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A misleading swelling of the tongue
  1. D Simon1,
  2. T Somanathan2,
  3. M Pandey1
  1. 1Department of Surgical Oncology , Regional Cancer Centre, Trivandrum, India
  2. 2Department of Pathology
  1. Correspondence to:
 Dr Manoj Pandey, Department of Surgical Oncology, Regional Cancer Centre, Medical College PO, Thiruvananthapuram, Kerala 695011, India;
 manojpandey{at}rcctvm.org/mpandey{at}hclinfinet.com

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Answers on p 424.

A 41 year old Indian man presented with a swelling on the tip of the tongue of six months’ duration. He reported having irregular sharp teeth that caused repeated ulceration on the tongue, for which he had earlier sought orthodontic therapy. Intraoral examination revealed a 2 × 2 cm hard multilobulated swelling, exhibiting a smooth mucosal surface, situated at the tip of the oral tongue (fig 1). Cervical lymphadenopathy was absent. Systemic examination was normal. The haematological and biochemical parameters failed to reveal any abnormality and the chest radiograph was normal. A wide excision of the lesion with primary closure was carried out.

Figure 1

Clinical photograph showing submucosal swelling at the tip of the tongue.

On gross examination, the specimen measured 2.5 × 2.5 × 1.5 cm and was covered with mucosa showing an irregular grey-white area measuring 1.5 × 1 cm extending close to deeper margin of excision. Microscopic examination revealed the lining stratified squamous epithelium with plenty of closely packed, well demarcated, non-caseating granulomas in the underlying connective tissue (fig 2). These granulomas were composed of epithelioid cells, few lymphocytes, occasional plasma cells, and multinucleated Langhan’s and foreign body type of giant cells (fig 3). Some of the giant cells showed reddish-pink, spider-like, stellate inclusions (asteroid bodies) within the cytoplasm (fig 4). There was no evidence of necrosis.

Figure 2

Photomicrograph showing many closely packed granulomas seen below the stratified squamous epithelium (haematoxylin and eosin × 100).

Figure 3

Photomicrograph showing granulomas composed of epithelioid cells, few lymphocytes and a giant cell with an asteroid body (haematoxylin and eosin × 400).

Figure 4

Photomicrograph showing giant cell with a stellate, spider-like asteroid body in the cytoplasm (haematoxylin and eosin x 1000).

QUESTIONS

  1. What is the differential diagnosis for this lesion?

  2. How will you establish a definitive diagnosis and suggest the investigations necessary for the same?

  3. Discuss the prognosis and treatment of this lesion?

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