AB208. SOH22ABS027. Rare case of amyloids deposition in tongue in patient with multiple myeloma

Background: Our case describes a difficulty in diagnosis and investigation methods in management of our patient.

Case Description: An 80 years old male, presented with dysphagia, odynophagia, (hot potato) voice, sluggish speech, and fixed (stony hard) swollen tongue. These symptoms started 6 months ago, progressively getting worse (red flag symptoms for malignancy). Patient has history of multiple myeloma, and other comorbidities. Non-smoker, non-alcohol drinker. All work up for investigation performed (CT neck + thorax with contrast, pan endoscopy + biopsy from tongue). Pan endoscopy identified: swollen, stony hard fixed tongue on palpation, with no obvious tumor present. Multiple biopsies performed 6 times, did not confirmed malignancy! After thorough search; suspicion raised for possibility of a very rare case of Amyloidosis. Histopathologist was asked to review biopsy samples for amyloid presence. Histopathologist has confirmed Amyloidosis presence in all samples. After discussing patient case on MDM, patient referred to oncology for treatment of Amyloidosis.

Conclusions: Malignancy suspected on presentation (red flags symptoms). Gold standard test (biopsy) performed (No malignancy). Look into the patient’s history to see if anything else may be helpful. This rare case presentation is ideal for us to learn, to improve our knowledge, to improve clinical search.

Keywords: Amyloidosis; malignancy; multiple myeloma; pan endoscopy; tongue biopsy