What causes palpable lingual nodules and papules?
Many entities, with most being variants of normalcy, but some being harbingers of malignancy.
Circumvallate papillae: These may become so prominent at times to appear suspicious. Easily
visualized by having the patient protrude the tongue, they are entirely normal.
Lingual thyroid: Another benign but more unusual entity, this is the vestigial remnant of the thyroid’s
embryologic site, before the gland migrated down to the front of the neck during the first trimester of pregnancy (failure to migrate causes a lingual thyroid; excessive migration causes instead a
mediastinal/substernal thyroid). It presents as a smooth, round, and red midline nodule at the base of
the tongue. Lingual thyroids are four times more common in females, typically asymptomatic, and
rarely >1 cm (even though at times they may exceed 4 cm). Larger lesions may interfere with swallowing and respiration, and even present with a typical “hot potato speech.” Also, up to 70% of patients may have
hypothyroidism, and 10% cretinism. A lump of this sort in a teenage or young adult should never be
removed, but instead diagnosed by confirming iodine uptake on radionuclide scan.
Lingual tonsils: Reddish and smooth-surfaced nodules/papules on the posterior lateral border of the
tongue in the foliate papilla area. Normal, albeit hypertrophic, lymphatic tissue.
Papilloma: Soft, well-circumscribed, and pedunculated nodule that originates in the lingual
mucosa and may achieve relatively large size. Caused by the human papilloma virus.
Carcinoma: Any nontender, firm, and whitish plaque, papule, or nodule (even ulcer) should be
considered neoplastic until proven otherwise.
Carcinomas, especially squamous cell, tend to involve the lateral aspects of the tongue; hence, they
may be missed by haphazard examinations.
Many entities, with most being variants of normalcy, but some being harbingers of malignancy.
Circumvallate papillae: These may become so prominent at times to appear suspicious. Easily
visualized by having the patient protrude the tongue, they are entirely normal.
Lingual thyroid: Another benign but more unusual entity, this is the vestigial remnant of the thyroid’s
embryologic site, before the gland migrated down to the front of the neck during the first trimester of pregnancy (failure to migrate causes a lingual thyroid; excessive migration causes instead a
mediastinal/substernal thyroid). It presents as a smooth, round, and red midline nodule at the base of
the tongue. Lingual thyroids are four times more common in females, typically asymptomatic, and
rarely >1 cm (even though at times they may exceed 4 cm). Larger lesions may interfere with swallowing and respiration, and even present with a typical “hot potato speech.” Also, up to 70% of patients may have
hypothyroidism, and 10% cretinism. A lump of this sort in a teenage or young adult should never be
removed, but instead diagnosed by confirming iodine uptake on radionuclide scan.
Lingual tonsils: Reddish and smooth-surfaced nodules/papules on the posterior lateral border of the
tongue in the foliate papilla area. Normal, albeit hypertrophic, lymphatic tissue.
Papilloma: Soft, well-circumscribed, and pedunculated nodule that originates in the lingual
mucosa and may achieve relatively large size. Caused by the human papilloma virus.
Carcinoma: Any nontender, firm, and whitish plaque, papule, or nodule (even ulcer) should be
considered neoplastic until proven otherwise.
Carcinomas, especially squamous cell, tend to involve the lateral aspects of the tongue; hence, they
may be missed by haphazard examinations.