Foreign body granuloma in the tongue differentiated from tongue cancer: A case report

BACKGROUND: Embedded foreign bodies in the tongue are rarely seen in clinical settings. An untreated foreign body can cause a granuloma which often presents as an enlarged tongue mass. However, if foreign body ingestion status is unknown, physical examination and magnetic resonance imaging (MRI) tend to lead to suspicion of tongue cancer, especially in older patients. Thus, differential diagnosis of an enlarged tongue mass is important, especially because it is closely related to the choice of treatment method. CASE SUMMARY: A 61-year-old woman was admitted to the hospital with pain and noticeable swelling in the tongue that had persisted for over 1 mo. She had no previous medical history. MRI revealed abnormal signal intensities that were indicative of a neoplasm. Thus, the oral surgeon and radiologist arrived at a primary diagnosis of tongue cancer. The patient visited the Ear Nose and Throat Department for further consultation and underwent an ultrasound examination of the tongue. The ultrasonography was consistent with a linear hyperechoic foreign body which was indicative of an embedded foreign body (bone) in the tongue, even though the patient denied any history of foreign body ingestion. Complete surgical enucleation of the lesion was conducted. The mass which included a fish bone was completely removed. The post-operative pathological examination confirmed that the mass was a granuloma containing collagen fibers, macrophages and chronic inflammatory cells. The patient recovered without complications over a 2 mo follow-up period. CONCLUSION: We report a rare case of foreign body granuloma in the tongue that was primarily diagnosed as tongue cancer. The MRI and ultrasound examinations revealed a piece of bone in the left lateral aspect of the tongue. The granuloma, which contained a fish bone, was completely removed via surgery and confirmed via biopsy. Differential diagnosis of the enlarged tongue mass was critical to the selection of treatment method.