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A Nodular Lesion of the Tongue

Case Challenge Number: 20

Diagnostic Information

Medical History

The patient reported that aside from mild hypertension, for which he receives a calcium channel blocker, he is in excellent health. He takes no other medications. His social history is significant due to his 20-pack per week history of cigarette smoking and occasional alcohol consumption.

Oral Findings

The patient exhibited a solitary, yellowish-white nodule on the right dorsum of the tongue. (Figure 1)


Figure 1. Raised nodular lesion of the dorsum of the tongue.

The overlying mucosa was intact, without ulceration, although it was firmly adherent to the submucosal mass. On palpation, the lesion was firm and fixed with moderately well-defined borders. The mass was nontender, and the surrounding tongue mucosa was normal in appearance. The remainder of the oral soft tissue examination did not reveal evidence of additional lesions.

Incisional Biopsy and Photomicrographs

An incisional biopsy was performed, which included a representative sample of both lesional and normal-appearing tissue. The overlying surface mucosa consisted of orthokeratinized stratified squamous epithelium (Figure 2) with focal areas of pseudoepitheliomatous hyperplasia. (Figures 3 and 4)


Figure 2. Low-power photomicrograph of the lesion within the lamina propria and adjacent to the surface mucosa.


Figure 3. Low-power photomicrograph of the lesion showing pseudoepitheliomatous hyperplasia of the overlying epithelium.


Figure 4. Medium-power photomicrograph showing pseudoepitheliomatous hyperplasia.

In the underlying connective tissue, syncytial sheets of large cells with coarse cytoplasmic granularity extended from the lamina propria into the striated muscle layer (Figures 5 and 6). The tumor cells had regular, basophilic nuclei, and there was no evidence of mitotic activity. (Figure 5)


Figure 5. High-power photomicrograph of lesional cells exhibiting coarse eosinophilic granular cytoplasm with indistinct cell borders.


Figure 6. Medium-power photomicrograph showing lesion infiltrating striated muscle.

The tumor cells infiltrated among the muscle bundles and around the peripheral nerve fibers. (Figure 7) Microscopically, lesional tissue extended to the margins of the specimen.


Figure 7. Medium-power photomicrograph showing lesion adjacent to peripheral nerve fibers.