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Chondroma of the tongue
91
TANI, AZLJMA, AND NAGAYAMA
J Oral Maxillofat: 47:91-92,
Surg
1989
Chondroma
of the Tongue
YOSHIAKI TANI, DDS, DDSc,* TOM10 AZUMA, DDS, DDSc,* AND MASARU NAGAYAMA, DDS, DMSct
Chondroma is uncommon in the oral region. It usually occurs in the hard palate, alveolar ridge,
condyle, or coronoid process. Only a few cases of oral extraskeletal chondroma have been reported,‘-’ the most common site being the tongue. We report an additional case of chondroma involving the tongue and present a brief review of the subject. Report of a Case A 75year-old woman was referred to us by her dentist for evaluation and treatment of an asymptomatic mass on the dorsum of the tongue. The mass had been growing slowly since the patient first noticed it 2 years before. There was no past history of trauma or chronic inflammation in the region of the lesion. Examination of the head and neck showed no abnormalities. Intraoral examination revealed the presence of a mass in the dorsal midLine of the anterior third of the tongue. It was round and measured 0.7 cm in diameter. The overlying mucosa was slightly elevated, but intact. The lesion was hard and freely movable. Tongue movement was normal. A diagnosis of a benign mesenchymal tumor was made. Under local infiltration anesthesia, the mass was excised along with a margin of normal tissue and the overlying mucosa. Gross examination of the lesion after formalin fixation showed a chalky-white, well-encapsulated tumor of hard consistency, which measured 0.5 x 0.4 x 0.4 cm. The specimen could be cut with a sharp blade and did not require decalcification for histologic preparation. Microscopic examination showed a well-circumscribed submucosal nodule of cartilage beneath the normal mucosa (Fig 1). Typical chondrocytes were set in regularly arranged lacunae. The hyaline chondromucin matrix contained considerable elastic fibers (Fig 2). There was no inflammatory reaction in the surrounding connective tissue. A diagnosis of chondroma of the tongue was made. Postoperative healing was uneventful. During the 2 year followup, there has been no sign of recurrence.
stated that approximately 20 cases of chondroma of the tongue were reported prior to 1985.’ Recently, Ling summarized 16 cases of chondroma of the tongue reported in the English-language literature until 1982.7 Of these 16 cases, nine were pure chondromas and seven were histologic variants, such as fibrochondroma, osteochondroma, and chondroma with osteoid tissue. Zegarelli reviewed the literature on pure chondroma of the tongue in 1977.4 In his report, a total of 11 cases are listed, including his own. The average age of the patients with chondroma of the tongue is 31 years.4,7’8 The lesion is distributed equally among the sexes. The majority of the lesions have a duration of 7 to 8 years before a diagnosis is made. The chondroma is most often found on the lateral borders or the dorsum of the anterior two thirds of the tongue. The clinical features most often described are hardness or firmness, slow growth, and mobility of the painless Iesion. The lesions vary from 0.3 to 5.0 cm in diameter. There are two definite theories proposed concerning the histogenesis of chondroma of the tongue. *-’ An embryonal theory postulates that the tumor is formed from heterotopic fetal cartilage remnants in the tongue. The lingual foramen caecum region is an interesting site embryologically. Choristoma of the tongue seems to occur predomi-
Discussion Chondroma is a benign tumor of cartilage that very rarely occurs in the tongue. Van der Wal et al Received from Tokushima University, Japan. * Depatiment of Oral Pathology, School of Dentistry. t The First Department of Oral and Maxillofacial Surgery. Address correspondence and reprint requests to Dr. Tani: Department of Oral Pathology, School of Dentistry, Tokushima University. 3 Kuramoto-cho, Tokushimo 770, Japan. 0 1989 American
Association
geons 0278-2391/89/4701-0023$3.00/O
of Oral and Maxillofacial
Sur-
FIGURE I. Low-power photomicrograph showing the entire tumor, which consists of a nodule of cartilage surrounded by connective tissue and covered by the lingual mucosa. (Hematoxylin and eosin. Original magnification, x 18.)
