Case 555 -- A 45 year old man with a midline tongue lesion

Contributed by Nidhi Aggarwal, MD and E. Leon Barnes, Jr., MD.


This 45 year old man presented to the emergency room with a history of a small quarter - sized midline tongue lesion present since childhood, which had recently increased in size to that of a golf ball and was associated with spontaneous drainage of a dark brown fluid. There was no mucosal ulceration, or history of dyspnea, odynophagia or bleeding.

On examination, a 3 X 4 cm deflated, mobile cyst in the tongue was observed with no associated lymphadenopathy. A CT scan showed a mildline soft tissue lesion in the tongue with a normally placed thyroid. He was placed on augmentin and scheduled for surgery.


The specimen consisted of an oval excision of the dorsal tongue. The mucosa was grossly unremarkable. A 2.5 (anterior- posterior) by 1.0 (right- left) X 1.3 (superficial - deep) cm smooth lined, unilocular cyst with variable wall thickness ranging from 0.2- 0.5 cm was identified. No cyst contents were identified.


Histologic sections revealed a cyst lined variably by benign pseudostratified ciliated columnar (respiratory), gastric, and stratified squamous non keratinized epithelium. Smooth muscle (muscularis propria) was identified surrounding a significant proportion of the cyst with an abrupt interface with the skeletal muscle of the tongue.


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