How to differentiate between lesions that cause swelling of the tongue.

1. D.D of Tongue
Swelling
Made by:
Mohamed Ali

2. Benign connective tissue tumors

3. Hemangioma
 Proliferative lesions of vascular
tissue.
 Clinical features :
• Raised, red/blue/purple lesions.
• Easily blanched on pressure.
• Soft and pulsatile.

9.  Histopathological features:
• small, numerous blood capillaries
lined by a single layer of
endothelial cells.

12.  D.D :
• Lymphangioma.
• Angiomyolipoma.
• Angiosarcoma.
• Hemangiosarcoma.
• Kaposi’s sarcoma.
• Pyogenic Granuloma.
 How to differentiate :
• Biopsy.
• Except for pyogenic granuloma by clinical
presentation.

13. Hemangioma Pyogenic granuloma
Raised, red/blue/purple
lesions.
Red, Ulcerated
Easily blanched on pressure. Easily bleeding.
Soft and pulsatile. Smooth or lobulated mass
that is usually pedunculated.

14. Lymphangioma
 Proliferative neoplasm of lymphatic vessels.
 Clinical features :
• Painless, nodules or vesicle like lesions.
• Color of lesion is lighter than surrounding
mucosa.
• On palpation ‘crepitation’ sound is
produced.
• Regress automatically.

15.  Lymphangioma.
• Pebbly, vesicle-like appearance of a tumor of the right
lateral tongue.

20.  Histopathological features :
• The lymphatic vessels are
characteristically located just beneath
the epithelial surface and often replace
the connective tissue papillae.

21.  Cavernous lymphangioma.
• Lesion of the tongue showing dilated lymphatic vessels beneath
the epithelium and in the deeper connective tissues.

22.  D.D :
• Hemangioma
• Amyloidosis
• Congenital hypothyroidism
• Neurofibromatosis
• Mongolism
• Primary muscular hypertrophy
 How to differentiate :
• Biopsy.

23. Benign soft tissue tumors

24. OSSEOUS AND CARTILAGINOUS
CHORISTOMAS
 Tumor like growth of microscopically normal
tissue in an abnormal location.
 Clinical features :
• Most common location is the posterior
tongue near the foramen cecum.
• firm, smooth-surfaced, sessile or
pedunculated.
• some complain of gagging or dysphagia.
• More common in women.

25.  Osseous Choristoma.
• Hard pedunculated nodule on the posterior dorsum of the
tongue.

27.  Histopathological features :
• Well circumscribed mass of dense lamellar
bone or mature cartilage that is
surrounded by dense fibrous connective
tissue.

28.  Osseous choristoma.
• Mass of dense lamellar bone beneath the surface epithelium.

29. Fibroma
 Reactive hyperplasia of fibrous connective tissue
in response to
local irritation or trauma.
 Clinical features :
• well circumscribed smooth surfaced nodule
• 1-2 cm in diameter.
• Most fibromas are sessile, although some are
pedunculated.
• Usually normal in color most common on
margins of tongue

30.  Fibroma.
• Lesion on the lateral border of the tongue.

32.  Histopathological features :
• Nodular mass of fibrous connective tissue
covered by stratified squamous epithelium.
• Connective tissue is usually dense and
collagenized.

33.  Fibroma.
• Higher-power view demonstrating dense collagen
beneath the epithelial surface.

34.  D.D :
• Neurofibroma.
• Neurilemmoma.
• Granular cell tumours .
• Lipoma.
 How to differentiate :
• Biopsy.

35. GRANULAR CELL TUMOR
 Clinical features:
• Most often occur on the dorsal
surface of the tongue.
• Dome-shaped.
• Asymptomatic sessile nodule.
• Submucosal nodules with a yellowish
or pinkish color.

40.  Histopathological features :
• Large, polygonal cells with abundant pale
eosinophilic, granular cytoplasm and small,
vesicular nuclei.
• The cells are usually arranged in sheets, cords and
nests.
• The cell borders often are indistinct, which results
in a syncytial appearance.

