Chondroma of the tongue

J Oral Maxlllofac

Surg

4435s158.1986

Chondroma

of the Tongue

K. C. LING. BDS, MDS, FDSRCS Chondroma in the oral region is uncommon. It occurs more frequently in bony sites, such as the hard palate, condyle, and coronoid process, than in the oral soft tissues. The most common oral extraskeletal site is the tongue. A case of chondroma of the tongue is reported, and the literature is reviewed. Report of a Case A 22-year-old Indian woman was referred to the author in 1980 for management of a tumor in the tongue. The exact duration of growth was unknown. According to the patient. the lesion had been present for more than IO From the Department of Oral Surgery, Faculty of Dentistry. University of Malaya, Kuala Lumpur. Malaysia. Address correspondence and reprint requests to Dr. Ling.

Table 1. Case

Summary of Reported Cases of Chondroma of the Tongue Patient’s Age (yr)/Sex

Duration

Author ( 1890j9

49/M

5

I

Berry

2

Butlin and Spencer (19OO)‘O Johns (1942)’

3 4 5 6 7 8

9 10 11 12 13 14 15 16

FlGURE I. Chondroma on the right dorsum, at the junction of the posterior third and anterior two thirds of the tongue.

22lF

20

-/M

20

Bruce and McDonald (1953)’ Bruce and McDonald (1953? ‘Rosen (1961)’

52/M

2

43iF

I

36lM

Yoel and Pundyk ( 1965)4 Ramachandran and Viswanathan (1968+ Viglioglia and Stirparo ( 1970)14 Roy et al. (1970)”

36/M

More than 20 8

1O/F

2

26iF

0.5

Samant and Gupta (1971)6 Gutmann et al. (1974)‘5 Phadke et al. (1974)‘* de1 Rio (1976)” Zegarelli (1977)’ Gabriele and Kaufman ( 1978)13

20/F

IO

16/M

6

42lF

1.5

24/M 21/M 50/F 22lF

IO Unknown Unknown Unknown

Histologic Diagnosis

Site

Wr)

Treatment

Fibrochondroma

Surgical

Right lateral surface and anterior third Anterior dorsum, near right margin Middle third of dorsum

Chondroma

Surgical

Chondroma

Surgical

Chondroma

Surgical

Dorsum. near tip and left border Between middle and posterior thirds Middle third of right dorsum and right lateral margin

Chondroma

Surgical

Chondroma

Surgical

Chondroma

Surgical

Dorsum, at junction of medial and posterior thirds Posterior aspect, near foramen cecum Dorsum of right posterior third Midline of middle third of dorsum Dorsum of right anterior one third Right posterior ventral surface Left ventrolateral region Right dorsum, anterolateral to foramen cecum

Chondroma with ossification Osteochondroma

Surgical

Chondroma

Surgical

Chondroma with osteoid tissue Osteochondroma

Surgical

Chondroma Chondroma Osteochondroma

Surgical Surgical Surgical

Right border. halfway base and tip -

156

between

Surgical

Surgical

LING

Low-power photomicrograph showing a portion of the chondroma. (Hematoxylin and eosin. x 51,) FIGURE 2 (I&). FIGURE 3 (right). High-power photomicrograph showing the cartilage with surrounding fatty tissues. (Hematoxylin

and eosin.

X510.)

years; it had grown slowly but was otherwise asymptomatic. The patient sought treatment because of the increasing size of the lesion. There was no history of trauma to the site. The lesion did not interfere with speech or mastication. Physical examination revealed a healthy young woman. There were no cervical lymph nodes palpated. Intraoral examination revealed a pale raised mass on the right dorsum at the junction of the posterior third and the anterior two thirds of the tongue (Fig. l), measuring 2.2 by 1.5 cm and covered by normal mucosa. Palpation revealed a nontender, freely mobile, hard mass. Tongue movement was normal. A provisional diagnosis of neurofibroma was made. A local anesthetic was administered, and an incisional biopsy was done. The histologic diagnosis was chondroma of the tongue. After the induction of general anesthesia, the entire mass was excised with an extended margin and with the overlying mucosa. The final histologic report confirmed the lesion to be a chondroma (Figs. 2,3). According to the report, microscopic examination of the sections revealed a surface covering of stratified squamous epithelium and evidence of numerous colonies of microorganisms. An area of fat cells and islands of hyaline cartilage were visible below the lamina propria.

Muscle bundles were also present.

