Nodular lesion on the posterior dorsal surface of the tongue

A 47-year-old man was referred to the Oral Medicine Service of our institution complaining discomfort during eating and speaking because presence a painless nodule on posterior dorsal surface tongue. The patient had noticed tongue lesion 1 month ago, it gradually expanded until reached size seen in current clinical presentation. medical history noncontributory. Intraoral examination revealed pink, pedunculated, exophytic, well-defined nodule, with discretely lobulated substantial ulcerated covered by yellowish pseudomembrane without any tendency bleed; measuring approximately 2 cm greatest diameter; located region (Figure 1). Considering that features favored reactive (pyogenic granuloma), benign tumor (schwannoma, neurofibroma, angioleiomyoma, rhabdomyoma, granular cell tumor, ectomesenchymal chondromyxoid tumor), developmental abnormality (lingual thyroid), we did not include malignant neoplasms, such as squamous carcinoma (especially, spindle variant), adenocarcinoma minor salivary glands, soft tissue sarcoma lymphoma differential diagnosis. is common site for lesions. Pyogenic granuloma oral cavity arises response various stimuli, chronic irritation or traumatic injury.1Jafarzadeh H. Sanatkhani M. Mohtasham N. pyogenic granuloma: review.J Sci. 2006; 48: 167-175Crossref PubMed Scopus (242) Google Scholar This can present wide variety appearances, ranging from sessile an elevated mass.2Kamal R. Dahiya P. Puri A. concepts etiopathogenesis.J Maxillofac Pathol. 2012; 16: 79-82Crossref (92) Its development slow, asymptomatic, but may also grow rapidly. characteristically be yellowish-gray fibrinous membrane.1Jafarzadeh gingiva predominant site, followed lips, tongue, buccal mucosa, hard palate.2Kamal Scholar,3Sharma S. Chandra Gupta Srivastava Heterogeneous conceptualization etiopathogenesis: granuloma.Natl J Surg. 2019; 10: 3-7Crossref Schwannomas, neurilemmomas, are peripheral nerve tumors found cavity, preferentially Schwannomas occur at age has no gender predilection. Clinically, slowly enlarging, nontender mass.4Rocha A.L. Nunes L.F.M. Travassos D.V. et al.A dorsum tongue.Oral Surg Med Pathol Radiol. 128: 449-455Abstract Full Text PDF (2) Multiple schwannomas detected patients neurofibromatosis type schwannomatosis. Similar schwannoma, neurofibroma manifest asymptomatic mass. Neurofibromas often diagnosed second fourth decades life have However, syndrome younger ages, uncommonly, these multiple neurofibromas. gingiva, lips affected neurofibromas, being most intraoral site.5Brito J.A. de Souza F.T. Lacerda J.C. Bernardes V.F. Gomes C.C. Gomez R.S. Asymptomatic 114: 281-283Abstract (4) Scholar,6Jouhilahti E.M. Visnapuu V. Soukka T. al.Oral alterations neurofibromatosis.Clin Investig. 551-558Crossref (28) Angioleiomyoma neoplastic proliferation vascular smooth muscle cells mainly affects middle-aged men, between sixth life. In angioleiomyoma affect palate, gingiva. circumscribed, slow-growing, nodular lesion. Surgical excision treatment choice. If completely removed, recurrence rare.7Rawal S.Y. Rawal Y.B. (vascular leiomyoma) cavity.Head Neck 2018; 12: 123-126Crossref (12) Rhabdomyoma mesenchymal striated origin, topographically differentiated into cardiac extracardiac types. Cardiac rhabdomyomas appear hamartomatous (often undergo spontaneous resolution) show strong association tuberous sclerosis. Extracardiac comprise 2% neoplasms skeletal differentiation. They divided adult, fetal, genital head neck region, been reported floor mouth, larynx, parapharynx, submandibular spaces.8Karaman E. Saritzali G. Ozcora tonsillar fossa.J Craniofac 2009; 20: 1207-1209Crossref (6) Granular (GCT) uncommon neoplasm, believed neural origin. GCT characterized solitary normal-colored surface. About 45% 65% GCTs region; these, 70% intraorally. borders anterior two-thirds sites cavity. There female predilection (female-to-male ratio 2:1), mean occurrence decade life.9Van Loo Thunnissen Postmus Van der Waal I. cavity: case series including metachronous lung.Med Patol Cir Bucal. 2015; 30-33Crossref (19) Scholar,10Lafuente Ibáñez Mendoza López Ortega K. Trierveiler tumour: multicentric study 56 cases systematic review.Oral Dis. 2020; 26: 573-589Crossref Ectomesenchymal rare neoplasm uncertain histogenesis, affecting few cases, affected. occurs third life, clinically presenting nodule. choice, rarely observed.11Almeida L.Y. Dominguete M.H.L. P.R. Ribeiro-Silva Teixeira L.R. León J.E. Immune infiltration tumor: immunohistochemical study.Oral Oncol. 