A 57-year-old male patient presented to the Oral Medicine Clinic with a one-month history of painful macroglossia associated with difficulty in speaking and swallowing. The patient complained of recent weight loss and chronic fatigue. Intra-oral examination showed the tongue to be enlarged with conspicuous nodules on the lateral borders. It had a multinodular, firm consistency on palpation. An incisional biopsy from the right lateral area of the tongue was submitted for histology.