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Lingual Osseous Choristoma
Lingual Osseous Choristoma
A
n 11-year-old boy followed for functional abdominal pain presented to clinic with complaints of an intermittent foreign body sensation localized to the upper throat with swallowing. He had no history of accidental or purposeful ingestion of non-food substances and he was not on any chronic medications. Examination revealed a pale pink, ovoid mass located on the base of the tongue. A thyroid scan to assess for a lingual thyroid was performed and failed to show ectopic thyroid tissue. Computed tomog-
raphy showed a calcified ovoid mass on the base of the tongue (Figures 1 and 2; Figure 1 available at www.jpeds.com). The patient was referred to otolaryngology and the mass was removed. Histologically, the mass was found to contain fragments of mature bone covered with reactive squamous mucosa consistent with a lingual osseous choristoma. The patient had resolution of the foreign body sensation following removal of the mass. Choristoma is defined as the finding of normal tissue in abnormal locations; osseous choristoma refers to heterotopic mature bone within soft tissues. Osseous choristoma is a rare, benign lesion most commonly affecting the tongue with fewer than 100 cases described in the English literature.1 The majority of cases have been reported in adults in the third to fourth decade of life, presenting most commonly as a pedunculated lesion on the dorsum of the tongue just anterior to the circumvallate papillae, although they can be found anywhere on the tongue.1-3 Presentation may be symptomatic (dysphagia, nausea, or a gagging sensation), or as an asymptomatic mass.1-3 The cause of lingual osseous choristoma is not known. It has been proposed that pluripotent cells from the brachial arches forming the tongue become entrapped where the arches join at the foramen cecum.2 The differential diagnosis is dependent on where the lesion is located. Lesions occurring on the posterior tongue include thyroglossal duct cyst, lingual thyroid, mucocele, and pyogenic granuloma. Lesions found on the tongue margins include traumatic neuroma, neurofibroma, schwannoma, fibroma, and cartilaginous choristoma. Lesions on the anterior portion of the tongue include pyogenic granuloma, mucocele, and cartilaginous choristoma.4 Treatment for lingual osseous choristoma is surgical excision; no evidence of recurrence exists in the literature.4 n
Samuel Davidson, BA School of Medicine
Michael Steiner, MD Division of Pediatric Radiology
Michael Nowicki, MD Figure 2. A three-dimensional reconstruction of the computed tomography scan best demonstrates the calcified lesion, which was confirmed to be an osseous choristoma by pathology.
Division of Pediatric Gastroenterology University of Mississippi Medical Center Jackson, Mississippi
References available at www.jpeds.com
J Pediatr 2016;168:247. 0022-3476/$ - see front matter. Copyright ª 2016 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.jpeds.2015.09.053
247
THE JOURNAL OF PEDIATRICS
www.jpeds.com
References 1. Andressakis DD, Pavlakis AG, Chrysomali E, Rapidis AD. Infected lingual osseous choristoma. Report of a case and review of the literature. Med Oral Patol Oral Cir Bucal 2008;13:E627-32.
Volume 168 2. Benamer MH, Elmangoush AM. Lingual osseous choristoma case report and review of literature. Libyan J Med 2007;2:46-8. 3. Manganaro AM. Lingual osseous choristoma. Gen Dent 1996;44:430-1. 4. Gorini E, Mullace M, Migliorini L, Mevio E. Osseous choristoma of the tongue: a review of etiopathogenesis. Case Rep Otolaryngol 2014;2014: 373104.
Figure 1. Scout film for the computed tomography scan showed a calcified lesion (arrow) at the base of the tongue. 247.e1
Davidson, Steiner, and Nowicki
A
n 11-year-old boy followed for functional abdominal pain presented to clinic with complaints of an intermittent foreign body sensation localized to the upper throat with swallowing. He had no history of accidental or purposeful ingestion of non-food substances and he was not on any chronic medications. Examination revealed a pale pink, ovoid mass located on the base of the tongue. A thyroid scan to assess for a lingual thyroid was performed and failed to show ectopic thyroid tissue. Computed tomog-
raphy showed a calcified ovoid mass on the base of the tongue (Figures 1 and 2; Figure 1 available at www.jpeds.com). The patient was referred to otolaryngology and the mass was removed. Histologically, the mass was found to contain fragments of mature bone covered with reactive squamous mucosa consistent with a lingual osseous choristoma. The patient had resolution of the foreign body sensation following removal of the mass. Choristoma is defined as the finding of normal tissue in abnormal locations; osseous choristoma refers to heterotopic mature bone within soft tissues. Osseous choristoma is a rare, benign lesion most commonly affecting the tongue with fewer than 100 cases described in the English literature.1 The majority of cases have been reported in adults in the third to fourth decade of life, presenting most commonly as a pedunculated lesion on the dorsum of the tongue just anterior to the circumvallate papillae, although they can be found anywhere on the tongue.1-3 Presentation may be symptomatic (dysphagia, nausea, or a gagging sensation), or as an asymptomatic mass.1-3 The cause of lingual osseous choristoma is not known. It has been proposed that pluripotent cells from the brachial arches forming the tongue become entrapped where the arches join at the foramen cecum.2 The differential diagnosis is dependent on where the lesion is located. Lesions occurring on the posterior tongue include thyroglossal duct cyst, lingual thyroid, mucocele, and pyogenic granuloma. Lesions found on the tongue margins include traumatic neuroma, neurofibroma, schwannoma, fibroma, and cartilaginous choristoma. Lesions on the anterior portion of the tongue include pyogenic granuloma, mucocele, and cartilaginous choristoma.4 Treatment for lingual osseous choristoma is surgical excision; no evidence of recurrence exists in the literature.4 n
Samuel Davidson, BA School of Medicine
Michael Steiner, MD Division of Pediatric Radiology
Michael Nowicki, MD Figure 2. A three-dimensional reconstruction of the computed tomography scan best demonstrates the calcified lesion, which was confirmed to be an osseous choristoma by pathology.
Division of Pediatric Gastroenterology University of Mississippi Medical Center Jackson, Mississippi
References available at www.jpeds.com
J Pediatr 2016;168:247. 0022-3476/$ - see front matter. Copyright ª 2016 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.jpeds.2015.09.053
247
THE JOURNAL OF PEDIATRICS
www.jpeds.com
References 1. Andressakis DD, Pavlakis AG, Chrysomali E, Rapidis AD. Infected lingual osseous choristoma. Report of a case and review of the literature. Med Oral Patol Oral Cir Bucal 2008;13:E627-32.
Volume 168 2. Benamer MH, Elmangoush AM. Lingual osseous choristoma case report and review of literature. Libyan J Med 2007;2:46-8. 3. Manganaro AM. Lingual osseous choristoma. Gen Dent 1996;44:430-1. 4. Gorini E, Mullace M, Migliorini L, Mevio E. Osseous choristoma of the tongue: a review of etiopathogenesis. Case Rep Otolaryngol 2014;2014: 373104.
Figure 1. Scout film for the computed tomography scan showed a calcified lesion (arrow) at the base of the tongue. 247.e1
Davidson, Steiner, and Nowicki