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Smooth-surfaced Nodule on the Ventral Tongue

Case Challenge Number: 37

Diagnostic Information

Medical History The patient’s medical history was not significant for any diseases or allergies. There was no history of trauma to the area. Oral Findings Upon examination, a well-demarcated, dome-shaped, smooth-surfaced, exophytic, pink to focally gray nodule was identified on the ventral surface of the tongue (Figure 1). The lesion was firm to palpation but was not painful, and there was no evidence of calcification associated with the lesion.


Figure 1. Clinical photograph taken at the first visit. Note the dome-shaped smooth surfaced exophytic grayish nodule on the ventral surface of tongue.

Excisional Biopsy Findings

Under general anesthesia, the lesion was completely excised and was found to be a fluid filled cyst-like structure. The fluid was viscous, honey-colored, and was expressed from the central cystic structure. Histologic examination revealed a cyst-like architecture lined by granulation tissue rather than epithelium (Figure 2) and filled with mucoid material, sheets of foamy macrophages, and a few neutrophils (Figure 3). This structure was focally surrounded by skeletal muscle bundles (Figure 2) and minor salivary gland lobules. The latter showed evidence of focal fibrosis and chronic inflammation (Figure 4).

Diagnostic Information - Figure 2

Figure 2. Low power (x100) histology shows a cyst-like structure lined by granulation tissue and filled with mucoid material and foamy macrophages. The lesion was focally surrounded by skeletal muscle bundles.


Figure 3. High power (x200) histology shows a closer view of the lumen of the cyst-like structure filled with mucoid material and foamy macrophages.


Figure 4. High power (x200) histology shows minor salivary gland lobules (Blandin-Nuhn glands) exhibiting focal stromal fibrosis and chronic inflammation.