Development of thoracic sarcoid reactions associated with complete response to anti-PD-1 therapy in a patient with advanced cutaneous squamous cell carcinoma.

In patients with advanced cutaneous squamous cell carcinoma (cSCC), positive efficacy data were reported for anti-PD-1 antibodies. However, anti-PD-1 treatment is associated with a wide range of immune-related adverse events (irAEs). Here, we report on a 78-year-old woman with a huge cSCC on the right cheek spanning from the temporal to the cervical region with evidence for infiltration of the parotid gland, right masseter muscle and right auditory canal. Ultrasound revealed cervical, submandibular and supraclavicular lymph node metastases on patient's right side. On the basis of a medical hardship application, treatment with pembrolizumab was initiated. After two applications, a dramatic regression of the tumour was observed. At this point, the patient was switched to cemiplimab, which, in the meantime, had become available in Germany. After 3 months on cemiplimab, the tumour-related ulcer on the right cheek showed almost complete regression and all previously affected lymph nodes displayed no evidence for malignancy. Thoracic computed tomography (CT) scans revealed enlarged mediastinal and bilateral hilar lymph nodes assessed as primarily reactive. Three months later, however, mediastinal and bilateral hilar lymph nodes further increased in size, accompanied by radiological alterations of the lung parenchyma. Lymph node biopsies revealed sarcoid reactions (SRs) including fibrotic non-caseating epitheloid cell granulomas surrounded by lymphocytes. Since the patient did not display any clinical symptoms, cemiplimab treatment was continued following a 4-week break. Three months later, CT showed significant regression of the described enlarged lymph nodes and parenchymal lung changes. Twenty months after anti-PD-1 treatment, the patient was still in complete remission. In conclusion, we describe, for the first time, the case of a patient with advanced cSCC who developed disseminated thoracic SRs which were associated with dramatic regression of tumour masses. Thus, as with other irAEs, development of SRs might be indicative of an anti-tumour response to anti-PD-1 therapy.

[An unusually painful leg ulcer in an 81-year-old patient: an interdisciplinary challenge]. / Außergewöhnlich schmerzhaftes Ulcus cruris bei einem 81­jährigen Patienten ­ eine interdisziplinäre Herausforderung.

An 81-year-old male patient with a history of peripheral arterial disease (PAD) was admitted to the authors' outpatient clinic with a painful lower leg ulcer. As the degree of PAD did not correspond to the clinical findings, multiple biopsies were taken from the base and edge of the ulcer. This resulted in the histopathological and clinical diagnosis of pyoderma gangrenosum (PG). Since PG is often associated with numerous underlying diseases, further thorough examinations were performed. A mass in the gastric antrum suspicious for malignancy was histopathologically identified as gastric cancer (signet ring cell carcinoma). The PG was successfully treated with cortisone p.o. and tacrolimus ointment. Since the cancer was locally limited, the patient underwent surgery involving gastric resection with D2 lymphadenectomy and gastrojejunostomy (Roux-en­Y anastomosis).

Factors influencing lymph node harvest in colorectal surgery.

BACKGROUND AND AIMS: Lymphadenectomy in colorectal cancer is a critical component concerning prognosis and survival of patients. Several variables influence the number of harvested lymph nodes (LN). However, results of studies are contradictory, and influencing factors remain to be identified. The aim of the present study was to identify factors that have a significant influence on the number of assessed LN in oncologic colorectal cancer resection. MATERIALS AND METHODS: Three hundred and forty-one patients (190 men and 151 women), who underwent a colorectal cancer resection in a curative intention in the years 2000-2005, were analysed retrospectively. All specimens were histologically examined by two pathologists. RESULTS: In a median, 15.1 LN per operation were resected. Early tumour stage (p<0.01), length of resected bowel segment (p<0.05) and right-sided location (p<0.001) had a significant influence on the number of resected LN. Age, gender, surgeon volume, differentiation of the tumour, LN metastases, lymphatic invasion and depth of tumour invasion had no significant association with harvested LN number. Furthermore, the presence or absence of the vermiform appendix and the length of the resected ileum segment in right-sided resections did not significantly affect the assessed LN. CONCLUSION: The question arises whether for colorectal cancers of all locations the same amount of resected and analysed LNs should be lasting to fulfill oncologic criteria, as the number of harvested LNs depends on several parameters.

