Solitary Condyloma Acuminatum of the Dorsal Tongue: An Atypical Presentation and Diagnostic Challenge

TL;DR

A rare case of a small, HPV-negative lesion on the tongue was diagnosed as condyloma acuminatum, highlighting the challenges in diagnosing atypical oral lesions.

Contribution

This case emphasizes the limitations of HPV testing and the need for combined clinical, histological, and molecular evaluation in atypical oral lesions.

Findings

A 2 mm lesion on the tongue was diagnosed as condyloma acuminatum despite negative HPV DNA testing.

Histopathology showed papillomatosis, acanthosis, and koilocytosis, confirming the diagnosis.

The case highlights the complexity of interpreting HPV test results and the importance of integrated diagnostic approaches.

Abstract

Solitary papillary lesions of the oral cavity may present diagnostic challenges, particularly when arising in uncommon locations, such as the dorsal surface of the tongue, and in the absence of other mucocutaneous involvement. We report the case of a 55-year-old male patient with a small, asymptomatic, sessile lesion on the dorsum of the tongue, measuring approximately 2 mm in height. The lesion appeared white, standing in sharp contrast to the surrounding erythematous mucosa, drawing attention despite its diminutive size. Clinical appearance suggested a benign proliferation, and human papillomavirus (HPV) DNA testing via real-time polymerase chain reaction (PCR) for a broad panel of high- and low-risk genotypes returned negative results. However, histopathological examination revealed features consistent with condyloma acuminatum, including papillomatosis, acanthosis, and scattered koilocytosis in the spinous layer. This discordance between molecular and histological findings underscores the diagnostic limitations of HPV testing and the complexity of interpreting viral clearance, which may reflect true elimination, low viral load below the assay’s detection threshold, latency, or inadequate sampling. These considerations highlight the importance of integrating clinical, histological, and molecular findings in the evaluation of atypical oral lesions.

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