Primary amyloidosis of the tongue

ORAL

PRIMARY

MEDICINE

AMYLOIDOSIS

OF THE

TONGUE

Report of a Case Richard E. ,WcCray, Jr., D.D.X., Hnm&urg,

A

Pa.

man, a,ged 70 years, reported to the Harrisburg 1957, complaining of a swollen tongue.

WHITE

Hospital

in July,

Chief Complaint.-The patient complained (1) of ha,ving lost his voice, (2) of difficulty in eating, and (3) of swelling of the feet, legs, face, and eyes. Radiographic ExaBnaination-Three mandibular incisors showed evidence of extreme resorption. There were congestive changes in the lung fields secondary to cardiac insufficiency, complica,ted by a bilateral pleural effusion. Hypertrophic degeneration ha.d produced changes in the cervical spine. There was a soft-tissue enlargement of undetermined cause in the left submaxillary area. an electrocardiogram showed definite myocardial disease with first-degree A-V block and rather striking low voltage, suggestive of myxedema or pericardial effusion. Physical Exam&&ion.-The patient, a slender 70-year-old man, was lucid and cooperative. He presented a swollen tongue, hoarseness, dyspnea., and loss of weight. His skin was wa,rm, and he had no rashes. Two small nodes could be palpated under the left axilla; these were not tender. The conjunctivae were muddy; the pupils were round and equal and reacted to light accommodation; the extraocular muscles were normal. Numerous ruptured vessels were seen about the eyes (Figs. 1 and 2). The tongue was enlarged and smooth, with indentations from the teeth. There were three carious loose teeth (Fig. 3). The lips were irritated, and the gingivae about the teeth were inflamed. The trachea showed slight deviation to the right. The heart was normal, but expansion of the lungs was poor. There was a plus 3 pitting edema of the upper thighs, as well as some presacral edema. The hands showed arthritic changes. From

Harrisburg

Hospital,

Harrisburg,

RmSYlVania. 534

PRIMARY

Figs.

lotographs

showing

AMYLOIDOBI8

OF

Fig.

1.

Fig.

2

numer’ous ruptured muddy conjunctivae.

‘TONGUE

sensek

:thout

rhe

e:

536

MC CRA’Y

Laboratory

OS., O.M. & O.F. May, 1960

findings were as follows:

Urinalytis:

Acid 5 Glucose, negative Acetone, negative Bloold Chemistry: Total protein 5.46 Globulin 1.60 Cholesterol 146 Urea 18 mg. per cent Albumin 3.86 A. G. ratio 2.4 Blood sugar 90 mg. per cent

Fig.

S.-Note

enlargement

and

smoothness

of

tongue.

Il’enaatology:

Platelets 170,000 Bleeding time 1 minut.e 15 seconds Clot.ting (venous glass) 7 minutes 3 seconds (silicone) 22 seconds Prothrombin time 85 per cent Hematocrit 49 Hemoglob’in 15.57 Sedimentation rate 30, corrected 20 mm. per hour. Biopsy.-Under local anesthesia, a V-shaped wedge was removed from the side of the tongue. The wound was sutured and the specimen was, sent for The biopsy report indicated a hyaline-like intermicroscopic examination. cellular matrix compatible with amyloid. This wa.s confirmed by special staining (Figs. 4, 5, and 6).

PRIMARY

Fig. Fig. Fig.

Fig.

OF

TONG

.Y lib ;

EE

Fig.

4.

4.-Low-power 5,-Higher

$.-Still

AMYLQIDOSIS

higher

view of magnification

magnification

5~

biopsy specimen P~‘om %~EEu~. of san:e specimen from tongue.

of

biopsy

specimen

ftom

tOngUe.

MC CRAY

538 Diagnosis:

Primary

O.S., O.M. & O.P. May,

1960

amyloidosis.

Postoperative Course.-After corrective diet control and bed rest, the patient’s condition was greatly improved. Proper medication was prescribed by his physician, and the patient was discharged from the hospital on Sept. 28, 1957. He died at home on Nov. 3, 1958. Autopsy.-Autopsy of dea,th was invasion

findings confirmed the previous diagnosis. o’f heart muscle by amyloid tissue.

The cause