Pathology · patient case question
For Patient A's tongue nodule, each of the following belongs in the differential diagnosis EXCEPT one. Which is the EXCEPTION?
Patient case: Three soft tissue and bony swellings
Patient: Multiple patients presenting on the same clinic session
Chief complaint: Three separate patients, each with a painless swelling.
History: None of the three has relevant systemic disease.
Findings: Patient A: a firm submucosal nodule on the dorsum of the tongue. Patient B: a firm swelling of the posterior lateral hard palate. Patient C: a small hard bump in the anterior mandibular labial vestibule.
Show answer and explanation
Correct answer: A. Verruca vulgaris
- A. CORRECT as the exception. Verruca vulgaris is a SURFACE lesion — an HPV-driven papillary, exophytic growth with a rough, cauliflower-like or finger-like surface and a keratinised white appearance. It is not a submucosal NODULE. The question hinges on that distinction: everything else listed is a mass lying beneath intact mucosa.
- B. Traumatic fibroma is the commonest oral submucosal nodule of all, a reactive fibrous hyperplasia at a site of chronic irritation — the tongue included.
- C. Schwannoma is a benign nerve sheath tumour arising from Schwann cells, and the tongue is its commonest intra-oral site. It presents exactly as described — a slow-growing, firm, painless submucosal nodule.
- D. Granular cell tumour has a striking predilection for the tongue and is a classic submucosal nodule. Its histology is characteristic, with large granular eosinophilic cells and pseudoepitheliomatous hyperplasia of the overlying epithelium that can be mistaken for carcinoma.
Note: The clean division to carry into the exam: SURFACE papillary lesions are squamous papilloma, verruca vulgaris, condyloma acuminatum and verruciform xanthoma. SUBMUCOSAL nodules are fibroma, granular cell tumour, schwannoma, neurofibroma, lipoma and salivary gland lesions.