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Bluish Mass on the Tongue

Case Challenge Number: 74

Diagnostic Information

History of Present Illness Mary is a healthy 43-year-old-female who presents for evaluation of a tongue mass. The patient has been aware of an asymptomatic bluish discoloration on her left anterior lateral tongue for the past 5-6 years. 3 months ago this area began to swell and it has now become bothersome. She has occasionally bitten the area and it is beginning to interfere with her speech. She is concerned that she has cancer. Medical History - Pertinent Medical History: Hashimoto thyroiditis

- Medications: levothyroxine

- Adverse Drug Reactions: nausea/vomiting with codeine use

Family History: paternal - prostate cancer; maternal - osteoporosis; siblings - two healthy younger sisters

- Social History: social alcohol use, recreational marijuana, no tobacco use Clinical Findings Extra-oral examination shows normal facial symmetry, no skin lesions, intact cranial nerve function, no trismus, and no cervical lymphadenopathy. The thyroid gland is palpable and multinodular. Intra-oral examination reveals no other mucosal lesions. The dentition is intact and oral hyigene is good with foci of mild marginal gingivitis. Periodontal probing depths are a maximum of 4 mm with focal bleeding on probing interproximally. The occulsion is class I with no evidence of temporomandibular dysfuction or paranormal habits. There is a 2.8 x 1.3 cm deep-seated nontender soft compressible mass on the left anterior dorsal and ventrolateral tongue. The mass is nonpulsatile and does not blanch. The remainder of the tongue is soft and freely mobile. Because of her concern for cancer, the patient requests that a biopsy be performed.

Case Challenge 74 - Content - Diagnostic Information - Figure 1

Figure 1. Bluish compressible non-tender mass of left anterior lateral tongue.

Histopathologic Findings

Case Challenge 74 - Content - Diagnostic Information - Figure 2

Figure 2. Low-power microscopic image showing numerous dilated blood filled thin-walled venous vascular channels involving the submucosa and tongue musculature.

Case Challenge 74 - Content - Diagnostic Information - Figure 3

Figure 3. High-power microscopic image revealing ectatic intramuscular venous blood vessels lined by bland flattened endothelial cells.