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Journal of Indian Association of Pediatric Surgeons
     Journal of Indian Association of Pediatric Surgeons
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Table of Contents   
CASE REPORT
Year : 2023  |  Volume : 28  |  Issue : 1  |  Page : 82-83
 

Dermoid cyst of tongue masquerading as a lingual neurofibroma


Department of General Surgery, Rural Medical College, Loni, Maharashtra, India

Date of Submission06-Sep-2021
Date of Decision19-Jun-2022
Date of Acceptance30-Jul-2022
Date of Web Publication10-Jan-2023

Correspondence Address:
Varsha Pattanaik
Department of General Surgery, Rural Medical College, Loni, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jiaps.jiaps_187_21

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   Abstract 


Dermoid cysts of the tongue are rare lesions of the head-and-neck region with only 16 reported cases in the English literature to date. We describe a 5-year-old girl who presented with a swelling in her tongue. Imaging done earlier was reported as a neurofibroma. It turned out to be a dermoid cyst. This was the first such case at our institute and this article reviews the literature and describes the said case in detail.


Keywords: Cyst, dermoid, tongue


How to cite this article:
Pattanaik V, Palagani R, Gharpure V. Dermoid cyst of tongue masquerading as a lingual neurofibroma. J Indian Assoc Pediatr Surg 2023;28:82-3

How to cite this URL:
Pattanaik V, Palagani R, Gharpure V. Dermoid cyst of tongue masquerading as a lingual neurofibroma. J Indian Assoc Pediatr Surg [serial online] 2023 [cited 2023 Feb 8];28:82-3. Available from: https://www.jiaps.com/text.asp?2023/28/1/82/367386





   Introduction Top


Dermoid cysts are uncommon lesions in the head and neck. About 7% of all dermoid cysts are present in this region, usually observed in the lateral third of the eyebrow, followed by the floor of the mouth, and rarely in the tongue with only 16 cases reported in the literature.[1] Dermoid cysts are derived from ectodermal elements and are benign, slow-growing tumors that are typically present as painless swelling in the tongue or the floor of the mouth but may cause complications of inflammation or dysphagia, dystonia, and airway encroachment due to mass effects. The etiology of these cysts is still controversial.[2]

Usually, lingual dermoid cysts are discovered at birth or in 1st year of life.[3] However, if they lie on the ventral aspect of the tongue, their clinical appearance will be later, in childhood or early adult life. The only effective treatment for dermoid cyst of the tongue is complete enucleation. Histological examination distinguishes this entity from other swellings in the oral cavity.


   Case Report Top


A 5-year-old girl presented with complaints of a swelling on the left lateral aspect of the tongue since birth, which gradually increased in size. The lesion was painless and did not interfere with speech, swallowing, or salivation.

On local examination, there was a swelling measuring around 3 cm × 2 cm × 1 cm on the left lateral aspect of the tongue, ovoid with regular borders and smooth surface. On palpation, it was firm in consistency, noncompressible, and nontender.

Magnetic resonance imaging (MRI) of the head, neck, and face done earlier was suggestive of a well-defined, discrete, hypointense cystic lesion in the muscle of the tongue suggestive of schwannoma, neurofibroma, or hemangioma as shown in [Figure 2].
Figure 1: Histopathological image of the surgical specimen

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Figure 2: MRI image of the lesion. MRI: Magnetic resonance imaging

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At this time, the differential diagnosis includes hemangioma, fibroma, schwannoma, or neurofibroma of the tongue.

The patient was admitted for surgery to excise the lesion. Under general anesthesia with endotracheal intubation, the swelling was aspirated with the needle to check for contents. No contents were obtained. Palpation under anesthesia showed the lesion to be discrete and mobile. Hence, the plan was modified and excision without resecting the part of the tongue was attempted. The incision on the lateral aspect of the tongue showed the tumor to be separate from the muscle. With gentle blunt dissection, the tumor was freed from all attachments and was removed in toto, when it was observed that it was a cyst. It contained cheesy white material. The tongue was sutured in single layer with interrupted sutures of 3–0 vicryl.

The patient started feeding after 24 h and made an uneventful recovery.

Gross pathological evaluation revealed a 3 cm × 1 cm × 1 cm thin-walled, unilocular cystic mass filled with keratin debris.

Histopathology showed a cystic lesion with cavity lined by stratified squamous epithelium, hyperorthokeratinized, and suggestive of a dermoid cyst as shown in [Figure 1].


   Discussion Top


Dermoid cysts are rare lesions in the head, neck, and face region, usually diagnosed at birth or in the 1st year of life, and are believed to arise congenitally from entrapment of ectodermal tissue during midline closure of the first and second branchial arches. In the tongue region, these lesions may be formed by remnants of the tuberculum impar.[4] They present as a discrete and painless swelling in the oral cavity which may or may not interfere with speech and mastication. Differential diagnosis includes hemangioma, schwannoma, neurofibroma, and perineurioma which is difficult to determine preoperatively. Irrespective of clinical diagnosis, all such patients require excision and diagnosis is usually confirmed on postoperative histopathology report. Computed tomography (CT) or MRI imaging best delineates the internal architecture of dermoid cysts and facilitates exact visualization of the location of the lesion in relation to the surrounding anatomy to guide surgical management. The mylohyoid muscle separates the sublingual from submental and submandibular spaces and is a key landmark used to determine whether an intraoral or cervical approach is most suitable during surgery. Lesions above the mylohyoid are typically operated on intraorally, whereas those below the muscle are removed using a cervical approach.

The case discussed above is of a 5-year-old girl with discrete tongue swelling since birth without any functional deficit which was identified clinically as a dermoid cyst intraoperatively which was later confirmed on a histopathology report. It was therefore excised, and the patient recovered well postoperatively with no impairment in speech or appearance.


   Conclusion Top


Dermoid cysts in the tongue are quite rare and need to be differentially diagnosed from numerous other diseases and conditions of the area. This is accomplished by thorough clinical examination aided by radiological examinations such as CT scan and MRI. They are managed by carefully planned surgical excision. The definitive confirmation and diagnosis of the disease are always achieved with histopathology. From the present case, it is concluded that such type of case needs to be reported as it calls importance to the importance of keeping the rarities in mind along with more prevalent lesions while making a diagnosis.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Chaari CM, Ho BT, Biller HF. Lingual dermoid cyst. Otolaryngol Head Neck Surg 1995;112:476-8.  Back to cited text no. 1
    
2.
Longo F, Maremonti P, Mangone GM, De Maria G, Califano L. Midline (dermoid) cysts of the floor of the mouth: Report of 16 cases and review of surgical techniques. Plast Reconstr Surg 2003;112:1560-5.  Back to cited text no. 2
    
3.
Lin HW, Silver AL, Cunnane ME, Sadow PM, Keiff DA. Lateral dermoid cyst of floor of mouth, unusual radiologic and pathologic findings. Auris Nasus Larynx 2011;38:650-3.  Back to cited text no. 3
    
4.
Woo SB. Oral Pathology: A Comprehensive Atlas and Text. 2nd ed. Philadelphia, PA: Elsevier; 2016..  Back to cited text no. 4
    


    Figures

  [Figure 1], [Figure 2]



 

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    Abstract
   Introduction
   Case Report
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    References
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