can lead to life-threatening airway obstruction. Management of macroglossia in systemic amyloidosis is controversial, and the role of surgery is unclear. Case Description We present a case of a 66-year-old woman affected by macroglossia due to light chain amyloidosis who presented with eating and breathing difficulties. Because of prior successful results of radiotherapy for localized amyloid disease, our patient was treated with external beam radiation therapy (20 Gy in 10 fractions). The treatment was well tolerated by the patient. However, her systemic amyloidosis progressed, with a subclinical increase in tongue width. Conclusions This is the first reported use of radiotherapy for amyloidosis of the tongue. There was no evidence of benefit using a total dose of 20 Gy. This therapeutic modality is not recommended for the routine management of macroglossia.
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Affiliation(s)
- Isabelle Thibault
- Département de Radio-oncologie, L'Hôtel-Dieu de Québec, Centre Hospitalier Universitaire de Québec (CHUQ), Québec, Qué., Canada
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Khurram SA, McPhaden A, Hislop WS, Hunter KD. Crystal storing histiocytosis of the tongue as the initial presentation of multiple myeloma. ACTA ACUST UNITED AC 2011; 111:494-6. [PMID: 21420638 DOI: 10.1016/j.tripleo.2010.12.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2010] [Revised: 11/29/2010] [Accepted: 12/20/2010] [Indexed: 11/17/2022]
Abstract
Crystal-storing histiocytosis (CSH) is a rare consequence of abnormal accumulation of immunoglobulins which may arise in a number of different clinical scenarios. In this report, we describe the case of a male patient who presented with an apparently innocuous lesion on the dorsum of tongue which showed the typical features of CSH. Subsequent investigations revealed an associated plasmacytoma, and the patient developed further systemic lesions. The rarity of such lesions presents diagnostic difficulties, yet accurate diagnosis underpins the timely implementation of appropriate therapy.
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Affiliation(s)
- Syed Ali Khurram
- Oral and Maxillofacial Pathology, School of Clinical Dentistry, University of Sheffield, Sheffield, United Kingdom
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Localized tongue Amyloidosis in a Patient with Neurofibromatosis type II. Head Neck Pathol 2011; 5:302-5. [PMID: 21340708 PMCID: PMC3173546 DOI: 10.1007/s12105-011-0251-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2011] [Accepted: 02/08/2011] [Indexed: 10/18/2022]
Abstract
BACKGROUND Localized Amyloidosis (AL) may rarely involve oral mucosa. This is the first known reported case describing the development of tongue AL in a 30-year-old patient with Neurofibromatosis (NF) type-2. CASE A female patient presented with a painless, well-circumscribed nodule of the tongue. Her medical history included NF type-2 with chromosome-22 abnormal karyotype (mosaicism), multiple intracranial and spinal meningiomas/schwannomas and unilateral blindness/deafness. The biopsy of the excised lesion of the tongue revealed subepithelial accumulation of an amorphous, nodular, fibrillar material positive for Congo red. Blood examination showed increased Thyroxine-T4 due to thyroid multinodular colloid goiter, but excluded any other hematological/immunological disorder or organ dysfunction. No recurrence was observed after a six-month follow-up. CONCLUSION This case highlights the possibility of oral manifestations as the only sign of AL and reveals the unexpected co-existence of AL and NF 2, for the first time.
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Neuner GA, Badros AA, Meyer TK, Nanaji NM, Regine WF. Complete resolution of laryngeal amyloidosis with radiation treatment. Head Neck 2010; 34:748-52. [DOI: 10.1002/hed.21626] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2010] [Accepted: 08/12/2010] [Indexed: 11/07/2022] Open
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Hammami B, Mnejja M, Kallel S, Bouguecha L, Chakroun A, Charfeddine I, Ghorbel A. Hypopharyngeal amyloidosis: A case report. Eur Ann Otorhinolaryngol Head Neck Dis 2010; 127:83-5. [PMID: 20822762 DOI: 10.1016/j.anorl.2010.02.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2009] [Accepted: 01/19/2010] [Indexed: 11/16/2022]
Abstract
Hypopharyngeal amyloidosis is rare. Management depends on etiology. We report a case of hypopharyngeal amyloidosis and review the characteristics of this exceptional pathology. A 60-year-old woman with a history of diabetes and chronic cervicalgia consulted for dysphagia and deteriorated general health status, which had been evolving for 2 months. Clinical examination found two ulcerations of the lateral edge of the tongue and right pyriform sinus salivary stasis. Panendoscopy found regular swelling of the posterior wall of the hypopharynx and cervical esophagus. The pyriform sinuses and larynx were normal. Cervical CT and MRI showed thickening of the posterior wall of the hypopharynx. Biopsy found amorphous acellular eosinophil interstitial deposits, shown to be amyloid on Congo red staining, leading to a diagnosis of amyloidosis. Etiological assessment pointed to myeloma. The patient was managed by chemotherapy associating melphalan and prednisone. Evolution at 12 months' follow-up was good. Localized amyloidosis is a rare lesion of the superior aerodigestive tract, predominating in the larynx. Hypopharyngeal involvement is exceptional. Diagnosis is histological. Management depends on etiology. Local treatment is exceptional other than in case of complication. Systemic forms with associated myeloma are of poor prognosis.
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Affiliation(s)
- B Hammami
- ENT and Head and Neck Surgery Department, Habib Bourguiba Teaching Hospital, Sfax 3029, Tunisia.
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Parmar H, Rath T, Castillo M, Gandhi D. Imaging of focal amyloid depositions in the head, neck, and spine: amyloidoma. AJNR Am J Neuroradiol 2010; 31:1165-70. [PMID: 20075086 DOI: 10.3174/ajnr.a1977] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Amyloidomas are benign tumorlike lesions consisting of localized deposits of amyloid and are the rarest form in the group of amyloidosis-related lesions. Diagnosis requires special stains; therefore, a high degree of suspicion for this disease is required. In this review, we describe the imaging features of amyloidomas involving the intracranial compartment, head and neck, and spine. We also discuss the differential diagnosis and briefly review the pertinent literature.
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Affiliation(s)
- Hemant Parmar
- Department of Radiology, University of Michigan Health System, Ann Arbor, Michigan 48109-0302, USA.
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