[Skip to Content]

Quiz

Otolaryngology

A Congenital Tongue Mass

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: September 21, 2023

Clinical Challenge

Article Information and Disclosures

Kenneth L. Kennedy, MD^1,2;

Jasmine Steele, MD^1,2;

Michael J. Cunningham, MD^1,2

Author Affiliations

¹Boston Children’s Hospital, Boston, Massachusetts
²Harvard Medical School, Boston, Massachusetts

Read article on JAMA Network

Read Case Take Quiz Answer

An otherwise healthy 13-month-old male was scheduled to undergo excisional biopsy of a left anterior tongue submucosal intramuscular mass (Figure 1). This firm-to-palpation mass was noted at birth and remained proportional in size with the child’s somatic growth, measuring approximately 1 cm in diameter on presentation. Preoperative magnetic resonance imaging (MRI) documented the mass to be uniformly solid and well circumscribed without cystic components or flow voids, hypointense on T2, and hyperintense with homogeneous contrast enhancement on T1. His head, neck, and general examination findings were otherwise normal with no cervical lymphadenopathy or additional masses.

Take Quiz

Please finish quiz first before checking answer.

An otherwise healthy 13-month-old male was scheduled to undergo excisional biopsy of a left anterior tongue submucosal intramuscular mass (Figure 1). This firm-to-palpation mass was noted at birth and remained proportional in size with the child’s somatic growth, measuring approximately 1 cm in diameter on presentation. Preoperative magnetic resonance imaging (MRI) documented the mass to be uniformly solid and well circumscribed without cystic components or flow voids, hypointense on T2, and hyperintense with homogeneous contrast enhancement on T1. His head, neck, and general examination findings were otherwise normal with no cervical lymphadenopathy or additional masses.

B. Rhabdomyoma

Neonatal tongue lesions have a broad differential diagnosis, including cystic, solid, and mixed composite lesions.¹ Differentiation of cystic from solid lesions is important, as each warrants a unique differential diagnosis. Ultrasonography, computed tomography, and MRI are modalities that can be used to make this differentiation. If sedation is required, MRI with contrast is preferable given the excellent soft tissue detail without risk of radiation.

Sign in to take quiz and track your certificates

Buy This Activity

Article Information

Corresponding Author: Kenneth L. Kennedy, MD, Boston Children’s Hospital, 300 Longwood Ave (Mailstop: BCH3129), Boston, MA 02115 (k.laurence.kennedy@gmail.com).

Published Online: September 21, 2023. doi:10.1001/jamaoto.2023.2911

Conflict of Interest Disclosures: None reported.

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

References

Horn C , Thaker HM , Tampakopoulou DA , De Serres LM , Keller JL , Haddad J Jr . Tongue lesions in the pediatric population. Otolaryngol Head Neck Surg. 2001;124(2):164-169.PubMed Google Scholar Crossref

Raewyn C , Paul W . Management of congenital lingual dermoid cysts. Int J Pediatr Otorhinolaryngol. 2010;74(6):567-571.PubMed Google Scholar Crossref

Who Classification Of Tumours Editorial Board. Soft Tissue and Bone Tumours. Lyon International Agency For Research On Cancer; 2020.

Kapadia SB , Meis JM , Frisman DM , Ellis GL , Heffner DK . Fetal rhabdomyoma of the head and neck. Hum Pathol. 1993;24(7):754-765.PubMed Google Scholar Crossref

Dehner LP , Enzinger FM , Font RL . Fetal rhabdomyoma. Cancer. 1972;30(1):160-166.PubMed Google Scholar Crossref

Kulbersh BD , Wiatrak BJ . Pediatric lingual and other intraoral lesions. Otolaryngol Clin North Am. 2015;48(1):175-190.PubMed Google Scholar Crossref

Gardner DG , Corio RL . Fetal rhabdomyoma of the tongue, with a discussion of the two histologic variants of this tumor. Oral Surg Oral Med Oral Pathol. 1983;56(3):293-300.PubMed Google Scholar Crossref

Valdez TA , Desai U , Volk MS . Recurrent fetal rhabdomyoma of the head and neck. Int J Pediatr Otorhinolaryngol. 2006;70(6):1115-1118.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 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.