A patient presents with a firm submucosal nodule on the dorsum of the tongue. Which lesion is LEAST likely in the differential?

Correct answer: A. Pleomorphic adenoma

• A. CORRECT — the LEAST likely. PLEOMORPHIC ADENOMA is the most common salivary gland tumor, but it arises overwhelmingly in the PAROTID, and among intraoral minor glands it favors the junction of the hard and soft PALATE, followed by the upper lip and buccal mucosa. The dorsum of the tongue contains few minor salivary glands, making this location distinctly uncommon.
• B. GRANULAR CELL TUMOR has a strong predilection for the TONGUE — it is the classic tongue nodule, of Schwann cell origin, characteristically showing PSEUDOEPITHELIOMATOUS HYPERPLASIA of the overlying epithelium (which can be misread as squamous cell carcinoma).
• C. Traumatic fibroma is the most common oral soft tissue mass overall and can occur anywhere in the mouth, including the tongue.
• D. SCHWANNOMA (neurilemmoma) also has a predilection for the tongue among intraoral sites, presenting as a slow-growing, painless submucosal nodule.

Note: Tongue nodule differential: granular cell tumor, schwannoma, neurofibroma, lipoma, fibroma, lingual thyroid (midline posterior dorsum), and rhabdomyoma.