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Oral Pathology:  Soft Tissue Case #30

 

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Patient: Young adult, either sex.

Chief Complaint:
The patient complains of a persistent, nontender soft tissue enlargement of six months duration. The lesion has not changed in size during the past three or four months.

Medical History:
No abnormalities are identified.

Dental History:
No abnormalities are identified.

Clinical Findings:
The lesion is a well-circumscribed, pedunculated, soft tissue enlargement on the right lateral border of the tongue. The lesion is firm, rough and fixed to the surface mucosa but not the underlying structures.

Clinical Images
right lateral tongue close-up of right lateral tongue
Right Lateral Tongue Close-up of Right Lateral Tongue

 

There are no radiographs available for this case.

There are no lab reports available for this case.

There are no charts available for this case.

Summary: The patient complains of a persistent, nontender, well-circumscribed, pedunculated, firm, soft tissue enlargement on the right lateral border of the tongue of 6 months duration.  The lesion has a rough surface and is fixed to the surface mucosa but not to the underlying structures.  The lesion has not changed in size during the past 3-4 months.

Lesions to Exclude from Differential Diagnosis:  This lesion is described as an exophytic soft tissue enlargement.  Reactive soft tissue enlargements can be excluded from the differential diagnosis because the lesion is persistant, has not changed in the past 3-4 months, and is asymptomatic.

Within the category of tumors, malignant tumors can be excluded because the lesion is well-circumscribed, slowly growing or stable in size, and is not fixed to the surrounding structures (just to surface mucosa).  Soft tissue cysts may also be eliminated because they do not have a rough surface, they are compressible and they are not pedunculated.

Benign tumors is the only category remaining and they are characterized by their slow growth rate (months to years) and also as being asymptomatic and freely movable (not attached to surrounding structures) all of which describe the present case.  Within the category of benign tumors, salivary gland and mesenchymal tumors can be eliminated because these do not have a rough overlying epithelium.

Benign epithelial tumors include papilloma, verruca vulgaris and condyloma acuminatum.  Condyloma acuminatum can be excluded because these are not pedunculated and are typically multiple.

Lesions to Include in the Differential Diagnosis: Thus, the differential diagnosis includes papilloma and verruca vulgaris.  Squamous papilloma is more likely simply because it is typically pedunculated.  Furthermore, although verruca vulgaris appears clinically similar to a papilloma, verruca vulgaris has a broad-base.

Management: Treatment often includes a conservative excisional biopsy.  The patient should be informed of the nature of the lesion (common etiology is human papilloma virus), reason for excision, and likelihood of recurrence.  Prognosis is generally good.

Final Diagnosis: Squamous papilloma

Diagnosis:

Soft Tissue Enlargements
Neoplastic
Benign
Epithelial
Papilloma