Primary systemic amyloidosis of tongue with chondroid metaplasia
A 26-year-old male, who is an iron molding laborer, was diagnosed with multiple myeloma in 2007. He was managed with thalidomide, dexamethasone, external beam radiotherapy to pelvis, and analgesics. He underwent autologous peripheral blood stem cell transplant in 2010.\nTwo years later, in January 2012, he presented with dysphagia and dysarthria.\nClinical examination showed two nodules measuring 2 cm on either side of hard palate. Whole tongue was enlarged, hard with multiple nodules extending from the tip to the base of tongue and further down. Regional lymph nodes were not enlarged. Laboratory investigations revealed anemia, raised serum creatinine, and kappa light chain levels. Other parameters were within normal limits.\nIncisional biopsy was done from one of the nodular lesions in the tongue with the diagnostic possibilities of carcinoma tongue/myeloma infiltration. Histopathology showed tissue lined by hyperplastic squamous epithelium with subepithelial deposits of eosinophilic amorphous material admixed with chondroid areas [Figures and ]. Congo red staining showed apple green birefringence of eosinophilic amorphous material in polarizing microscopy, thus confirming the presence of amyloid []. Bone marrow biopsy was done which showed sheets of immature plasma cells [].