Ectomesenchymal Chondromyxoid Tumour of the Dorsal Tongue Presenting with Impaired Speech

Abstract

Ectomesenchymal chondromyxoid tumours (ECTs) are rare mesenchymal soft tissue neoplasms that typically present as a slow-growing asymptomatic mass on the anterior dorsum of the tongue. Our patient presented with impaired speech articulation and pain associated with upper respiratory tract infections when the lesion on his dorsal tongue would swell, and he would accidentally bite down on it. Microscopically, ECTs appear as unencapsulated, well-circumscribed proliferations of uniform round to fusiform cells embedded within chondromyxoid matrices. Most cases of ECT have been detected in the third to the sixth decades of life, with no sex preference. ECT may cause a range of symptoms that negatively impact patients' quality of life, including pain, dysphagia, odynophagia, bleeding, and, in the case of our patient, impairment of speech. We provide a unique preoperative clinical photograph and case description that should help readers in recognizing this neoplasm. Considering the rarity of ECT presenting clinically as well as in the literature, we believe this report will add to our growing understanding of ECT and its management. We report a case of ECT presenting on the anterior dorsal tongue that was successfully surgically resected under local anesthesia with clear margins, accompanied by a review of the pertinent literature.

Ectomesenchymal chondromyxoid tumor: a comprehensive updated review of the literature and case report

“…In 63 cases (85.1%) data concerning the location were given. 1 – 28 , 30 , 31 Fifty-six lesions occurred on the anterior part of the tongue, and four lesions on the posterior part; the remaining three lesions were only reported to be on the dorsum of the tongue but without further positional information. Of the “anterior cases” 26 could be found in males and 24 in females.…”

“…In 47 cases the size of the lesions could be determined by clinical inspection; they ranged in size from 3 to 50 mm (mean 13.6 mm). Of them, 45 were located on the anterior aspect of the tongue and ranged in size from 3 to 50 mm (mean 13.3 mm) 1 – 3 , 5 – 7 , 9 – 24 , 26 , 28 , 30 , 31 ; the two lesions on the posterior tongue each had a diameter of 20 mm. 4 , 16 In the 31 cases (exclusively anterior lesions) that described the impression of palpation, 19 cases were described as firm 1 , 2 , 5 , 7 , 9 , 10 , 12 – 14 , 16 , 17 , 20 , 23 , 26 , 31 , 1 as soft 1 , 1 cystic, 1 1 firm-cystic 1 , 4 elastic, 3 , 18 , 19 , 22 2 non-tender 24 , 28 , 1 tender 20 , 1 firm-cystic 1 , 1 soft-cystic.…”

“…In 54 of 74 cases the lesions were removed in toto by excision 1 – 3 , 5 – 22 , 24 – 26 , 28 , 30 , 31 , whereas in the remaining cases there was no information on the nature of the surgical procedure. 2 , 4 , 13 , 27 …”

“…For 74 lesions, only partial information was available for the following parameters: 61 lesions were described as circumscribed 1 – 3 , 5 – 8 , 10 , 11 , 13 – 23 , 26 , 28 – 31 and 37 as lobular/nodular 1 , 2 , 7 , 8 , 12 – 14 , 17 , 19 , 22 – 24 , 26 , 28 , 30 ; 44 lesions revealed a growth pattern forming cords, strands, and net-like structures. 1 , 3 , 5 , 6 , 8 , 14 , 16 , 17 , 20 – 27 , 31 All lesions showed a mixture of varying numbers of round, spindled, ovoid, and fusiform cells. 1 – 3 , 5 – 31 Among them four lesions also exhibited epithelioid cells.…”

“…At present 74 lingual cases have been reported in the English and German literatures, nearly equally affecting males and females with a mean age of 39.3 years. 1 – 31 The term “ectomesenchymal chondromyxoid tumor,” given in the first relevant publication, is descriptive, based on the presumption of tumor origin from migrated ectomesenchymal cells of the neural crest, and on histological and immunohistological features. 1…”