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Otolaryngology

Nodule of the Midline Dorsal Tongue

Educational Objective
Based on this clinical scenario and the accompanying image, understand how to arrive at a correct diagnosis.

1 Credit CME

JAMA Otolaryngology–Head & Neck Surgery

Published Online: June 8, 2023

Clinical Challenge

Article Information and Disclosures

Khanh Trinh, DMD¹;

Leib Wiener, BS²;

Elizabeth Philipone, DMD¹

Author Affiliations

¹Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, New York
²Columbia University College of Dental Medicine, New York, New York

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A 46-year-old man presented for an evaluation of a lesion on the dorsal tongue. The patient was asymptomatic and unaware of the lesion prior to it being discovered by his dentist. He underwent incisional biopsy at another institution and presented for a second opinion on the diagnosis. Overall, he was in good health with no underlying systemic diseases. Results of the most recent serologic analysis and urinalysis were also reportedly within normal limits.

The extraoral examination was unremarkable, with no skin lesions, asymmetry, redness, swelling, or lymphadenopathy observed. The intraoral examination revealed an erythematous denuded area of the midline posterior dorsal tongue, with a central nodular component (Figure 1A). The nodule was firm to palpation and nontender. The remaining oral soft tissue was unremarkable. Because a biopsy specimen was already obtained, blank slides were requested from the aforementioned institution, and staining was performed in house.

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A 46-year-old man presented for an evaluation of a lesion on the dorsal tongue. The patient was asymptomatic and unaware of the lesion prior to it being discovered by his dentist. He underwent incisional biopsy at another institution and presented for a second opinion on the diagnosis. Overall, he was in good health with no underlying systemic diseases. Results of the most recent serologic analysis and urinalysis were also reportedly within normal limits.

The extraoral examination was unremarkable, with no skin lesions, asymmetry, redness, swelling, or lymphadenopathy observed. The intraoral examination revealed an erythematous denuded area of the midline posterior dorsal tongue, with a central nodular component (Figure 1A). The nodule was firm to palpation and nontender. The remaining oral soft tissue was unremarkable. Because a biopsy specimen was already obtained, blank slides were requested from the aforementioned institution, and staining was performed in house.

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Article Information

Corresponding Author: Elizabeth Philipone, DMD, Department of Pathology and Cell Biology, Columbia University Irving Medical Center, 630 W 168th St, PH15 West Room 1562, New York, NY 10032 (ep2464@cumc.columbia.edu).

Published Online: June 8, 2023. doi:10.1001/jamaoto.2023.1205

Conflict of Interest Disclosures: None reported.

Additional Contributions: We thank the patient for granting permission to publish this information.

References

Rejas RA , Campos MS , Cortes AR , Pinto DD , de Sousa SC . The neural histogenetic origin of the oral granular cell tumor: an immunohistochemical evidence. Med Oral Patol Oral Cir Bucal. 2011;16(1):e6-e10. doi:10.4317/medoral.16.e6 PubMed Google Scholar Crossref

Sangle VA , Pooja VK , Holani A , Shah N , Chaudhary M , Khanapure S . Reactive hyperplastic lesions of the oral cavity: a retrospective survey study and literature review. Indian J Dent Res. 2018;29(1):61-66. doi:10.4103/ijdr.IJDR_599_16 PubMed Google Scholar Crossref

Neelon D , Lannan F , Childs J . Granular cell tumor. In: StatPearls. StatPearls Publishing; 2023.

Patil S , Rao RS , Majumdar B , Anil S . Clinical appearance of oral Candida infection and therapeutic strategies. Front Microbiol. 2015;6:1391. doi:10.3389/fmicb.2015.01391 PubMed Google Scholar Crossref

Adamo D , Gasparro R , Marenzi G , et al. Amyloidoma of the tongue: case report, surgical management, and review of the literature. J Oral Maxillofac Surg. 2020;78(9):1572-1582. doi:10.1016/j.joms.2020.04.022 PubMed Google Scholar Crossref

O’Reilly A , D’Souza A , Lust J , Price D . Localized tongue amyloidosis: a single institutional case series. Otolaryngol Head Neck Surg. 2013;149(2):240-244. doi:10.1177/0194599813490896 PubMed Google Scholar Crossref

Fahrner KS , Black CC , Gosselin BJ . Localized amyloidosis of the tongue: a review. Am J Otolaryngol. 2004;25(3):186-189. doi:10.1016/j.amjoto.2004.01.007 PubMed Google Scholar Crossref

Babburi S , B R , RV S , V A , Srivastava G . Amyloidosis of the tongue—report of a rare case. J Clin Diagn Res. 2013;7(12):3094-3095. doi:10.7860/JCDR/2013/7028.3865 PubMed Google Scholar Crossref

AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
1.00 credit toward the CME [and Self-Assessment requirements] of the American Board of Surgery’s Continuous Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.