[The benign metastasizing leiomyoma: case collection and therapeutical options]. / Das "benigne" metastasierende leiomyom: fallsammlung und therapeutische optionen.

We report two patients with pulmonary nodules detected by chance. Histopathology of biopsies retrieved by surgical videothoracoscopy revealed benign metastasizing leiomyoma (BML). The origin of this disease as well as its dignity are not fully understood. We discuss the origin of this disease and different therapeutic options - from oophorectomy to different hormon therapies. A standardized therapeutic recommendation cannot be given.

Sputum screening for lung cancer in radon exposed uranium miners: a comparison of semi-automated sputum cytometry and conventional cytology.

Preparing for a prospective study on early lung cancer, correlation between semi-automated sputum cytometry (ASC) and conventional cytology (CY) was examined in 1517 former uranium miners with posterior-anterior and lateral chest roentgenograms. A hundred and twenty sputum specimens were classified as suspicious (grade II) and another 18 as highly suspicious (grade III) by ASC. Within grade III group, 9 samples were classified by CY as tumor cell positive, 7 severe, and 1 mild and 1 moderate dysplasias. In the group of grade II ASC, 7 were tumor cell positive, 27 classified as severe dysplasia or CIS, 20 as moderate and 19 as mild dysplasia. Twenty seven contained metaplasias and 18 were normal or inflammatory. Of the 1358 samples classified as benign (grade I) by ASC, only 5 samples were classified by CY as severe dysplasia, 6 as moderate and 34 as mild dysplasia, 173 as metaplasia, the others were normal or inflammatory. Twenty one samples were judged as inadequate for ASC and CY. At present, 23 tumors were found in final diagnosis. Sensitivity of ASC was 87% at a specificity of 92%, while CY, at high grade alterations as a threshold, had a sensitivity of 83% at 97% specificity. We conclude that, along with modern radiological procedures and molecular biological markers, ASC and CY should be included in a controlled prospective randomized study on early lung cancer.

Laparoscopic ligation of the infrarenal vena cava in combination with transfemoral thrombin infusion: a new animal model of chronic deep venous thrombosis.

OBJECTIVE: We describe a new technique to create an animal model of chronic venous thrombosis. The morphological and histological properties of the resulting thrombi are described. METHODS: Thirteen pigs underwent laparoscopic ligation of the infrarenal vena cava in combination with transfemoral thrombin infusion. After 1, 3, 6, 9, 12 and 15 days, respectively, two animals were killed and the thrombosed vein segments were explanted. After recording their weight and dimensions, the thrombi underwent histological examination by light microscopy. RESULTS: In all 13 cases, the procedure was completed laparoscopically and all 13 animals survived the procedure. While 12 pigs (92%) had an uneventful postoperative course, one animal died on the first postoperative night of an unknown cause. Autopsy revealed correct placing of the ligature with occlusive thrombosis of the inferior vena cava and the iliac veins in 12 animals, in one animal the ligature had been incorrectly placed around the origin of the right iliac vein with thrombosis limited to that vessel. Histological evaluation demonstrated mixed thrombi that showed increasing signs of organisation with advancing age. CONCLUSIONS: Laparoscopic ligation of the infrarenal vena cava in combination with transfemoral thrombin infusion is a safe and reliable way to produce chronic venous thrombosis in an animal model. The resulting thrombi are comparable to human deep venous thrombosis in terms of extent, size and organisation process.

[Prostate cancer diagnosis using ultrasound elastography. Introduction of a novel technique and first clinical results]. / Prostatakarzinomdiagnostik durch UltraschallelastographieVorstellung eines neuartigen Verfahrens und erste klinische Ergebnisse.

During the last decade screening has improved prostate cancer detection. The main reason for this development is a better understanding of the margins of prostate-specific antigen (PSA) serum levels and the classification of PSA subtypes. In contrast, the introduction of transrectal ultrasound has not led to a measurable change in the prostate cancer detection rate. Our aim was to develop a novel ultrasound system for the acquisition of elastographic images of the prostate and evaluate the system regarding its clinical applicability. We used a technically modified conventional ultrasound system and analyzed the high-frequency ultrasonic data with a computer program. The first patient-based results suggest that elastography allows an accurate measurement of tumor size and localization in contrast to conventional transrectal ultrasound. Elastography visualizes different tissue elasticities to distinguish benign and cancerous tissue. Thus, we were able to even correctly classify prostate cancer lesions which are iso- or hyperechoic in B-mode sonography.

