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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.
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.
What is the differential diagnosis for this lesion?
How will you establish a definitive diagnosis and suggest the investigations necessary for the same?
Discuss the prognosis and treatment of this lesion?