A 57-year-old woman who presented to hospital with an acute onset of left-sided hemiparesis. An NECT brain in axial (Figure 1A) and coronal (Figure 1B) views revealed an isodense mass (white arrows) in the right frontal and temporal regions with significant perilesional oedema (arrow heads) with effacement of the cerebral sulci in the right cerebral hemisphere, significant midline shift, mass effect to the body of the right lateral ventricle, temporal horn of the right lateral ventricle and third ventricle.

Flexion deformity of 30⁰ at the distal Interphalangeal joint and slight hyperextension of the proximal interphalangeal joint of the of the right ring finger.

(A) BMA showed minimal plasma cells (←) in the background of reactive marrow (X100, May-Grunwald Giemsa stain). (B) Trephine biopsy showing scattered areas of extracellular pinkish amorphous amyloid-like materials (↑) (X40, Haematoxylin & Eosin stain). (C) Trephine biopsy showing extracellular pinkish amorphous amyloid-like materials (→) under light microscopy (X200, Congo red stain). (D) Trephine biopsy showing apple-green birefringence (white arrow) under polarised light microscopy (X200, Congo Red stain).

Intraoral view showing an ulcer on the right lateral border of the tongue