Ultrasonic tissue characterization for prostate diagnostics: spectral parameters vs. texture parameters.

An ultrasonic multi-feature tissue characterizing system for the detection of prostate cancer is presented. The system is based on the processing of radio frequency (RF) ultrasonic echo data. Data from 100 patients was acquired in a clinical study. Parameters are extracted from the RF echo data and classified using two adaptive network-based fuzzy inference systems (FIS) working in parallel as a nonlinear classifier. Next to spectral parameters, conventional texture parameters are calculated using demodulated and log-compressed echo data. In the first approach, the classifier is trained on both, spectral and texture parameters. In the second approach, the classifier is only trained on texture parameters. Classification results of both approaches are compared and it is demonstrated, that only the use of spectral parameters yields satisfying classification results. Results of a minimum distance classifier (MDC) are presented for comparison with the fuzzy inference system. For the final fuzzy inference systems used in this approach, the area under the ROC curve is between 84% and 86% for the combined approach and between 70% and 74% for the approach based on texture parameters only.

Health hazards due to the inhalation of amorphous silica.

Occupational exposure to crystalline silica dust is associated with an increased risk for pulmonary diseases such as silicosis, tuberculosis, chronic bronchitis, chronic obstructive pulmonary disease (COPD) and lung cancer. This review summarizes the current knowledge about the health effects of amorphous (non-crystalline) forms of silica. The major problem in the assessment of health effects of amorphous silica is its contamination with crystalline silica. This applies particularly to well-documented pneumoconiosis among diatomaceous earth workers. Intentionally manufactured synthetic amorphous silicas are without contamination of crystalline silica. These synthetic forms may be classified as (1) wet process silica, (2) pyrogenic ("thermal" or "fumed") silica, and (3) chemically or physically modified silica. According to the different physicochemical properties, the major classes of synthetic amorphous silica are used in a variety of products, e.g. as fillers in the rubber industry, in tyre compounds, as free-flow and anti-caking agents in powder materials, and as liquid carriers, particularly in the manufacture of animal feed and agrochemicals; other uses are found in toothpaste additives, paints, silicon rubber, insulation material, liquid systems in coatings, adhesives, printing inks, plastisol car undercoats, and cosmetics. Animal inhalation studies with intentionally manufactured synthetic amorphous silica showed at least partially reversible inflammation, granuloma formation and emphysema, but no progressive fibrosis of the lungs. Epidemiological studies do not support the hypothesis that amorphous silicas have any relevant potential to induce fibrosis in workers with high occupational exposure to these substances, although one study disclosed four cases with silicosis among subjects exposed to apparently non-contaminated amorphous silica. Since the data have been limited, a risk of chronic bronchitis, COPD or emphysema cannot be excluded. There is no study that allows the classification of amorphous silica with regard to its carcinogenicity in humans. Further work is necessary in order to define the effects of amorphous silica on morbidity and mortality of workers with exposure to these substances.

Modulation of angiogenesis and tumorigenicity of human melanocytic cells by vascular endothelial growth factor and basic fibroblast growth factor.

Human melanoma cells express two prominent angiogenic factors, e.g., vascular endothelial growth factor (VEGF) and basic fibroblast growth factor (bFGF/fibroblast growth factor-2). In this study, we report on the relative contribution of these two factors to in vitro and in vivo growth of a tumorigenic melanoma cell line (WM164) and nontumorigenic, immortalized melanocytes (FM516SV). Overexpression of either cytokine significantly boosted tumorigenicity of WM164 cells in immunodeficient SCID mice. Attempting to overexpress bFGF antisense sequences produced no viable clones confirming earlier reports that autocrine bFGF is obligatory to melanoma cell survival and growth. By contrast, down-regulation of endogenous VEGF production did not affect growth of WM164 cells in vitro. In vivo expansion of WM164 cells expressing VEGF antisense was delayed but not abrogated. Forced expression of either bFGF or VEGF in immortalized but nontumorigenic melanocytes did not induce sustained tumor growth in vivo highlighting that neither of the two factors is sufficient for induction of tumorigenicity in this model system. Overexpression of either cytokine in WM164 cells led to the development of atypical large vessels but not to an increase in microvessel density. Taken together our results confirm an essential autocrine role of bFGF in human melanoma and indicate a beneficial but nonessential role of VEGF in the tumorigenic phenotype of human melanoma cells.

