Congenital foregut duplication cysts of the anterior tongue

Objective: To review our experience with foregut duplication cysts of the anterior tongue, an unusual and rarely encountered mass in this location. Design: A retrospective review of patients with anterior tongue foregut duplication cysts identified between 1990 and 2000. Setting: Academic, tertiary care children's medical center. Patients: Six pediatric patients (5 boys and 1 girl) ranging in age from birth to 8 months at diagnosis. Intervention: Three patients underwent preoperative magnetic resonance imaging (MRI). All 6 patients underwent excisional biopsy. Main Outcome Measures: Clinical description of foregut duplication cysts, ability to make the diagnosis preoperatively, and recurrence rates. Results: No patient presented with respiratory compromise, despite the large size of the anterior tongue masses (range, 1.5-2.4 cm). An MRI study was performed in 3 patients, all given a presumptive diagnosis of dermoid cyst based on the radiographic findings. No patient was diagnosed correctly prior to surgical excision. All patients underwent surgical excision, and the average time from birth to surgical excision was 11 months (range, 3 days to 3.7 years). Surgical pathologic findings were reported as a foregut duplication cyst (enterocystoma) in all patients, with 3 specimens containing foci of gastric mucosa. No recurrence has occurred at 1-month follow-up. Conclusions: Foregut duplication cysts rarely present in the anterior tongue and are easily misdiagnosed preoperatively. An MRI study is helpful in preoperative planning, although all lesions were radiologically indistinguishable from dermoid cysts. These masses may be an underappreciated entity in the differential diagnosis of congenital anterior tongue masses.