Lymphoid Hyperplasia of the Posterior-Lateral Tongue

Lymphoid hyperplasia of the lateral lingual tonsils: The multinodular peach-colored tissue of the posterior lateral tongue (circle) represents hyperplastic lymphoid tissue. The color is due to the presence of lymphocytes below the surface epithelium. The tissue was soft, bilateral and symmetrical. (from Non-HPV Papillary Lesions of the Oral Mucosa: Clinical and Histopathologic Features of Reactive and Neoplastic Conditions)

The lateral lingual tonsils are aggregates of lymphoid tissue located bilaterally on the posterior-lateral surfaces of the tongue, related to the foliate papillae. Together, the foliate papillae and these lymphoid aggregates can give a pebbly or micronodular appearance to the posterior regions of the lateral surfaces of the tongue. When the lateral lingual tonsils are hypertrophic, they form clustered, nontender papules that may appear yellow or peachy when the lymphoid tissue is close to the surface; or pink-red when the tissue is deeper. The cause of lingual tonsil hypertrophy (LTH) is unclear. One research group found that young age, smoking and severe laryngopharyngeal acid reflux were associated with the development of LTH.

The diagnosis of LTH can usually be made based on the clinical appearance and history. To the unexperienced examiner, the color and texture change can resemble oral squamous cell carcinoma (OSCC). However, the bilateral, symmetrical location and soft texture of this tissue should be reassuring. A biopsy can be performed if there is any doubt regarding the clinical diagnosis. Histopathologically, follicular lymphoid hyperplasia is seen. This is considered a benign lymphoproliferative process . Once the diagnosis of follicular lymphoid hyperplasia is confirmed, no treatment is necessary.