Asymptomatic pinkish-red nodule in the posterior tongue
The present case has been reported in the Journal of Cutaneous and Aesthetic Surgery.

A 28-year-old man presented with otherwise completely asymptomatic fleshy swelling over the posterolateral surface of right side of tongue for 6 months. He denied addictions such as chewing of betel nut/tobacco and smoking.

Despite lack of symptoms, the patient was anxious about the lesion being oral cancer. Intraoral examination revealed an oval nodular swelling of 1×2cm size in the foliate papillae of the right posterolateral tongue. The pinkish-red nodule was firm, non-tender, and had subtle transverse grooves and superficial erosion over the surface.

Histopathology revealed numerous oval and spindle-shaped cells in the lamina propria arranged as circumscribed nodules. Within the circumscribed neural plexus, the deepest portion showed small nerve fascicles and the superficial portion revealed linear bundles of spindle cells interspersed with thin fibrillary collagen fibers. Abundant lymphatic tissue with germinal centers was conspicuous.

The patient was diagnosed with Subgemmal Neurogenous Plaque (SNP).

Learning Points:-
• SNP typically arises in foliate papillae as an asymptomatic pinkish nodule or a frankly exophytic lesion, sometimes accompanied by trauma-induced ulceration.

• Histological hallmark of SNP is subepithelial proliferation of nerve plexus with aggregates of ganglion cells with a biphasic microscopic pattern comprising a circumscribed nerve plexus and spindle cells.

• Clinical differentials include soft tissue lesions such as inflammatory fibrous hyperplasia, fibroma, neurofibroma and mucosal neuroma, and hyperplastic lingual tonsils and lingual thyroid.

• Neurofibroma, traumatic neuroma, and mucosal neuroma are often confused on histopathology because of the abundant neuronal cells.

• Awareness about this condition is imperative for clinicians and pathologists to avoid misdiagnosis and prevent unnecessary procedures.

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