81: 112-115Crossref Lingual thyroid condition, defined ectopic gland midline base caused anomaly descent gland. It usually manifests Interestingly, autopsy studies, prevalence 10%. about lingual only present. females (ratio varying 4:1 7:1) ages 18 40 years, especially Asiatic population. Scintigraphy scanning use Tc-99 m useful diagnostic tool localizing tissue.12Castro P.H. Volpato L.E. Tramujas J. Borges A.H. Ectopic young patient.Case Rep Dent. 2016; 20169174970PubMed Treatment consists hormone therapy suppress reduce its size. Rarely, surgical necessary, when ulceration secondary infection present.12Castro On basis possibilities diagnosis mentioned above, favored, excisional biopsy performed. Before this, scintigraphy required exclude possibility thyroid, result negative. Microscopy findings fusocellular fascicles spindle-shaped cells, showing areas leakage diffuse lymphoplasmacytic inflammatory infiltrate, red blood extravasation, siderophages, eosinophilic globules. proliferating exhibited hyperchromatism scarce mitotic figures. At periphery, focal evidenced 2). deepest part lesion, detected. After histopathologic analysis, markers CK AE1/AE3, epithelial membrane antigen, vimentin, alpha-smooth actin, desmin, CD34, S100, p53, Ki-67, performed characterize proliferation. positivity vimentin CD34. Ki-67 labeling index 5%, whereas were p53 positive scarce. Complementary analysis showed human herpesvirus?8 (HHV?8)–encoded latency?associated nuclear antigen 3). Thus, consistent Kaposi (KS).Fig. 3Immunohistochemical negativity AE1/AE3 (A), actin (SMA) (B) faintly positive. S100 (C) dendritic-like through entire Differently, CD34 strongly (D). 5% (E). Notably, homogeneously (F) (A, × 10; B, 40; C, D, E, F, 10). high-resolution version slides Virtual Microscope available eSlide: VM05823 3D), VM05824 3E), VM05820 3F).View Large Image Figure ViewerDownload Hi-res image Download (PPT) view this diagnosis, KS condition individuals immunosuppressive states, serology immunodeficiency virus (HIV) requested, specialized service follow-up. Currently, he well, alteration lesional area, under regular monitoring 4). locally aggressive intermediate-grade biologic potential presents 4 variants: classic, endemic, epidemic acquired (AIDS)–associated, iatrogenic post-transplantation types.13Fatahzadeh Schwartz R.A.. Kaposi's sarcoma: review update.Int Dermatol. 2013; 52: 666-672Crossref (37) associated HHV-8 infection.14Sikora A.G. Shnayder Y. Yee DeLacure M.D. Oropharyngeal related persons negative virus.Ann Otol Rhinol Laryngol. 2008; 117: 172-176Crossref (8) specifically palates, dorsum; however, some involving mucosae pharynx, nasal described. form locations, variations shape, manifesting macule, which progress papule, exophytic mass.13Fatahzadeh Scholar,15Keles Türker C. Arta? Karl?da? Tonsillar HIV-negative patient: report.Turk Arch Otorhinolaryngol. 57: 46-49Crossref Microscopically, mixture incomplete slits, hyaline globules, extravasated erythrocytes.13Fatahzadeh supported endothelial (CD34, CD31, D2-40, Lyve-1, factor VIII-related antigen), HHV-8, confirms final diagnosis.14Sikora Scholar,16Lombardi Varoni Sardella Lodi patient.Oral 17104567Crossref Moreover, transcription factors erythroblast transformation-specific–related gene, Prox1, Fli-1 expressed and, therefore, confirming diagnosis.17Miettinen Wang Z.F. Paetau al.ERG marker prostatic carcinoma.Am 2011; 35: 432-441Crossref (227) case, after HIV test obtained. Of note, other signs observed. Instead, given serologic result, non-injected illicit drug unprotected extramarital sexual practices. As variants frequent, contrast endemic classic KS, represent respectively.13Fatahzadeh HIV-associated extraoral (skin, visceral lymphatic organs) frequently involved. Simultaneous involvement both skin mucosa 16% 25% HIV-positive patients.18Birman E.G. Silveira F.R.X. Godoy L.F. Costa C.R. Brazilian AIDS patients: 144 cases.Pesqui Odontol Bras. 2000; 14: 362-366Crossref Scholar,19Khammissa R.A. Pantanowitz L. Feller Sarcoma: Ga-Rankuwa South Africa.AIDS Res Treat. 