42.  D.D :
• Neurofibroma
• Ossifying fibromyxoid tumor
• Lipoma
• Chondroma
• Fibroma
• Neuroma
• Schwannoma
 How to differentiate :
• Biopsy

43. NEUROFIBROMA
 Clinical features :
• Slow-growing, soft, painless lesions.
• vary in size from small nodules to
larger masses.
• Unilateral macroglossia

46.  Histopathological feature :
• Interlacing bundles of spindle-shaped cells
that often exhibit wavy nuclei.
• Mast cells tend to be numerous and can be
a helpful diagnostic feature.

47. Neurofibroma. High-power view showing spindle-shaped cells
with wavy nuclei.

48.  D.D :
• Lingual thyroid.
• Lipoma.
• Hemangioma.
• Vascular malformations.
• Infection of tongue.
• Schwannoma.
• Malignant neoplasm.
 How to differentiate :
• Biopsy.

49. PYOGENIC GRANULOMA
 Tumor like growth of the oral cavity.
Clinical features :
• Smooth or lobulated mass that is usually
pedunculated.
• Usually red, ulcerated, easily bleeding.

50. Pyogenic granuloma. Ulcerated and lobulated mass on the
dorsum of the tongue.

52. Histopathological features :
• Numerous small and larger endothelium-lined
channels are formed that are engorged with red
blood cells.
• These vessels sometimes are organized in lobular
aggregates.

53. Pyogenic granuloma. Higher-power view showing capillary blood
vessels and scattered inflammation.

54.  D.D :
• Squamous cell papilloma.
• Hemangioma.
 How to differentiate :
• Biopsy.
• Clinical presentation.

55. Malignant non odontogenic
epithelial tumors

56. Squamous cell carcinoma
 Clinical features :
• Painless, indurated masses or ulcers of the
posterior lateral border
• Tumor with rough, granular, irregular surface
• Its color may vary from normal to red to white.
• 20% occur on anterior lateral or ventral
surfaces.
• 4% occur on the dorsum.
• The tumor feels hard (indurated) on
palpation

57.  Squamous cell carcinoma.
• An exophytic lesion of the posterior lateral tongue
demonstrates surface nodularity and minimal surface
keratin production. It is painless and indurated.

58.  Squamous cell carcinoma.
• Ulcerated, exophytic mass of the posterior lateral border of
the tongue.

60. Histopathological features :
• Well differentiated :
Islands of tumor cells with abundant keratin
formation forming keratin pearls.
• Moderately differentiated :
Epithelial Islands with little keratin formation.
• Poorly differentiated :
Tumor cells scatered through the connective
tissue with many signs of cellular atypia.

61. Well-differentiated squamous
cell carcinoma.

62. Moderately differentiated squamous cell carcinoma.

63. Poorly differentiated squamous cell carcinoma.

64. Salivary gland diseases

65. MUCOCELE (MUCUS
EXTRAVASATION PHENOMENON)
Clinical features :
• Usually on the anterior ventral surface
• Dome-shaped mucosal swellings.
• The swelling is bluish in color.
• Fluctuant on palpation.

69.  Histopathological features :
• The mucocele shows an area of spilled
mucin surrounded by a granulation
tissue response.

70. Mucocele. Mucin filled cyst like cavity beneath the
mucosal surface.

71.  D.D :
• Hemangioma.
• Lympangioma.
• Lipoma.
• Soft tissue abscess.
 How to differentiate :
• Biopsy.
• History taking.

72. Malignant salivary gland
tumors

73. MUCOEPIDERMOID CARCINOMA
 Clinical features :
• Asymptomatic swellings, fluctuant.
• Have a blue or red color that can be
mistaken clinically for a mucocele.

74. Mucoepidermoid carcinoma. Mass of the tongue.

77.  Histopathological features :
• Low-grade tumors show prominent cyst
formation, minimal cellular atypia, and a relatively
high proportion of mucous cells.
• High-grade tumors consist of solid islands of
squamous and intermediate cells, which can
demonstrate considerable pleomorphic and mitotic
activity.
• Intermediate-grade tumors show features that
fall between those of the low-grade and high-grade
neoplasms.

78. Mucoepidermoid carcinoma. This low-grade tumor
shows numerous large mucous cells surrounding a cystic
space.

79. Reference
1. Neville B., Damm D., Allen C and Bouquot J: (2016) Oral
and Maxillofacial Pathology, 4th edition, Saunders
Elsevier. ISBN-9788131215708.
2. Differential diagnosis of dental diseases ,Priya Verma
Gupta ,JAYPEE (2008) First edition.