An Atypical Presentation of Osseous Choristoma in a 63-Year-Old Male: A Lesion Beyond the Common Demographic and Anatomical Norms

Osseous choristomas, characterized by ectopic bone, are rare and typically found in the head and neck, particularly on the tongue. This report describes a unique case of an osseous choristoma in a 63-year-old male with an unusual posterior tongue location. An incidental base of tongue (BOT) mass was discovered during a bronchoscopy for lung biopsy. Physical examination revealed a 3-4 cm pedunculated mass at the root of the tongue posterior to the foramen cecum. The patient had a significant 60-pack-year smoking history. A biopsy confirmed the diagnosis of osseous choristoma. The mass was surgically debulked using an intraoral approach. Histopathology revealed findings consistent with osseous choristoma. Intraoral osseous choristomas are exceedingly rare, with fewer than 100 cases reported. This case is unusual due to the patient's older age, male gender, and the mass's posterior location. Surgical excision remains the treatment of choice, with recurrence being rare. This case adds to the limited literature on osseous choristomas by documenting an atypical presentation. The report underscores the importance of considering choristomas in differential diagnoses, regardless of patient age or lesion location, and highlights the efficacy of patient-centered surgical approaches in managing these rare lesions.