Systemic amyloidosis diagnosed by labial salivary gland biopsy

A patient in his 60s presented to the local emergency department with symptoms of acute decompensating heart failure. Following initial investigations under cardiology he was transferred to haematology, where a provisional diagnosis of cardiac amyloidosis was established. Unfortunately, it was not possible to obtain an appropriate tissue sample for confirmation of diagnosis, and the patient was referred to oral medicine for consideration of a buccal fat pad biopsy. A labial salivary gland (LSG) biopsy was undertaken and demonstrated amyloid deposits staining salmon pink with Congo red under light microscopy and an apple-green birefringence with polarised light. The blocks were transferred to the National Amyloidosis Centre where a diagnosis of amyloid light-chain amyloidosis was made. LSG biopsy is a minimally invasive and effective method in the diagnosis of systemic amyloidosis.