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CASE REPORT Table of Contents   
Year : 2009  |  Volume : 52  |  Issue : 1  |  Page : 86-87
Choristoma of the base of the tongue


1 Department of Pathology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
2 Department of Otorhinolaryngology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia

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   Abstract 

Choristoma is a benign tumor where new bone formation occurs. It occurs exclusively in the flat bones of the skull and face. These are slow growing lesions that are usually completely asymptomatic and only present when there is a disruption in the function of the organ due to its large size as it grows. These choristomas can rarely occur in soft tissues especially in the head, eye, tongue, or extremities. Choristomas of the soft tissues are very rare. Only 61 cases of choristomas of the tongue have been reported in literature. Here we report a case of choristoma in the base of the tongue in a 25-year-old Malay female.

Keywords: Benign, choristoma, female, tongue

How to cite this article:
Naik VR, Wan Faiziah W, Musa M Y. Choristoma of the base of the tongue. Indian J Pathol Microbiol 2009;52:86-7

How to cite this URL:
Naik VR, Wan Faiziah W, Musa M Y. Choristoma of the base of the tongue. Indian J Pathol Microbiol [serial online] 2009 [cited 2014 Sep 1];52:86-7. Available from: http://www.ijpmonline.org/text.asp?2009/52/1/86/44975



   Introduction Top


Monserrat [1] was the first to report an osseous lesion in the tongue in 1913 and he labeled it as 'lingual choristoma', the term that normally describes neoplastic pathology. Krolls [2] changed this term later to 'osseous choristoma' in 1971, which means a mass consisting of normal cells in an abnormal location. He used this term as he noticed that these lesions were not osteogenic in origin and not progressively enlarging like benign lesions.

Clinically, these lesions were described as a hard mass, either pedunculated or sessile.[2] All lesions were treated by surgical excision with uneventful healing. Recurrence or malignant transformation has not been reported.


   Case Report Top


A 25-year-old Malay female was referred to the ENT clinic at the hospital of our institution in October 2006 with a complaint of swelling at the base of the tongue for the past 5 years. The lump was initially slow growing and painless but 3 weeks before coming to the hospital, the lump had started increasing in size rapidly and was causing discomfort. The patient had an unremarkable medical history and the family history was noncontributory. She had no history of trauma to the tongue, mandible, or sublingual regions.

A clinical examination revealed a firm, white and well circumscribed swelling measuring 2 x 3 cm located at the posterior third of the tongue. The lump was fixed and non tender. The movement of the tongue was normal. The patient underwent an uneventful excision under general anesthesia and the excised specimen was sent for a histopathological examination.

Grossly, the specimen consisted of a gray-white mass measuring 12x11x5 mm. The mass was hard in consistency and had a smooth surface. As the mass was hard, it was decalcified.

A microscopic examination showed a globular mass of tissue, the surface of which was lined by stratified squamous epithelium [Figure 1]. The underlying fibrocollagenous stroma contained well-formed lamellar bone [Figure 2] with benign looking osteocytes.


   Discussion Top


The pathogenesis of lingual choristoma is still uncertain but it is not a debatable entity because its existence is well recognized. [3] Several theories have tried to explain the pathogenesis of these lesions. In general, these theories can be divided into two main categories; the developmental malformation theory and the reactive (posttraumatic) theory. [2],[4]

The first developmental theory is based on the anatomic location of the lesion in the foramen cecum. Embryologically, the anterior two-thirds of the tongue originates from the first branchial arch and the posterior one-third originates from the third branchial arch. The union takes place in the region of the foramen cecum and the sulcus terminalis. Both of these arches also give rise to normal bony structures such as the middle ear bony ossicles and the hyoid bone. Therefore, it was suggested that pluripotential cells from these branchial arches might give rise to these osseous lesions. [1],[2],[5]

The second developmental theory is associated with remnants of thyroid tissue. The foramen cecum is the site of the development and the descent of the future thyroid gland in the neck and it was suggested that the remnants of the undescended thyroid tissue might produce osseous proliferating lesions later in life, mainly during puberty and adolescence. [1],[2]

The reactive (posttraumatic) theory is based on the fact that there is frequent and constant irritation by different lingual activity such as swallowing and articulation. This frequent trauma can lead to local inflammation, similar to what happens in the case of 'myositis ossificans'. However, this theory cannot explain the formation of fully developed bone with the haversian system and not the zonation seen in myositis ossificans. [1],[2]

Awareness of this entity is required so that an early and accurate diagnosis can be made. As this is a benign neoplasm without serious complication, knowing its behavior and clinical presentation will assist the clinician in commencing prompt and adequate treatment. The wrong diagnosis may subject the patient to aggressive treatment that can be avoided as surgical excision is adequate.

 
   References Top

1.Monserrat M. Osteome de la langue. Bulletin de la sociιtι d' anatomie 1913;88:282-3.  Back to cited text no. 1    
2.Kroll SO, Jacoway JR, Alexander WN. Osseous Choristomas (Choristomas) of intraoral soft tissue. Oral Surg Oral Med Oral Pathol 1971;32:588-95.  Back to cited text no. 2    
3.Vered M, Lustig JP, Buchner A. Lingual osteoma: A debatable entity. J Oral Maxillofac Sur 1998;56:9-13.  Back to cited text no. 3    
4.Supiyaphun P, Sampatanakul P, Kerekhanjanarong V, Chawakitchareon P, Sastarasadhit V. Lingual osseous choristoma: A study of right cases and review of the literature. Ear Nose Throat J 1998;77:316-8.  Back to cited text no. 4    
5.Benamer MH, Elmangoush AM. Lingual osseous choristoma: Case report and review of literature. Libyan J Med 2006:061211.  Back to cited text no. 5    

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Correspondence Address:
Venkatesh R Naik
Department of Pathology, School of Medical Sciences, Universiti Sains Malaysia, Kubang kerian, Kelantan
Malaysia
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DOI: 10.4103/0377-4929.44975

PMID: 19136792

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    Figures

  [Figure 1], [Figure 2]

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