92
CHONDROMA OF THE TONGUE
may help to explain the marginal or dorsal site for the chondroma, because of the greater chance of mechanical or physical irritation at these sites. Takeda reported three cases of cartilaginous metaplasia of the aponeurosis linguae in irradiated human tongue.’ He stated that such metaplastic tissue might have a potential for differentiation into a tumor of the tongue. Although this theory is logical, our patient had no history of irradiation, trauma, or chronic inflammation in the region. References FIGURE 2. Higher magnification of the tumor showing typical cartilaginous tissue. (Hematoxylin and eosin. Original magnification, X200.)
nantly posterior to the circumvalate papillae or close to the foramen caecum. Van der Wal et al studied a series of 130 cadaver tongues histologically and found no cartilage tissue.8 He concluded that ectopic cartilage formation in the tongue is indeed rare. The second theory supports a metaplastic origin, supposing that pluripotential mesenchymal cells differentiate into chondrocytes, or that connective tissues undergo cartilaginous metaplasia. This theory
1. Viglioglia PA, Stirparo MA: Chondroma of the tongue. Oral Surg 29820, 1970 2. Samant HC, Gupta OP: Chondroma of the tongue. Oral Surg 32:450, 1971 3. Gutmann J, Cifuentes C, Balzarini MA, et al: Chondroma of the tongue. Oral Surg 37:75, 1974 4. Zegarelli DJ: Chondroma of the tongue. Oral Surg 43:738, 1977 5. de1 Rio CE: Chondroma of the tongue: Review of the literature and a case report. J Oral Med 3354, 1978 6. Segal K, Katzav Y: Chondroma of the tongue: Report of two cases. Ann Otol Rhino1 Laryngol 93:271, 1984 7. Ling KC: Chondroma of the tongue. J Oral Maxillofac Surg 44: 156, 1986 8. van der Wal N, van der Waal I: Osteoma or chondroma of the tongue: A clinical and postmortem study. Int J Oral Maxillofac Surg 16:713, 1987 9. Takeda Y: Cartilaginous metaplasia of the human aponeurosis linguae: Histologic and ultrastructural study. J Oral Med 42:35, 1987
TANI, AZLJMA, AND NAGAYAMA
J Oral Maxillofat: 47:91-92,
Surg
1989
Chondroma
of the Tongue
YOSHIAKI TANI, DDS, DDSc,* TOM10 AZUMA, DDS, DDSc,* AND MASARU NAGAYAMA, DDS, DMSct
Chondroma is uncommon in the oral region. It usually occurs in the hard palate, alveolar ridge,
condyle, or coronoid process. Only a few cases of oral extraskeletal chondroma have been reported,‘-’ the most common site being the tongue. We report an additional case of chondroma involving the tongue and present a brief review of the subject. Report of a Case A 75year-old woman was referred to us by her dentist for evaluation and treatment of an asymptomatic mass on the dorsum of the tongue. The mass had been growing slowly since the patient first noticed it 2 years before. There was no past history of trauma or chronic inflammation in the region of the lesion. Examination of the head and neck showed no abnormalities. Intraoral examination revealed the presence of a mass in the dorsal midLine of the anterior third of the tongue. It was round and measured 0.7 cm in diameter. The overlying mucosa was slightly elevated, but intact. The lesion was hard and freely movable. Tongue movement was normal. A diagnosis of a benign mesenchymal tumor was made. Under local infiltration anesthesia, the mass was excised along with a margin of normal tissue and the overlying mucosa. Gross examination of the lesion after formalin fixation showed a chalky-white, well-encapsulated tumor of hard consistency, which measured 0.5 x 0.4 x 0.4 cm. The specimen could be cut with a sharp blade and did not require decalcification for histologic preparation. Microscopic examination showed a well-circumscribed submucosal nodule of cartilage beneath the normal mucosa (Fig 1). Typical chondrocytes were set in regularly arranged lacunae. The hyaline chondromucin matrix contained considerable elastic fibers (Fig 2). There was no inflammatory reaction in the surrounding connective tissue. A diagnosis of chondroma of the tongue was made. Postoperative healing was uneventful. During the 2 year followup, there has been no sign of recurrence.
