Granular Cell Tumour — ORE Part 1 MCQ

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HardOral PathologyGranular Cell TumourORE Part 1

A 35-year-old patient presents with a painless well-circumscribed swelling on the dorsum of the tongue. It is firm and approximately 15 mm in diameter. The overlying mucosa is smooth and normal. What is the most likely diagnosis?

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Correct answer: A — Granular cell tumour

Explanation lettering: E = shown as B · B = shown as D · D = shown as E

The correct answer is A: Granular cell tumour (GCT). The clinical presentation is classic for GCT: it occurs most commonly on the dorsum of the tongue (81% of cases), typically affects female adults around age 33–35 years, presents as an asymptomatic firm nodule (89.3% are asymptomatic), and measures 5–20 mm. Crucially, the overlying mucosa is smooth and normal, which is characteristic of GCT. Option B (squamous cell carcinoma) is excluded because SCC typically presents with ulceration, erythroleukoplakia, or dysplastic mucosal changes, not smooth normal mucosa. Although GCT can occasionally show pseudoepitheliomatous hyperplasia mimicking SCC histologically, the clinical presentation here—smooth, non-ulcerated, normal-coloured mucosa—is not consistent with SCC. Options C, D, and E are less common in this location and lack the strong anatomical predilection for the tongue dorsum that GCT exhibits. GCT is a benign Schwann cell–derived neoplasm and requires no treatment unless symptomatic; definitive diagnosis is histopathological.

Reference: Bubola JL, et al. Oral granular cell tumors: an analysis of the clinical and histopathologic features of 126 tumors. Oral Surg Oral Med Oral Pathol Oral Radiol. 2024. https://pubmed.ncbi.nlm.nih.gov/40254476/