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A young woman presented with a 1-year history of a right tongue mass that developed after initial bite trauma. The lesion waxed and waned but never completely healed; however, it greatly increased in size over 3 weeks before presentation. She reported constant, severe stabbing pain, right otalgia, and occasional swelling that caused oral dysphagia. She reported no constitutional symptoms or any history of tobacco or alcohol use. On examination, the mass was a 3 × 2-cm, exophytic and raised, plateaulike lesion on the right dorsolateral tongue with approximately 1 to 2 cm of surrounding induration (Figure, A).
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B. Schwannoma with a traumatic ulcerative granuloma with stromal eosinophilialike reaction
This case demonstrates a unique example of a lateral tongue schwannoma with an associated traumatic ulcerative granuloma with stromal eosinophilia (TUGSE)–like reaction that produced a large, exophytic mass mimicking more clinically concerning lesions, such as squamous cell carcinoma.
Schwannoma is a benign, peripheral nerve sheath tumor that can occur throughout the body, but most commonly develops in the head and neck.1 An oral tongue location has been a well-documented site for this tumor. The histologic features of schwannomas in an oral tongue location parallel those at other sites and consist of a spindled cell proliferation with hypercellular and hypocellular areas that refer to specific patterns known as Antoni A and Antoni B.1 In the hypercellular areas, there are foci with nuclear palisading known as Verocay bodies. Immunohistochemistry demonstrates that the spindled cells are strongly and diffusely positive for S-100 and SOX-10 and typically negative for markers of epithelial differentiation, such as cytokeratins.1 To our knowledge, a brisk inflammatory infiltrate, such as the kind seen with TUGSE, has not been reported to occur with schwannoma.
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Corresponding Author: Joseph B. Meleca, MD, Head and Neck Institute, Cleveland Clinic, 9500 Euclid Ave, A-71, Cleveland, OH 44195 (email@example.com).
Published Online: May 23, 2019. doi:10.1001/jamaoto.2019.0935
Conflict of Interest Disclosures: None reported.
Meeting Presentation: This case report was presented as a poster at the Triological Society Conference 2018; January 18, 2018; Scottsdale, Arizona.
Additional Contributions: We thank the patient for granting permission to publish this information.
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