Surgical complications of amyloid disease

Waldenström's Macroglobulinemia Associated With Generalized AA-Amyloidosis

The authors present a case of Waldenström's macroglobulinemia (WM) associated with generalized amyloidosis of amyloid-A type. A 77-year-old man with a 25-year history of degenerative joint disease and a 13-year history of WM died of multisystemic failure. At autopsy, generalized and severe amyloid deposits were detected. Special conventional stains and immunohistochemical examination revealed amyloid-A de posits, which are extinguishingly rare in WM. This is probably related to the disease being chronic, which results in excessive production of precursor protein. The detection of amyloid-A type fibrils was possible only through the application of the immunohis tochemical procedure. The authors emphasize using the immunohistochemical typing of amyloid deposits for the purpose of classification, therapy, and prognosis. Int J Surg Pathol 1 (2):123-128, 1993

Macroglossia Secondary to Systemic Amyloidosis: Case Report and Literature Review

Amyloidosis is characterized by an abnormal extracellular deposition of amyloid in different tissues and organs, where it usually causes some type of dysfunction. Its cause is unknown. The two main forms of amyloidosis are systemic and localized; the latter is rare. No satisfactory treatment for systemic amyloidosis has been discovered, and mean survival is poor, ranging from 5 to 15 months depending on the presence or absence of multiple myeloma. We report a case of primary systemic amyloidosis in a 71-year-old man. The diagnosis of amyloidosis was established by tongue biopsy, and its systemic nature was identified by analysis of aspirated abdominal fat. At the 1-year follow-up, the patient's clinical condition had not changed, and he was thereafter lost to follow-up.

Primary amyloidoma of the spine. A case report and review of the literature

STUDY DESIGN

A rare case is reported of primary or idiopathic amyloidoma of the spine derived from production of light chain immunoglobulins. The tumor was successfully treated by anterior decompression and fusion with a fibula strut allograft.

OBJECTIVE

To describe a rare case of AL amyloidoma of the spine.

SUMMARY OF BACKGROUND DATA

Radiographic characteristics of this benign deposit are similar to harmful aggressive conditions afflicting the spine.

RESULTS

The patient returned to full function after the surgery with no evidence of systemic amyloidosis or development of multiple myeloma.

METHODS

An isolated AL amyloidoma of the spine was resected and successfully reconstructed with a fibula strut allograft and internal fixation.

CONCLUSIONS

Isolated deposits of amyloid in the spine occur very rarely. When no evidence of myeloproliferative disease or systemic amyloidosis is found, prognosis is excellent. The deposit, when it occurs in the spine has a predilection for the thoracic region and can cause neurologic compromise, pain, and deformity that is responsive to decompression and fusion. The diagnosis of primary amyloidoma requires histologic studies for confirmation.

Tongue, primary amyloidosis, and multiple myeloma

A case of macroglossia and resulting apertognathia because of primary amyloidosis in a 65-year-old man with multiple myeloma is described. In addition, a retrospective study of the oral manifestations of primary amyloidosis and multiple myeloma in the last 15 years is reported.

Massive macroglossia, amyloidosis and myeloma

A 74 year old man with light-chain myeloma developed amyloidosis with macroglossia after 10 years of therapy with alkylating agents. Over a 2-year period his tongue enlarged to persistently protrude from his mouth, inhibit his speech, interfere with normal swallowing and eventually threaten his airway. As a life-saving procedure the tumorous anterior two-thirds of the tongue was resected, with excellent primary healing. Within two weeks the patient's speech became comprehensible and his ability to eat returned to normal. Although rare in amyloidosis, massive macroglossia may occur and surgical correction is easily achieved.