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Unusual lesion of tongue
Suhail Amin Patigaroo1, Tabish Maqbool1, Summaiya Farooq2
A 20 years-old female came to our outpatient department with complaints of swelling over the tip of the tongue gradually increasing since 2 years. There was no history of bleeding or associated pain except for mild discomfort and foreign body sensation.
The swelling on the tip of the tongue measured around 3 cm × 4 cm (Figure 1). It was non-tender, smooth, soft, did not bleed on touch and the overlying mucosa of the tongue was normal. Fine needle aspiration showed the aspirate to be mucinous with scattered mucinophages and lymphocytes seen in a mucinous background.
The patient underwent transoral excision of the mass. The mass was cystic.
Histo-pathological examination of multiple sections showed lining squamous epithelium. Subepithelium showed encapsulated spindle cell lesion with hyper and hypocellular areas and many verocay bodies along with dilated congested vessels. (Figure 2). The final diagnosis was cystic schwannoma tongue. Patient reported on the 7th day with no speech or swallowing problems and thereafter she was lost to follow up.
Discussion with conclusion
Schwannomas, or neurilemmomas, are benign neoplasms that take their origin from Schwann cells that surround the peripheral, cranial or autonomic nerve sheaths .
While the incidence of schwannoma is uncommon , about 25–45% of all schwannomas occur in the head and neck  with the parapharyngeal space being the most common site . Around 1–12% of these occur intraorally with the tongue being the most common site . The lesion is painless and slow growing and is usually solid; however, cystic changes are seen in approximately 4% of the cases . Cystic schwannomas are often comparatively large. Mucinous degeneration, necrosis, haemorrhage and microcyst formation are thought to be the reasons for these cystic changes .
The aspirated fluid may contain individual spindle cells, histiocytes, fibroblasts, or lymphocytes but in the absence of characteristic cellular architecture, such schwannomas may escape diagnosis. Fine needle aspiration cytology (FNAC) as a sole modality has been found to be of limited value in achieving a preoperative diagnosis in such cystic lesions .
Apart from cystic variants, the other variants are:
- cellular schwannoma,
- plexiform schwannoma,
- melanotic schwannoma,
- reticular schwannoma and
- neuroblastoma-like schwannoma .
Transoral total excision is the treatment of choice.
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Figure 1. Smooth and mucosa covered swelling over the tip of the tongue.
[please click on the image to enlarge]
Figure 2. Subepithelium showing encapsulated spindle cell lesion with hyper and hypocellular areas and many verocay bodies along with dilated congested vessels.
[please click on the image to enlarge]
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Conflict of interest: none declared.
1 Department of ENT and HNS, Government Medical College, Srinagar, India
2 Department of Pathology, Government Medical College, Srinagar, India
Dr Suhail Amin Patigaroo, MBBS MS MFHNO
Department of ENT and HNS
Government Medical College
To cite this article: Patigaroo SA, Maqbool T, Farooq S. Unusual lesion of tongue. World J Med Images Videos Cases 2023; 9:e1-3.
Submitted for publication: 3 January 2023
Accepted for publication: 17 January 2023
Published on: 27 January 2023
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