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Oral Pathology:  Soft Tissue Case #44

 

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Patient: Young adult, either sex.

Chief Complaint:
The patient is concerned about a persistent, nontender lesion first noticed one year ago.

Medical History:
No abnormalities are identified.

Dental History:
Routine regular care.

Clinical Findings:
The lesion is a well-circumscribed, pale, submucosal nodule, 4 mm in diameter, located on the left posterior lateral border of the tongue, in the area of the filiform papillae. The lesion is firm and nontender to palpation. Because of its posterior position in the oral cavity, it was difficult to determine if the lesion was fixed to surrounding structures.

Clinical Images
left lateral tongue showing white area left lateral tongue, close-up
Left Lateral Tongue Showing White Area Left Lateral Tongue, Close-up

 

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 reports a persistent, progressive, nontender, well-circumscribed, firm, 4 mm in diameter enlargement on the left lateral posterior surface of the tongue first noted one year ago.  The lesion appears to be of submucosal origin, despite the surface appearing tan-white, because the epithelium in not thickened, rough, or uneven.  Lymphadenopathy is not present.

Lesions to Exclude from the Differential Diagnosis:
The lesion is described as a soft tissue enlargement.  Reactive soft tissue enlargements may be excluded from the differential diagnosis because the lesion is described as persistent, progressive, and nontender.

Within the category of tumors, malignant tumors can be excluded because the lesion in this case is well-circumscribed, slowly growing, and nontender.  Benign epithelial tumors are excluded because the lesion in this case has a smooth surface.

The following benign mesenchymal tumors may be excluded.  The congenital lesions, (hemangioma, lymphangioma and congenital epulis), are excluded because the lesion in this case was first noted one year ago.  The vascular lesions (pyogenic granuloma, peripheral giant cell granuloma, hemangioma, vascular leiomyoma) are excluded because they appear red, blue or purple and blanch upon pressure.  Lesions found only on the gingiva or edentulous alveolar ridge (peripheral ossifying fibroma, peripheral giant cell granuloma, congenital epulis) are excluded because this lesion is located on the tongue.  Lesions specific to certain locations or situations are excluded, including epulis fissuratum which is found associated with a denture flange, and inflammatory papillary hyperplasia which is found on the mucosa beneath a denture.  The remaining benign mesenchymal tumors, except lipoma, and the benign salivary gland tumors, are excluded because they have a normal mucosal color while the lesion in this case is distinctly tan to white.  Granular cell tumor may sometimes have a white surface but the surface is rough and thickened.

Lesions to Include in the Differential Diagnosis:
Lymphoepithelial cyst is included because it occurs on the posterior-lateral tongue, has a yellow-tan-white surface, and is usually small.  The remaining cysts typically do not occur in this location.  Lipoma can be included, but the small size of this lesion and the characteristic location make lymphoepithelial cyst the most likely diagnosis.

Management:
Excisional biopsy.

Final Diagnosis and Prognosis:
Microscopic examination of the excisional biopsy specimen is diagnosed as lymphoepithelial cyst.  The prognosis of lymphoepithelial cyst is good and recurrence is not expected.