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