Pathology · single question
Patient with tongue nodule — which is LEAST likely in the differential diagnosis?
Show answer and explanation
Correct answer: B. Verruca vulgaris
Verruca vulgaris (HPV 2, 4, 7) typically appears on SKIN (hands/fingers) or occasionally oral mucosa — less commonly presents as a smooth tongue nodule. Schwannoma, pleomorphic adenoma, and fibroma are all common smooth tongue nodules. HPV 2,4,7 = verruca vulgaris (NOT oral hairy leukoplakia which is EBV).
- A. CORRECT — LEAST likely. Verruca vulgaris (common wart, caused by HPV types 2 and 4) predominantly occurs on keratinized skin (fingers, hands, feet). Intraoral HPV lesions on the tongue are more likely to be condyloma acuminatum (HPV 6/11) or squamous papilloma (HPV 6/11). Verruca vulgaris is uncommon as a tongue lesion and would be the least likely among the options.
- B. INCORRECT (schwannoma IS in the differential). Schwannoma (neurilemmoma) is a benign nerve sheath tumor that can occur on the tongue, as the tongue has rich nerve supply. It presents as a slow-growing, encapsulated nodule.
- C. INCORRECT (granular cell tumor IS in the differential). Granular cell tumor (formerly granular cell myoblastoma) has a predilection for the tongue and is one of the most important tumors to consider in tongue nodule differentials. It originates from Schwann cells.
- D. INCORRECT (fibroma IS in the differential). Irritation fibroma is the most common oral soft tissue nodule overall and commonly occurs on the tongue. It results from chronic trauma and reactive fibrous tissue hyperplasia.