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Clinical Challenge
July 2016

Asymptomatic Dorsal Tongue Mass

Author Affiliations
  • 1Department of Otolaryngology, Tripler Army Medical Center, Honolulu, Hawaii
JAMA Otolaryngol Head Neck Surg. 2016;142(7):705-706. doi:10.1001/jamaoto.2015.3966

A woman in her 30s presented with a lump on her tongue that had been progressively enlarging for several years without a precipitating event or symptoms. The size now caused intermittent gagging and a foreign-body sensation in her throat. She denied pain and was an otherwise healthy nonsmoker. Examination of the oral cavity revealed an approximately 1-cm, pedunculated mass of the posterior dorsal tongue just lateral to the circumvallate papillae. The lesion was mobile and well-circumscribed without ulceration or surrounding mucosal abnormalities. It was nontender to palpation without drainage or discharge. Flexible fiber-optic laryngoscopy showed no other lesions. Neck ultrasonography showed a normal thyroid gland. Excisional biopsy was performed with the patient under local anesthesia, and the entire lesion was sent for pathologic examination. Grossly, the firm, polypoid mass measured 0.5 × 0.5 × 0.8 cm. Histopathologic examination revealed a discrete proliferation of mature bone with overlying mildly hyperplastic stratified squamous epithelium without surrounding inflammation (Figure, A). The core was composed of dense lamellar osseous matrix with numerous Haversian canals and associated regularly dispersed osteocytes in lacunae (Figure, B).