stated that approximately 20 cases of chondroma of the tongue were reported prior to 1985.’ Recently, Ling summarized 16 cases of chondroma of the tongue reported in the English-language literature until 1982.7 Of these 16 cases, nine were pure chondromas and seven were histologic variants, such as fibrochondroma, osteochondroma, and chondroma with osteoid tissue. Zegarelli reviewed the literature on pure chondroma of the tongue in 1977.4 In his report, a total of 11 cases are listed, including his own. The average age of the patients with chondroma of the tongue is 31 years.4,7’8 The lesion is distributed equally among the sexes. The majority of the lesions have a duration of 7 to 8 years before a diagnosis is made. The chondroma is most often found on the lateral borders or the dorsum of the anterior two thirds of the tongue. The clinical features most often described are hardness or firmness, slow growth, and mobility of the painless Iesion. The lesions vary from 0.3 to 5.0 cm in diameter. There are two definite theories proposed concerning the histogenesis of chondroma of the tongue. *-’ An embryonal theory postulates that the tumor is formed from heterotopic fetal cartilage remnants in the tongue. The lingual foramen caecum region is an interesting site embryologically. Choristoma of the tongue seems to occur predomi-
Discussion Chondroma is a benign tumor of cartilage that very rarely occurs in the tongue. Van der Wal et al Received from Tokushima University, Japan. * Depatiment of Oral Pathology, School of Dentistry. t The First Department of Oral and Maxillofacial Surgery. Address correspondence and reprint requests to Dr. Tani: Department of Oral Pathology, School of Dentistry, Tokushima University. 3 Kuramoto-cho, Tokushimo 770, Japan. 0 1989 American
Association
geons 0278-2391/89/4701-0023$3.00/O
of Oral and Maxillofacial
Sur-
FIGURE I. Low-power photomicrograph showing the entire tumor, which consists of a nodule of cartilage surrounded by connective tissue and covered by the lingual mucosa. (Hematoxylin and eosin. Original magnification, x 18.)
92
CHONDROMA OF THE TONGUE
may help to explain the marginal or dorsal site for the chondroma, because of the greater chance of mechanical or physical irritation at these sites. Takeda reported three cases of cartilaginous metaplasia of the aponeurosis linguae in irradiated human tongue.’ He stated that such metaplastic tissue might have a potential for differentiation into a tumor of the tongue. Although this theory is logical, our patient had no history of irradiation, trauma, or chronic inflammation in the region. References FIGURE 2. Higher magnification of the tumor showing typical cartilaginous tissue. (Hematoxylin and eosin. Original magnification, X200.)
nantly posterior to the circumvalate papillae or close to the foramen caecum. Van der Wal et al studied a series of 130 cadaver tongues histologically and found no cartilage tissue.8 He concluded that ectopic cartilage formation in the tongue is indeed rare. The second theory supports a metaplastic origin, supposing that pluripotential mesenchymal cells differentiate into chondrocytes, or that connective tissues undergo cartilaginous metaplasia. This theory
1. Viglioglia PA, Stirparo MA: Chondroma of the tongue. Oral Surg 29820, 1970 2. Samant HC, Gupta OP: Chondroma of the tongue. Oral Surg 32:450, 1971 3. Gutmann J, Cifuentes C, Balzarini MA, et al: Chondroma of the tongue. Oral Surg 37:75, 1974 4. Zegarelli DJ: Chondroma of the tongue. Oral Surg 43:738, 1977 5. de1 Rio CE: Chondroma of the tongue: Review of the literature and a case report. J Oral Med 3354, 1978 6. Segal K, Katzav Y: Chondroma of the tongue: Report of two cases. Ann Otol Rhino1 Laryngol 93:271, 1984 7. Ling KC: Chondroma of the tongue. J Oral Maxillofac Surg 44: 156, 1986 8. van der Wal N, van der Waal I: Osteoma or chondroma of the tongue: A clinical and postmortem study. Int J Oral Maxillofac Surg 16:713, 1987 9. Takeda Y: Cartilaginous metaplasia of the human aponeurosis linguae: Histologic and ultrastructural study. J Oral Med 42:35, 1987