Good morning readers! It’s Monday, so I know you are all itching to act like the medical student and diagnose this week’s case. Best of luck!
A forty-five year old woman presents to her primary care physician’s office because for the past few months she has noticed that she has had an in increase of difficulty in speaking. The woman claims that her tongue seems like it is constantly swollen and cumbersome to move around. Additionally, she thinks she has noticed some problems swallowing, and her husband has told her that she has begun snoring at night, which had never occurred previously. She cannot think of any other symptoms.
The patient’s history is significant for a 10-year history of multiple myeloma, which is well-controlled using bortezomib and lenalidomide. She has had no strong side effects to the medication, and she has no symptoms from it currently. She has no other major health issues.
On physical exam, the physician notices the enlarged tongue, seen below. Suspecting a certain diagnosis, the doctor orders a biopsy of the tongue, and a special stain to be used in the histological workup. The results of the biopsy are shown below, which solidify the diagnosis.
Given this information, what is the most likely diagnosis?