A 65-year-old male presented to us with a painful, progressively increasing swelling of the tongue of 8 months duration. There was no history of cough, fever, dysphagia, or weight loss. He was a nonsmoker, but a tobacco chewer for the past 15 years. He was an alcoholic since past 15 years. He was not a known case of diabetes mellitus, but a hypertensive since past 4 years and was on regular treatment for it. On examination, patient was well built with good general condition. Examination of oral cavity revealed an 8 × 6 cm firm swelling over the left side of anterior 2/3rd of tongue, crossing the midline, with smooth surface and well-defined margins. The lesion apparently looked like hemimacroglossia (). There was no deviation of tongue, with all movements being normal. No lymphadenopathy was found in the neck. Systemic examination did not reveal any abnormal findings. Clinical suspicion of submucosal carcinoma of tongue was entertained. Complete blood count was within normal limits. ESR was found raised to 35 mm in first hour. A deep punch biopsy from lateral aspect of the lesion was taken, which revealed granulomatous inflammation suggestive of tuberculosis (). Acid fast bacilli were found in Ziehl-Neelsen stained sections (). A histopathological diagnosis of tuberculosis was made. Mantoux test performed with PPD antigen measured 18 mm after 72 hours reading. ELISA test for HIV was nonreactive. Chest X-ray was within normal limits. With a final diagnosis of primary tuberculoma of tongue, patient was started on antitubercular therapy with a four drug regimen for 6 months. Dramatic improvement was observed within 2 months of therapy. Size of the lesion was significantly reduced, from an apparent hemimacroglossia to a small nodular lesion. After 6 months the patient was completely cured and is on regular followup with no residual or recurrent lesion.
This 47-year-old male presented with a non-healing tongue ulcer of 3 months’ duration and associated pain for 2 months. He had initially noticed the asymptomatic ulcer on the ventral surface of tongue which had been increasing in size for the last 1 month. He had smoked beedis for the last 20 years and had consumed alcohol daily for past 15 years. On examination, ulcers were noticed in the tongue and buccal mucosa. A solitary ulcer (3 cm × 4 cm) with undermined edges and minimal induration was seen on right ventral surface of the tongue extending from the midline past the lateral border, up to the dorsal area of the anterior two-thirds of the tongue []. The area adjacent to the tongue ulcer appeared to be lobulated. Another ulcer (0.5 cm × 0.5 cm), also with an undermined edge was seen on the dorsal surface of tongue. In the left buccal mucosa, a single ulcer (1 × 1 cm2) covered with pseudomembrane was present, extending 3 cm from the angle of the mouth and 5 mm below the occlusal plane []. The patient was not aware of this ulcer. A single firm, non-tender (<1 cm) sub-mandibular lymph node was present on the right side.\nProvisional diagnoses of squamous cell carcinoma and lichen planus were given for the lesions of the tongue and buccal mucosa, respectively. Incisional biopsy from the edge of tongue ulcer revealed proliferating epithelium with the underlying connective tissue exhibiting chronic inflammatory cell infiltrate without evidence of epithelial dysplasia or malignant invasion. Biopsy was repeated from a different area of the tongue ulcer for further review. On examining serial sections, giant cells with peripherally arranged nucleus resembling Langerhans cells were appreciated along with caseous necrosis []. Chest radiography revealed bilateral upper lobe infiltrates [], and sputum was positive for acid-fast bacilli. HIV was negative. With anti-tuberculous therapy the lesions began to heal on a follow-up visit a month later. He was referred to local primary health care center for continuation of therapy.