Postoperative healing was uneventful. About a month after the operation a small nodule (3 mm in diameter) was seen posterior to the surgical site. This nodule was excised, and histologic examination showed it to be normal tissue. There was no sign of recurrence when the patient was examined 15 months after the excision of the tumor. Discussion

Table 1 summarizes the cases of chondroma of the tongue reported in the English-language literature up to 1982. Of the total of 16 cases, nine were pure chondromas,t-* and seven were histologic variants, such as fibrochondroma,9 osteochondroma lo-l3 and chondromast4~t5 with osteoid tissue: The case of Huies’16 was not included because of uncertainty as to the exact site of occurrence. The average age of the patients was 31.3 years; the youngest and the oldest patients were 10 and 50 years of age, respectively. The male-to-female ratio was 1 to 1. The average duration of the lesions prior to diagnosis was 8.2 years. The shortest duration was six months while the longest was more than 20

158

CHONDROMA

years. The lesions were located in the region of the lateral margin in six cases, on the dorsum in eight cases, and on the ventral surface in one case. Five of the nine cases of pure chondroma occurred in the region of the lateral margin of the tongue. The four cases of osteochondroma and the two cases of chondroma with osteoid tissue all occurred on the dorsum of the tongue. The most often described clinical feature was a slowly growing, firm or hard, painless and asymptomatic mass. The lesions varied from 0.3 to 5.0 cm in diameter. Treatment when mentioned, was surgical. No recurrences were mentioned for cases which follow-up data were available. Cartilage is not normally found in the tongue, and the exact histogenesis of lingual chondroma is thus unknown. However, there are two definite theories-the embryonal and the cellular metaplasia theories. The embryonal theory postulates that the tumor is the result of proliferation of heterotopic fetal cartilage remnants in the tongue. The cellular metaplasia theory involves differentiation of pluripotential mesenchymal cells into chondrocytes or cartilaginous metaplasia of the connective tissue. This metaplasia is presumably stimulated by some type of trauma or chronic inflammation. In the present case there was no history of trauma or chronic inflammation. The tumor was present at the site of fusion of the base of the tongue (derived from the third branchial arch) and the body of the tongue (derived from the first and second arches) and could thus have formed from the proliferation of the heterotopic remnants of Meckel’s cartilage of the first arch at the site of fusion. J Oral Mamllofac 44:156-162,

OF TONGUE

The lesion is this case contained cartilage and fatty tissue. ZegareW would not consider this lesion a chondroma because of the presence of the fatty tissue, but rather would consider it a histologic variant of chondroma of the tongue, a lipochondroma. References 1. Johns J: Chondroma of the tongue. J Michigan State Med sot 41:471, 194’ 2. Bruce KW, McDonald JR: Chondroma of the tongue. Oral Surg 6:1281. 1953 3. Rosen MD: Chondroma of the tongue. J Oral Surg 19:157. 1961 4. Yoel J. Pundyk C: Chondroma of the tongue. Oral Surg 20578. 1965 5 Ramachandran K. Viswanathan R: Chondroma of the tongue. Oral Surg X:487, 1968 6. Samant HC. Guuta OP: Chondroma of the toneue. Oral Sura 32:450. 1971 . 7. Zegarelli DJ: Chondroma of the tongue. Oral Surg 43:738. 1977 of the tongue: review of the liter8. del Rio CE: Chondroma ature and a case report. J Oral Med 33:.54, 1978 9. Berry J: Fibro-chondroma of tongue. Trans Pathol Sot London 41:81. 1890 IO. Butlin HT. Spencer WG: Diseases of the Tongue. London. Cassel, 1900. p 286 II. Roy JJ. Klein HZ, Tipton DJ: Osteochondroma of the tongue. Arch Pathol 89:565. 1970 12. Phadke AR. Tambaku SN. Phadke SA: Osteochondroma of the tongue. Ind J Cancer I l:482, 1974 13. Gabriele R, Kaufman PS: Osteochondroma of the tongue: report of case. J Oral Surg 36:476. 1978 14. Vialioelia PA. Stiroaro MA: Chondroma of the tonaue. Oral Surg 29:820. I970 IS. Gutmann J. Cifuentes C. Balzarini MA. et al: Chondroma of the tongue. Oral Surg 37:75. 1974 16. Fitzwilliams DCL: The Tongue and Its Diseases. London, Oxford Medical Publications. 1927. pp 328-329.

Surg

1966

Tuberculosis

of the Jaws

T. SEPHERIADOU-MAVROPOULOU, PHD, DDS, AND A. YANNOULOPOULOS, PHD, DDS Tuberculosis is still a health problem, even in the developed countries.’ It can affect any part of the body, and the jaws, although rarely affected, are no exception. Tuberculosis of the jaws is usually manifested as a tuberculous granuloma or tuberculous osteomy-

From the Department of Oral and Maxillofacial versity of Athens. Address correspondence and reprint requests iadou-Mavropoulou: IO Codrington Str., Athens

Surgery,

Uni-

to Dr. Sepher11257, Greece.

elitis. The tuberculous granuloma appears radiographically as a periapical radiolucency involving a nonvital tooth: it is clinically asymptomatic or produces mild symptoms of chronic inflammation. It is believed that existing apical granulomas are infected by Mycobacterium tuberculosis2-S although exceptional cases of tuberculous apical granulomas involving vital teeth have been reported.4,6 Tuberculous osteomyelitis is characterized by single or repeated attacks of pain, described as toothache, and swelling of the affected area, which