case_images: PMC10635748_01
case_images: Clinical findings of the patient. (a) A mass lesion of the tongue. An exophytic mass measuring 20 mm in diameter was observed on the right side of the tongue (arrowheads), which was surrounded by a flat white leukoplakia-like lesion (dotted line). (b) Magnetic resonance imaging with gadolinium contrast. Enhancement of the lesion (white arrowheads) at the right edge of the tongue is observed. The tumor measured approximately 4 mm in thickness. (c) Ultrasound examination. An enlarged lymph node was detected in the superior internal jugular node area. The node was round and showed internal heterogeneous echoes; therefore, it was suspected as a metastasis. (d) Computed tomography with contrast. An enlarged lymph node is seen on the right side of the neck, containing a low-density area within and an enhancing edge, similar to the characteristic findings of lymph node metastasis from squamous cell carcinomas.
case_images: CRIOT2023-9469814.001.jpg
case_images: PMC10635748_01_CRIOT2023-9469814.001.jpg
case_images: fig1
case_images: Physical examination of the patient at our hospital revealed a mass lesion in the tongue measuring approximately 20 mm in diameter, with a 45-mm flat white leukoplakia-like lesion at the right edge of the tongue (Figure 1(a)); contrast-enhanced MRI showed enhancement of the tongue lesion, which measured 4 mm in thickness (Figure 1(b)). Ultrasound examination showed a right cervical mass with internal heterogeneous echoes (Figure 1(c)). Contrast-enhanced CT revealed an enlarged right deep cervical lymph node with central necrosis (Figure 1(d)).
case_images: Pathological findings. (a) Hematoxylin and eosin staining of the tongue lesion. Reactive nuclear enlargement of the epithelial cells is seen, accompanied by neutrophilic infiltration of the epithelium and plasma cells into the subepithelial layer. No evidence of malignancy was detected. Scale bar = 200 mum. (b) Immunohistochemical staining of the tongue lesion for Treponema pallidum (TP). Numerous spirochetes are seen within the epithelium. Scale bar = 100 mum. (c) Hematoxylin and eosin staining of the suspected metastatic lymph node. Epithelioid cell granulomas with necrosis at the center of fibrotic changes are observed. Scale bar = 100 mum. (d) Immunohistochemical stain of the lymph node for TP: multiple spirochetes are seen. Scale bar = 50 mum.
case_images: CRIOT2023-9469814.002.jpg
case_images: PMC10635748_01_CRIOT2023-9469814.002.jpg
case_images: fig2
case_images: The findings of postoperative histopathology of the resected specimen are described in Figure 2.