Glutathione transferase activities in renal carcinomas and adjacent normal renal tissues: factors influencing renal carcinogenesis induced by xenobiotics.

In general, the biological activation of nephrocarcinogenic chlorinated hydrocarbons proceeds via conjugation with glutathione. It has mostly been assumed that the main site of initial conjugation is the liver, followed by a mandatory transfer of intermediates to the kidney. It was therefore of interest to study the enzyme activities of subgroups of glutathione transferases (GSTs) in renal cancers and the surrounding normal renal tissues of the same individuals (n = 21). For genotyping the individuals with respect to known polymorphic GST isozymes the following substrates with differential specificity were used: 1-chloro-2,4-dinitrobenzene for overall GST activity (except GST theta); 7-chloro-4-nitrobenzo-2-oxa- 1,3-diazole for GST alpha; 1,2-dichloro-4-nitro-benzene for GST mu; ethacrynic acid and 4-vinylpyridine for GST pi; and methyl chloride for GST theta. In general, the normal tissues were able to metabolize the test substrates. A general decrease in individual GST enzyme activities was apparent in the course of cancerization, and in some (exceptional) cases individual activities, expressed in the normal renal tissue, were lost in the tumour tissue. The GST enzyme activities in tumours were independent of tumour stage, or the age and gender of the patients. There was little influence of known polymorphisms of GSTM1, GSTM3 and GSTP1 upon the activities towards the test substrates, whereas the influence of GSTT1 polymorphism on the activity towads methyl chloride was straightforward. In general, the present findings support the concept that the initial GST-dependent bioactivation step of nephrocarcinogenic chlorinated hydrocarbons may take place in the kidney itself. This should be a consideration in toxicokinetic modelling.

Neoadjuvant, hyperfractionated irradiation induces apoptosis and decreases proliferation in squamous cell cancer of the oral cavity.

Twenty-eight patients with squamous cell carcinoma of the oral cavity were treated with a total dose of 20 Gy. Tissue samples for immunohistochemistry were taken at the time of diagnostic biopsy and at surgery after radiotherapy (RX). For detection of proliferating cells, the immunoperoxidase reaction with Ki67 was performed. Apoptotic cells were detected by the TdT-mediated biotin dUTP nick end labeling (TUNEL) method. RX reduced proliferation in 27 patients, only in one case did the proliferation index (PI) increase. Delta PI (PI before RX PI following RX) amounted to 4.11% (SD=3.2%; P<0.0001). The apoptotic index (AI) increased significantly subsequent to neoadjuvant RX. Delta AI (AI after RX--AI before RX) measured 1.82% (SD=0.9; P<0.001). These data indicate that RX of patients suffering from squamous cell carcinoma of the oral cavity with a dosis of 20 Gy induces apoptosis and inhibits proliferation of tumor cells.

Respiratory syncytial virus-induced chronic bronchiolitis in experimentally infected calves.

Human (RSV) and bovine (BRSV) respiratory syncytial virus cause similar infections of the lower respiratory tract. Therefore, experimentally infected calves are suited to the study of RSV-induced chronic bronchiolitis. Colostrum-fed calves aged 17-24 days were successfully infected with BRSV. BRSV strain 375 was applied as an aerosol on 4 consecutive days. Clinical symptoms were already evident on the 1st day after infection. The calves were necropsied 12 weeks after the first infection. Focal severe chronic bronchiolitis with atelectasis and focal bronchiolitis obliterans were demonstrated. The bronchiolar lumina were filled with secretion. Transmission electron microscopy revealed an alteration of the ciliogenesis and partial loss of cilia. Immunhistochemically virus P protein could still be detected, mainly in the epithelial cells of the inflamed bronchioli.

Biomechanical investigations on chondromalacia of the knee after meniscal flap lesion and partial meniscal resection: an experimental model.

