We represent a patient with undiagnosed lingual osteoma, accidentally detected during laryngoscopy for intubation for a gynecologic surgery. General anesthesia was planned for a 52 year-old undergoing gynecologic surgery. Before surgery a laryngoscopy was performed for intubation. During this procedure a pedunculated mass was seen in the posterior region of the tongue. Although the pathogenesis and terminology is controversial, surgical excision is the preferred treatment modality. We aimed to present an osseos lesion in tongue, to review the literature in regard to relevant clinical, histological features and to discuss the pathogenesis and terminology involved.
Figure 1: Lingual osteoma on the dorsum of the tongue.
Macroscopic examination showed a yellow- beige colored, polypoid osseous mass measuring 4x2x2 cm. After decalcification, the samples underwent routine tissue processing and the paraffin blocks were prepared. Five micron sections retrieved from the paraffin blocks stained with hematoxylin eosin were examined under light microscope.
Microscopic examination revealed mostly dense lamellar osteoid tissue with rare osteoblasts, fibroadipose tissue and bone marrow (Figure 3-4).
Figure 3: Dense lamellar bone including fibroadipose tissue with rare osteoblasts (HE x400).
The second theory suggests that osseous lesions of the tongue represent a reactive or posttraumatic center for ossification. 'Myositis ossificans' is the term used for this kind of lesions in other muscles of the body. Chronic inflammation due to trauma or irritation is a common finding at the posterior third of the tongue. Inflammatory and posttraumatic lesions have irregular areas of ossification, with neither haversian systems nor normal bone architecture[3]. Controversially osseous lesions in the tongue are composed of well-developed mature bone that could not be associated with trauma. On the other hand two cases was cited in literature that showed diffuse foci of ossification without a well-circumscribed osseous lesion[7,8]. Reactive responses of the tissue to trauma and irritation may differ from chronic inflammation to metaplasia, and also osteoma which might be the most mature stage of metaplastic process[9].
Our case was reported as osteoma. Differential diagnosis includes sialolithiasis, lipoma with osseous metaplasia, osteo-cartilaginous choristoma, metastatic osteosarcoma, liposarcoma with metaplasia, and post-traumatic chondrification[9,10,11].
There is not a consensus on the terminology for these lesions. Osteoma defines a benign, progressively enlarging neoplasm of bone originating from osteogenic tissue and it is closely associated with the skeleton. Lingual osteoma doesn't fulfill these criteria because the tongue is not associated with skeleton and it is not an osteogenic tissue. “Lingual choristoma” is suggested as an alternative term because it describes a cohesive tumor like mass consisting of normal cells in an abnormal location. As some of the lesions have been reported to increase in size, the term choristoma fails to fit these definitions. Also not widely used 'osseous tumor like lesions of the tongue' is a descriptive term for this kind of lesions[12].
Even it may be asymptomatic, surgical excision is the preferred treatment modality. Histopathologic examinations are necessary for the diagnosis. After removing the lesion, recurrence is not expected.
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