Lingual amyloidosis associated to long-term hemodialysis: Two case reports

Amyloidosis initially only manifesting as oral mucosal hemorrhagic lesions: a case series report

Amyloidosis is a heterogeneous series of diseases associated with extracellular amyloid protein depositions, which can involve multiple organs and tissues, leading to tissue structure alterations and organ dysfunction. The tongue is the most frequently involved site of oral amyloidosis, and one of its characteristic clinical presentations is macroglossia. Here, we report 3 extremely rare cases of amyloidosis exclusively appearing as multiple blood blisters, petechiae, and ecchymoses of the oral mucosa, in the absence of common clinical manifestations of oral and systemic amyloidosis. In a word, we highlight the possibility of oral mucosal hemorrhagic lesions as the initial clinical signs of systemic amyloidosis and the significance of the early and timely diagnosis of amyloidosis.

Etiological diagnosis of macroglossia: Systematic review and diagnostic algorithm

BACKGROUND

The objective of this literature review was to list the different etiologies of macroglossia reported in the literature, to identify characteristics that might guide diagnosis, and to create a diagnostic algorithm.

METHODS

The bibliographic search was carried out between October 2019 and July 2020 in the PubMed research base using the keywords "macroglossia" (MESH) and/or "tongue enlargement".

RESULTS

Of the 1711 references identified, 615 articles were excluded, and 1096 abstracts were reviewed. We classified the different etiologies identified according to their mechanism and whether they were congenital or acquired. The etiologies are divided into the following categories: genetic malformation syndromes, non-syndromic congenital malformations, endocrinopathies, neuromuscular diseases, storage disorders, infectious, inflammatory, traumatic, and iatrogenic diseases.

CONCLUSION

Based on this review, we propose a diagnostic algorithm for macroglossia according to the characteristics described. The most common diagnoses among acquired causes were amyloidosis (13.7%), endocrinopathies (8.8%), myopathies (4%) and tongue tumors (6.7%). The most common congenital causes were aneuploidy, lymphatic malformations, and Beckwith-Wiedemann syndrome, which is the main cause of congenital macroglossia, even if it appears isolated.

Hemodialysis-Related Amyloidosis in the Tongue

Dialysis-related amyloidosis (DRA) represents a group of relatively rare disorders characterized by the systemic extracellular deposition of insoluble fibrils of amyloid protein in long-term dialysis patients. We describe herein a case of relatively early DRA on the tongue of a long-term dialysis patient. A 67-year-old man with a 39-year history of dialysis was referred for diagnosis of a tongue mass. On examination, a collection of whitish-yellow papules was identified on the ventral surface of the tongue tip. The pathological diagnosis was DRA. Clinicians should be aware that long-term dialysis can cause oral amyloidosis of the tongue.

Amyloidoma of the Tongue: Case Report, Surgical Management, and Review of the Literature

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.