Meniscal tears and resections may cause chondral lesions of the knee. To eliminate muscular control during investigation of this problem, we designed a biomechanical setup based on a knee-joint simulator, ensuring physiological, free-motion mobility of the joint. Fresh human knee specimens with intact cartilage were exposed to loads to 2,000 N at a frequency of 0.85 Hz during 48 hours of gait. After a preliminary test series, 18 specimens were divided into three groups: group I was tested with unchanged meniscal status, group II with arthroscopically induced mobile flap tears at the posterior horns of the menisci, and group III after partial resection of the posterior horns. Motion patterns between the groups changed after as little as a few hours due to increased translation in group III. Macroscopic and histological examination and scanning electron microscopy revealed severe chondromalacic changes after meniscal resection. We conclude that meniscal resection-however partial-may have considerable joint-damaging potential if muscle control is lacking whereas mobile flap tears maintain stability. Our findings might explain the differences in clinical reports on cartilage status after partial meniscal resection. This study underlines the importance of muscle training when active stabilisation of the knee is reduced after partial meniscal resection.

[Functional and morphological defects of the mucociliary system in secretory otitis media]. / Funktionelle und morphologische Störungen des mukoziliären Systems bei der sekretorischen Otitis media.

BACKGROUND: One of the main functions of the ciliated cells of the middle ear mucosa is the continuous drainage of fluids from the middle ear cavity to the Eustachian tube. Impaired mucociliary clearance is related to disturbed clearance of middle ear secretions and results in otitis media with effusion. The aim of this study was to evaluate the ciliary beat frequency (CBF) and the ultrastructure of cilia in young patients suffering from otitis media with effusion (OME). METHODS: CBF and ciliary ultrastructure were studied in 36 patients with OME and 10 normal subjects without any history of middle ear effusion. RESULTS: The CBF was significantly decreased in the study group (6.59 Hz, +/- 1.83) compared to the controls (10.68 Hz, +/- 1.87) and the incidence of ultrastructural defects was higher than in controls. The most common defect were compound cilia, random orientation of the ciliary axes, and defects of the central microtubules. Defects of the dynein arms were not observed.

[Ultrasound elastography of the prostate. A new technique for tumor detection]. / Ultraschall-Elastographie der Prostata. Ein neues Verfahren für die Tumorerkennung.

AIM: Prostate tumours are often of harder consistency than the surrounding tissue. During digital rectal examination, this fact can be used not only to detect hypertrophy but also localized hardenings. The examination by digital palpation is inaccurate and, even in combination with PSA-value and a transrectal ultrasonic examination, the result is often not reliable. Ultrasound elastography enables us to measure and visualize the elastic properties of a tissue region and is a useful supplement to the examination by digital palpation. Ultrasound elastography is able to measure and visualize the elastic properties of a tissue region, therefore it is a useful supplement to commonly used diagnostic procedures. METHOD: We have developed a new system for elastographic prostate diagnosis which can be used during the transrectal ultrasonic examination. During the examination a sequence of ultrasonic images is acquired while the organ is slightly compressed by the ultrasound probe. Using numerical analysis of image pairs for the acquired sequence we calculate the tissue strain which represents the spatial elasticity distribution of a specific cross-section of the organ. This enables us to distinguish hard areas in the tissue. Image artifacts resulting from lateral motion components, i.e., orthogonal to the direction of the applied force, are compensated for by a special approach. RESULTS: We present results obtained from a typical elastography phantom and also the first in vivo images from patients who were undergoing radical prostatectomy. Our images prove that ultrasound elastography has the potential to detect malignant tissue areas, which are inconspicuous in the B-mode image. Our findings are confirmed by the corresponding histological specimens.

Mesalazine changes apoptosis and proliferation in normal mucosa of patients with sporadic polyps of the large bowel.

BACKGROUND AND STUDY AIMS: Regular intake of nonsteroidal anti-inflammatory drugs (NSAIDs) may reduce the occurrence of colorectal adenoma and carcinoma, possibly by inducing apoptosis and/or decreasing proliferation in colorectal epithelial cells. Mesalazine is widely used in the treatment of patients with inflammatory bowel disease, and well tolerated. We investigated its effect on apoptosis and proliferation of colorectal mucosa in 21 patients with sporadic polyps of the large bowel. PATIENTS AND METHODS: In total, 17 patients with sporadic colorectal polyps (> or = 5 mm) underwent polypectomy and biopsy of uninvolved mucosa before and after treatment with 1 g/d mesalazine for 1, 3, 7 or 14 days. Four additional patients served as untreated controls. Apoptotic index (AI) was measured by terminal deoxynucleotidyl transferase-mediated d-uridine triphosphate nick-end labeling (TUNEL) assay; proliferation index (PI) was measured by immunohistochemical examination with anti-Ki67 antibody. RESULTS: AI was significantly increased 1 and 3 days after initiation of treatment with mesalazine compared with controls (P= 0.0107 for the 1-day treatment group and P=0.0142 for the 3-day treatment group), and seemed to remain largely unchanged after longer treatment duration. Proliferation appeared to be decreased by mesalazine in all treatment groups, while proliferation in controls did not change (P=0.0107 for the 1-day treatment group and P= 0.0142 for the 3-day treatment group compared with controls. CONCLUSIONS: Mesalazine significantly induces apoptosis and decreases proliferation in colorectal mucosa in patients with sporadic polyps of the large bowel. This may be clinically relevant in that it may lower the rate of polyp recurrence after polypectomy, thereby possibly contributing to the chemoprevention of sporadic colorectal carcinoma.

