Localized amyloidosis of the upper gingiva: a case report

Abstract

IntroductionLocalized amyloidosis in the head and neck is a rare and generally benign condition. In the oral cavity, amyloidosis usually involves the tongue or buccal mucosa. We present the second case of oral amyloidosis arising in the gingiva ever reported, to the best of our knowledge.Case presentationA 73-year-old White Spanish man presented a persistent nodular mass involving his upper gingiva. The lesion was surgically resected and the histological examination revealed a subepithelial, multinodular amorphous and fibrillar accumulation. Staining of the specimen for Congo red proved positive, exhibiting a reddish colour under light microscopy and apple-green birefringence under polarized light. With immunohistochemical tests, pentagonal amyloid component was demonstrated. An extensive study excluded any systemic involvement; a diagnosis of localized primary amyloidosis was made. After 2 years of follow-up, no clinical progression to systemic amyloidosis or local recurrence was observed.ConclusionsLocalized amyloidosis of the gingiva is an extremely rare condition that seems to show no clinically distinct feature. Histologic examination is the first step towards diagnosis, followed by immunohistochemical tests. The diagnosis of localized amyloidosis should always be integrated with blood tests, a bone marrow biopsy, echocardiography and digestive endoscopy to intercept systemic involvement.

Orofacial amyloidosis—unusual ­presentation of a rare condition: A case report

“…Petechiae, bullous lesions, vesicles, and ulcers can also appear on the oral mucosa and lips. Amyloidosis can manifest as periodontal destruction, and the lesions can be exacerbated or reactive amyloidosis may develop by the inflammation of the periodontium …”

“…Clinically, for macroglossia, malignancy, tuberculosis, lymphangioma, hypothyroidism, acromegaly, granular cell tumors, lingual infarction caused by giant cell arteritis, idiopathic muscular hypertrophy, and Beckwith–Wiedemann syndrome must be considered under differential diagnosis . In the developing countries, tuberculosis remains the leading cause of secondary amyloidosis .…”

“…We ruled out the possibility of tuberculosis by tuberculin skin testing. Even when amyloidosis is suspected clinically, histopathologic examination is a must for confirming the diagnosis . Biopsies can be obtained from the compromised tissues.…”

“…This accumulation of excessive amyloid may affect virtually any organ or tissue of the body, which can be clinically deleterious impairing both structure and function. Amyloid is an insoluble fibrillar protein, which results due to an abnormal folding process of normally soluble proteins in a β‐pleated sheet configuration . As a result, the body finds it difficult to remove these nonrecyclable and nonbiodegradable proteins, which get deposited as insoluble fibrils in different tissues and organs .…”

“…This deposition of amyloid can be either localized, where it is restricted in one small area of the body or systemic, affecting many organs of the body. This disease may be acquired or hereditary; the acquired forms may be primary (immunologic) and secondary (reactive) . Amyloidosis affecting the head and neck may involve any site; however, the most common sites are the larynx and the tongue.…”