2012873171PubMed more men (age range 20– years). sites.13Fatahzadeh Scholar,18Birman Scholar,20Ficarra Berson A.M. Silverman Jr., al.Kaposi's 134 pathogenesis, epidemiology, aspects, treatment.Oral 1988; 66: 543-550Abstract (101) assessing 11% presented isolated KS.18Birman Additionally, relevant mention initial manifestation 22% 57% patients,19Khammissa Scholar, 20Ficarra 21Fatahzadeh management update.Oral 113: 2-16Abstract (66) palate,20Ficarra Scholar,22Arul A.S. Kumar A.R. Verma Arul sole presentation seropositive patient.J Nat Sci Biol Med. 6: 459-461Crossref gingiva.20Ficarra An interesting 12 (9%) dorsum.20Ficarra Relevantly, one (see 4)20Ficarra characteristics, those described evident KS.20Ficarra Similarly, another evaluating observed (1.4%) involvement.18Birman These rare. To date, oropharyngeal cavities literature (Table I). none extraoropharyngeal sites. them, females, 8 males 28–83 years; 61 lesions papules, nodules, submucosal masses, palatine tonsil, Seven five lesions, respectively, 3 unrelated systemic conditions, diabetes mellitus, hypertension, asthma. thyroid.23Bottler Kuttenberger Hardt Oehen H.P. Baltensperger Non-HIV-associated Case report literature.Int 2007; 36: 1218-1220Abstract (18) Therefore, midposterior should included if clinicopathologic features, age, gender, symptomatology, time evolution, accordance possibility, investigated using scintigraphy, before treatment, therapeutic prognostic implications. raise suspicion, detailed individual assessment multidisciplinary team decision, recommended. patients, treated surgery, chemotherapy, radiotherapy, resulting good prognosis. fact, Table implicated pathogenesis predisposing status. absence latter difficult explain cellular and/or molecular mechanisms involved KS. context, seems reasonable think age-associated immunologic dysfunction (immunosenescence) aged 53 86 years I).Table IClinicopathologic locationsCasesReferencesAge/GenderClinical presentationAnatomic locationClinical diagnosisHHV-8Systemic conditionsTreatment prognosis1Reis-Filho al., 200225Reis-Filho J.S. Souto-Moura Lopes J.M. Classic tongue: emphasis diagnosis.J 2002; 60: 951-954Abstract (16) Scholar83/FBlue-to-purplish, ulcerative lesionDorsal tonguePyogenic granuloma, angiomaNANASurgical excision; recurrence2Kua 200426Kua H.W. Merchant W. Waugh M.A. non-HIV homosexual white male.Int STD AIDS. 2004; 15: 775-777Crossref Scholar53/MVascular noduleBuccal mucosaNA+NAErythromycin stearate; recurrence3Bottler 200723Bottler Scholar76/FExophytic tongueLingual thyroid+NALocal radiation; recurrence4Mohanna 200727Mohanna Bravo F. Ferrufino Sanchez Gotuzzo two Quechua patients.Med E365-E368PubMed Scholar71/FMultiple red, papulesHard palateNA+NAChemotherapy; recurrence56Sikora 200814Sikora Scholar49/M34/MSessile mass pinkish mucosaWell-circumscribed massRight tonsilLeft tonsil extending left lateral wallNA NA++NAAsthmaTonsillectomy; recurrenceTonsillectomy; recurrence7Ozbudak 201124Ozbudak I.H. Guney Mutlu D. Gelen Ozbilim Bilateral esophageal patient.Ear Nose Throat 90: E23-E26Crossref Scholar68/MBilateral asymmetric massesPalatine tonsilNA+NARadiotherapy chemotherapy; recurrence8Braga 201228Braga Bezerra Matos al.Uncommon elderly virus-seronegative adult.J Am Geriatr Soc. 1174-1175Crossref (3) Scholar83/MPedunculated firm nodulesSoft palateNA+Arterial hypertensionNA9Faden 201729Faden AlSheddi AlKindi Alabdulaaly HIV-seronegative Saudi report.Saudi Dent 2017; 29: 129-134Crossref Scholar80/MMultiple dark red–purplish, lesionsHard palatePyogenic granuloma; granulomatous diseases+Type II mellitus hypertensionRadiotherapy; recurrence10Keles 201915Keles Scholar72/FA non-ulcerated, tonsilNA+NAChemotherapy; recurrence11Sethia 201930Sethia Hari-Raj Koenigs Ozer Non-HIV literature.Ear 29145561319876917Google Scholar28/MMultiple swelling lesionsUpper lower palateNA+NARadiotherapy; recurrence12Lombardi 202016Lombardi Scholar35/MRounded, purplish, pedunculated massMucogingival junctionPyogenic giant granuloma+NASurgical recurrenceWith regard medications, captopril.+, positive; female; herpesvirus?8; M, male; NA, available. Open table new tab With captopril. +, previously mentioned, considering AIDS-associated frequent presentations compared types, corresponding tests all confirm rule out association.24Ozbudak approach interferon-?.14Sikora 15Keles 16Lombardi Scholar,23Bottler 24Ozbudak 25Reis-Filho 26Kua 27Mohanna 28Braga 29Faden 30Sethia For HIV, highly active antiretroviral first modality considered. prognosis variable, depending patient's immune status.13Fatahzadeh data reveal who do state immunosuppression.14Sikora summary, regardless yielding Importantly, crucial significant impact