[Quantitative vascular analysis in the marginal periodontium using PECAM-1]. / Quantitative Gefässanalyse im marginalen Parodont mit Hilfe von PECAM-1.

BACKGROUND: Systemic sclerosis (SSc) is a generalized disorder of the interstitial tissues and vasculature with distinct abnormalities in three systems, immune and autoimmune, vascular and microvascular, and mesenchymal extracellular matrix (ECM), that lead to exuberant fibrosis. The aim of this study was to compare the number of blood vessel profiles in the marginal gingiva between SSc patients and patients with periodontitis but without SSc by using biopsies. METHODS: Marginal gingiva and gingival papilla were obtained from 13 scleroderma patients and 8 patients with periodontitis after routine tooth extraction and gingival curettage. On the histological sections, immunohistochemical investigations were performed using the avidin-biotin complex method (ABC) and the monoclonal antibody CD 31/Clone JC70A (platelet endothelial cell adhesion molecule-1). Blood vessels were identified by light microscopy (original magnification x400) and counted within 0.3615 mm2. Medians of blood vessel profiles were compared by Mann-Whitney U-test. RESULTS: There is no statistical difference between the median of blood vessel profiles in the marginal gingiva of SSc patients as compared to the median of blood vessel profiles in the marginal gingiva of patients with periodontitis (P = 0.665). We did not discover avascular areas in the subepithelial connective tissue. DISCUSSION: The pathological changes in the microvasculature in the dermis of SSc patients are not transferable to the marginal periodont, as intraindividual histological examinations of dermis and oral mucosa in relation to the degree of the disease are not available yet.

Solid-pseudopapillary tumor of the pancreas--a rare and frequently misdiagnosed neoplasm.

INTRODUCTION: We describe a young woman with an unusual pancreatic tumor. FINDINGS AND DISCUSSION: Intraoperatively, a smoothly demarcated and encapsulated tumor was exposed. It was large (5 cmx4 cm) and of solid consistency, with a small stalk attached to the uncinate process. The tumor was partially surrounded by the pancreatic head. The macroscopic appearance suggested a benign tumor. Frozen sections revealed a benign pancreatic tumor, most likely of endocrine nature. Based on these findings, tumor enucleation was performed. The patient recovered rapidly from the intervention and was discharged from hospital after 2 weeks. One year after surgical treatment, the patient is without recurrence. The final diagnosis of the tumor was a solid pseudo-papillary tumor.

[Amyloidosis of the tongue as a possible diagnostic manifestation of plasmacytoma]. / Amyloidose der Zunge als diagnostisch richtungsweisende Manifestation des Plasmozytoms.

Plasmocytic non-Hodgkin's lymphoma is the most common tumor of bone and bone marrow, typically diagnosed by symptoms such as monoclonal paraproteinemia, proteinuria, anemia and hypercalcemia. In its progress, deposits of amyloids in almost all organs can be observed. However, plasmacytomas which are diagnosed by macroglossia of primarily unknown etiology are rare. This case report presents a 61-year-old woman who suffered from a persistent swelling of the tongue with painful ulcerations. A biopsy led to the diagnosis of primary systemic amyloidosis of the light-chain type, which subsequently proved to be a plasmacytoma with lambda light-chains stage II after Durie and Salmon. In the course of the disease the patient developed further deposits of amyloids in the whole gastro-enteric system. Macroglossia as a primary manifestation of plasmacytoma is rarely described in medical literature. However, reports on deposits of amyloid in the tongue in advanced stages of disease are well known.