Tumeur bénigne de la cavité buccale: granulome idiopathique de la langue

The diagnosis of granuloma of the oral cavity can favour the detection of several diseases such as sarcoidosis, Crohn's disease, tuberculosis, syphilis and malignant tumors. In Melkerson Rosenthal syndrome it has an idiopathic origin. In this regard, we here report an original case of idiopathic granuloma of the tongue not secondary to Melkerson Rosenthal syndrome and being part of benign tumors of the oral cavity. The study involved a 60-year old female patient, with no particular past medical history, presenting with discomfort during mastication secondary to a swelling on the free edge of the tongue which had occurred one month before her admission. Physical examination showed overgrowth at the level of the right edge of the tongue measuring 15 mm along its longer axis. The tongue was not plicated and there was no cervical adenopathy. The remainder of the physical examination was normal. MRI of the oral cavity showed suspected necrotizing tissue lesion on the right free edge of the mobile tongue measuring 15x12x19 mm without signs of extension to the ipsilateral lingual pedicle or to the floor of the oral cavity and without cervical adenomegalies. Biopsy of tongue lesion showed gigantocellular epithelioid granulomas without caseous necrosis or histological signs of malignancy. Biologically, there was no inflammatory syndrome, leukopenia or lymphopenia. The assessment of an underlying cause was negative: syphilis serology, evaluation of phosphocalcic profile, dosing of the angiotensin-converting enzyme, intradermo tuberculin reaction, chest radiograph, thoracoabdominopelvic CT scan and ophthalmological examination. Finally, the diagnosis of idiopathic granuloma was retained in the absence of arguments in favor of its secondary nature.