CLINICALLY SIMILAR BUT NOT THE SAME: 2 LINGUAL SWELLING

Abstract

<h3>Introduction</h3> The presence of lingual lesions in pediatric patients represents a diagnostic challenge, since most of these may feature a similar clinical presentation but unique histopathologic characteristics. <h3>Case Report</h3> Case #1, a 4-year-old female patient with a lingual swelling of approximately 3 cm located on the anterior and middle third of the ventral surface of the tongue. The patient's parents refer that this lesion has been present since birth but has grown significantly during the last year. TC scan shows a circumscribed hypodense lesion; a yellow and brown doughy material was seen on gross examination. The histopathologic final diagnosis was dermoid cyst. Case #2, an 8-year-old female patient presented with an asymptomatic swelling of approximately 7 cm in the middle third of the tongue, with a soft consistency and 2-year evolution. An excisional biopsy was performed; a mucoid material was seen on gross examination. The final diagnosis was a lingual cyst with a respiratory epithelium. <h3>Discussion</h3> Only 34 cases of lingual cyst with respiratory epithelium have been reported. This is a congenital cyst characterized by the presence of pseudostratified columnar ciliated epithelium with mucus secreting cells PAS+, while the dermoid cyst produces keratin, and its capsule contains cutaneous annexes. The treatment for both lesions includes complete surgical enucleation. <h3>Conclusions</h3> The presence of lingual lesions must include differential diagnoses such as epidermoid cyst, dermoid cyst, mesenchymal tumors, mucocele, lymphangioma, hemangioma, and choristomas. Another rare differential diagnosis to consider is congenital cysts with respiratory or gastric lining.