A 53 year-old female with no significant history of tobacco or alcohol use was referred to our Otolaryngology clinic in late 2004 with a 7 week history of tongue ulceration and edema. She was originally evaluated by an Otolaryngologist in her community, and a mass identified in the right base of her tongue. Clinically, the mass was rubbery, mucosally covered, and crossed the midline to the left, occupying about 60-70% of the tongue base. Magnetic resonance imaging revealed a well-circumscribed mass in the right posterior tongue base measuring 4.5 x 3.4 x 3.9 cm which enhanced heterogeneously with gadolinium contrast (Figures 1, 2). Surgical biopsy was performed, and immunohistochemistry studies were positive for cytokeratin and S-100, confirming a myoepithelial lineage, and a MIB1 (Ki-67) stain demonstrating a low proliferative rate. Surgical excision of the mass was later undertaken via a trans-oral midline glossectomy approach (Figure 3). The encapsulated mass measured 4.8 x 4.2 x 3.6 cm and was grossly benign appearing (Figure 4). Microscopically, the tumor had a variable appearance, but was comprised mostly of round, hyperchromatic cells with ill-defined pink cytoplasm and multiple dilated cyst-like spaces filled with proteinaceous material (Figure 5). Immunohistochemistry again showed focal S-100 positivity (Figure 6), weakly positive smooth muscle actin, and positive keratin. These features were felt to be most consistent with an epithelial-myoepithelial carcinoma. Review by the Armed Forces Institute of Pathology was consistent with a low grade salivary gland tumor, likely a myoepithelial neoplasm versus an ectomesenchymal chondromyxoid tumor. No adjuvant radiation was administered, and close follow up with annual MRI scans for the past 3 years has failed to show any evidence of recurrence.