Approximately five years ago, a 49-year-old Caucasian woman came to our hospital for diagnosis, evaluation and treatment of a lingual lesion.
She complained of constant dysphagia and dysgeusia. These symptoms had worsened in the past three months because of growth of the lingual mass (Figure ).
Clinical presentation of the lesion.
Her medical history was uneventful, except for breast cancer several years earlier, and included no history of smoking or drinking.
Clinical examination revealed the presence of a nodular neoformation with a fibrotic aspect on the dorsum of the tongue. Its consistency was hard, and it consisted of nodular, sessile microsurveys.
Because of the rapid clinical evolution of the lesion in a patient with previous breast cancer, the pathologist (UM) decided to perform an incisional biopsy immediately to exclude malignancy. Local anesthesia was administered deep around the proposed biopsy site. The specimen was taken with a scalpel to a depth of at least 5 mm, and a 3- to 5-mm margin of clinically normal mucosa was also included. The tissue was submitted in 10% neutral buffered formalin fixative for microscopic examination. A resorbable suture with polyglactin (Vicryl Rapide, Ethicon Ltd, Edinburgh, UK) was used. An axial magnetic resonance imaging (MRI) study was also requested for a diagnostic scope (Figure ).
Tongue magnetic resonance image showing the neoformation (arrow).
The histopathologic diagnosis was histiocytic proliferation with the presence of giant cells, Touton type, compatible with juvenile xanthogranuloma (Figure ).
Microscopic features show giant cells, Touton type (asterisk), and hematoxylin-eosin staining; original magnification ×400.
After the diagnosis, the patient was included in a bimestrial follow-up program. During the first two months, we observed a modest volume reduction of the neoformation together with a reduction of its consistency.
Afterward the lingual lesion underwent a spontaneous involution. To date, a hyperchromic area and a mild atrophy remain, without any evidence of local recurrence after follow-up of more than four years (Figure ).
Follow-up after more than four years.