A 35-year-old female housewife presented with a 2-month history of a right-sided tongue swelling that had been increasing in size. On examination, a 6x5 cm firm mass was found on the right ventral surface of the tongue, extending to the sublingual area. Differential diagnoses included ranula, dermoid cyst, hemangioma, and minor salivary gland tumors. Laboratory tests were normal. An ultrasound and CT neck were planned to further investigate the mass, and an incisional biopsy was scheduled for the following week to determine the nature of the swelling.

1. Dr. Arwa Osman M. Elmahi

2. Name : N. M. A.
Age : 35 years .
Gender : female .
Occupation : housewife .
Residence : Kadugli .

3. c/o :
Rt. Side tongue swelling / 2 months.

4. HPI :
 The condition started 2 months ago when accidentally patient
feel lump in mouth in right side of undersurface of tongue, not
painful or tender , increased progressively in size over two
months. She has no lump in the rest of oral cavity , no ulcers in
mouth .
 The lump interfere the mastication so she took semisolid and
liquid feed. Also she had slurred speech.
 She didn’t suffer from dry throat or sore throat , there is no
odynophagia , dysphagia no neck swelling.
 There is no change of voice or S.O.B ,no chocking.
 No epistaxis or nasal obstruction ,no nasal discharge or post
nasal drip and she had normal smell .

5.  No decrease in hearing ,no earache or aural discharge .No
vertigo or tinnitus .
 No nasal symptoms
 No facial numbness ,pain or swelling .
 She had normal vision . No headache , no fever night
sweat or loss of weight .
 No cough ,chest pain ,palpitation or hemoptysis .

6. systemic review:

 CVS /
 Resp. / unremarkable
 GIT /
 GU /

7. PMH :
She is not known asthmatic , diabetic or hypertensive .
No history of hospitalization .
No history of surgical operation or blood transfusion .
Family history :
No history of similar condition . No history of HTN, DM
,bronchial asthma or chronic cough .

8. Social history :
She is of moderate socioeconomic class , not smoker, or
alcoholic .
She had no health insurance .

9.  Drug history :
she is not to be allergic to any drug known by her .
Not on long term medications .

10. Summary :
 35 years old female pt. presented complain of Rt. Side
tongue mass in ventral aspect for two months increase
progressively in size . Interfere with mastication and
had slurred speech
 No odynophagia , dysphagia ,or neck swelling
 No fever or weight loss .

11. Differential diagnosis:
 Ranula
 Dermoid cyst
 Hemangioma
 Minor salivary gland tumors

12. Examination :
Pt. looks well , not pale , jaundiced ,not cyanosed .
PR: 80 b/m
RR: 18 C/M .
BP : 120/80 mmHg .

13.  Oral cavity :
Pt. had normal lips and teeth , normal buccal mucosa
,normal gingiva. Adequate mouth opening
There is mass in rt. Side of ventral surface of tongue
measures about 6*5 , extend to sublingual area well defined
edges , not tender ,firm in consistency, mucosa over it is
normal ,no discharge sinus ,not compressible
.mobile tongue ,no fasciculation or wasting.
Intact hard palate
Mobile soft palate
Oropharynx :
Normal .

14.  IDL:
 Unremarkable

16.  Neck examination :
No palpable lymph nodes .
No thyroid enlargement .
Trachea is central .

17.  Nasal ex. :
Normal .
Cold spatula test :
Anterior rhinoscopy:normal
Post. Rhinoscopy : free nasopharynx
 Ear ex. :
Normal bilaterally .
 Cranial nerves :
Are intact .
Systemic examination :
Normal

18. Investigation :
 CBC : normal .
 ESR : 10 mm/h .
 RFT and electrolytes : normal .
 RBS : 90 mg /dl .
 Urinalysis : clear .
 ECG : normal .
 Chest x-ray : normal .

19.  Radiological study :
Ultra sound.

21.  CT neck

23. pt. plan for incisional biopsy next week

24. Thanks ..