Abstract
Squamous cell carcinoma is the most common carcinoma of the tongue. However, the majority of carcinoma originates in the lateral border of the tongue and midline dorsum only represents about 2–5% of tongue cancer patients. We present a rare case of squamous cell carcinoma in a 59 years old male patient originating in the midline dorsum of tongue and the management dilemma.
Keywords: Squamous cell carcinoma, Tongue dorsum, Midline tongue
Case Report
A 59 years old chronic smoker male patient presented with a complaint of non-healing, painless ulcer over tongue for 1 month. He was already treated for the Carcinoma of Hypopharynx in 2020 for which he received concurrent chemoradiotherapy. He further underwent left radical nephrectomy for Left RCC in 2022. On examination there was a superficial indurated ulcer over the midline dorsum of tongue of size 1.5 × 1 cm. (Fig. 1) There was no involvement of the floor of mouth or the under surface of tongue. No enlarged cervical Lymph nodes were present. There were post radiotherapy changes over the neck. The patient was ignorant about the complaints as he thought this was a superficial ulcer caused due to repeated intake of vitamin C tablets which he used to consume keeping it over the tongue. Biopsy was taken from ulcer which was reported to be Moderately differentiated Squamous cell carcinoma. (Fig. 2) In view of the rarity of the tumour location and third primary tumour the patient was discussed in a multidisciplinary tumour board. An MRI tongue was planned and further subtotal glossectomy with bilateral modified radical neck dissection and radial forearm free flap reconstruction was explained to the patient. However, the patient was not willing for the above extensive surgery or investigation citing poor general condition and mental agony of suffering from third primary malignancy. The challenges and dilemma of management without major surgery and high chance of recurrence was explained to the patient and he underwent Wide Local excision with primary repair for symptomatic management only. Post operative recovery was uneventful.
Fig. 1.
Ulcer over midline of dorsum of tongue
Fig. 2.
Histologic picture of Midline tongue squamous cell carcinoma
Discussion
This case is important because of a few reasons. The first reason is that the carcinoma of tongue is one of the most common sites of oral cancer, among which Squamous cell carcinoma (SCC) is the most common type seen in more than 70% of the cases. They usually occur in the 4–5th decade [1]. They usually occur in the lateral border of the tongue. SCC in midline Dorsum of tongue is a rare entity which accounts for only 2–5% of total carcinoma tongue [2–4]. So here we are highlighting that any lesion over midline tongue should not be neglected and proper biopsy should be done. The lesions over dorsum of tongue are neglected many times as benign disease [5]. Most of the dorsal lesion share clinical resemblance to other conditions such as oral lichen planus, amyloidosis, median rhomboid glossitis [4, 5]. Similar reports of clinical resemblance of Carcinoma dorsum tongue with benign conditions reported by Ogus et al. [2] Patient usually present with complains of pain or burning sensation of tongue or ulcer over tongue [4, 6]. Biopsy and histopathologic examination is a must needed evaluation to clinically rule out malignancy in patients presenting dorsum of tongue ulcer [6]. The other thing which is of utmost importance is management. Carcinoma of midline tongue requires major compartmental tongue resection along with neck dissection. The patient may require adjuvant radiation as well. However, because of the rarity of this entity we do not have data regarding outcome and prognosis of major resection done for midline tongue carcinoma. Nonetheless a simple wide resection with adequate margin is an acceptable management for selected cases or symptomatic management.
Funding
No funding required.
Declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Ethical Approval
Not applicable.
Human Participants and/or Animals Rights
Not applicable.
Informed Consent
Taken.
Footnotes
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References
- 1.Toh T, Akita T, Saito M. Squamous cell carcinoma initially arising in the midline of the dorsum of the tongue in a young adult: a case report and review of the literature. J Oral Maxillofacial Surg Med Pathol. 2019;31(3):185–188. doi: 10.1016/j.ajoms.2018.12.001. [DOI] [Google Scholar]
- 2.Ogus HD, Bennett MH. Carcinoma of the dorsum of the tongue: a rarity or misdiagnosis. Br J Oral Surg. 1978;16:115–124. doi: 10.1016/0007-117X(78)90021-5. [DOI] [PubMed] [Google Scholar]
- 3.Goldenberg D, Ardekian L, Rachmiel A. Carcinoma of the dorsum of the tongue. Head Neck. 2000;22:190–194. doi: 10.1002/(SICI)1097-0347(200003)22:2<190::AID-HED12>3.0.CO;2-O. [DOI] [PubMed] [Google Scholar]
- 4.Coombes D, Cascarini L, Booth PW. Carcinoma of the midline dorsum of the tongue. Br J Oral Maxillofac Surg. 2008;46:485–486. doi: 10.1016/j.bjoms.2007.11.022. [DOI] [PubMed] [Google Scholar]
- 5.Okubo M, Iwai T, Nakashima H. Squamous cell carcinoma of the Tongue Dorsum: incidence and treatment considerations. Indian J Otolaryngol Head Neck Surg. 2017;69:6–10. doi: 10.1007/s12070-016-0979-z. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 6.Ohta K, Yoshimura H. Squamous cell carcinoma of the dorsal tongue. CMAJ. 2019;25(47):E1310. doi: 10.1503/cmaj.190677. [DOI] [PMC free article] [PubMed] [Google Scholar]