Tongue cancer differential diagnosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Simrat Sarai, M.D. [2]

Overview

Tongue cancer must be differentiated from other diseases that cause malignant lesions of the oral cavity and from few non-neoplastic lesions of the oral cavity, such as lymphoma, adenoid cystic carcinoma, adenocarcinoma, mucoepidermoid carcinoma, rhabdomyosarcoma, liposarcoma, infections at the floor of mouth and mandible, and normal adenoid tissue for lesions at base of tongue.

Differential Diagnosis

The differential diagnosis for a squamous cell carcinoma of the tongue is essentially that of other malignant lesions of the oral cavity as well as a few non-neoplastic lesions.

It includes the following:

Other malignancy

Infections:

Benign neoplasm

Idiopathic

Metabolic causes

Site Clinical presentation Investigations Others
Symptoms Signs
Infections Tuberculosis (TB)[1] Dorsum
  • History of contact with TB patients
  • Primary TB symptoms: night fever, sweating, bloody cough, and loss of weight
  • Painful tongue ulcers
  • Ulcer: irregular outline, undulated borders, and covered with a yellowish-gray, and fibrinous layer 
Scarlet fever[2] Dorsum
  • Heavy gray-white coating
  • Enlargement of the fungiform papillae, which appear as multiple red dots
  • Dots disappear with time.
  • Throat swab and culture
  • Rapid streptococcal antigen tests 
Mainly in children due to group A streptococcal infection
Syphilis[3] Dorsum

The primary stage

  • The lingual chancre is a solitary, painless, slightly raised, well-demarcated ulcer
  • Enlarged, painless, regional lymph nodes

The secondary stage:

  • The mucous patches are slightly raised, grayish-white, and usually surrounded by a red halo
  • If the lesion is scraped, it leaves a raw, bleeding surface

The third stage:

Benign neoplasms Papilloma Dorsum and lateral borders
  • Painless slowly growing mass
  • Warty surface or consist of hyperkeratotic finger-like projections
Lipoma[4] Dorsum and lateral borders
  • Painless slowly growing mass
  • Soft, sessile, and yellowish
  • Biopsy
Leiomyoma[5] Dorsum
  • Painless slowly growing mass
  • Small, single

or multiple, circumscribed mass

  • Biopsy
Schwannoma[6] Dorsum and lateral borders
  • Painless slowly growing lesions, may be painful
  • Firm, submucosal mass
  • Biopsy
Neurofibroma[7] Dorsum and lateral borders
  • Slowly growing multiple nodules
  • Unilateral macroglossia
  • Tongue may show multiple nodules or there may be a more diffuse involvement causing unilateral macroglossia
  • Biopsy
Granular cell tumor Dorsum
  • Painless, firm, slwoly growing nodules
  • Submucosal nodules with a yellowish or pinkish color 
  • Biopsy
Malignant neoplasms Squamous cell carcinoma Lateral borders
  • Painless ulcer or exophytic mass.
  • History of heavy use of alcohol and tobacco
  • The lesion has an ulcerated appearance with rolled borders around a necrotic center
  • It frequently resembles a traumatic ulcer
Malignant salivary gland tumors[8] Ventral and dorsum
  • Slow-growing, painless mass
  • Submueosal mass
  • May ulcerate in the later stages
Metastatic tumor Base of tongue
  • Painful mass
  • Dysphagia
  • Symptoms of primary tumor
  • Mass in tongue base
  • Cachexia and loss of appetite
  • Signs of primary tumor
  • Mass in tongue base
  • Cachexia and loss of appetite
  • Signs of primary tumor
Subtypes:
  • Mucoepidemoid tumors
  • Acinic cell tumors
  • Adenocarcinomas
Sarcoma[9] Palate and tongue
  • Painless slowly growing mass
  • Dysphagia and weight loss
  • Biopsy
Subtypes:
Idiopathic Benign migratory glossitis[10] Dorsum

Painless redish ulcerative lesions

The lesions appear as one or more irregularly shaped, reddish areas of depapillation surrounded by a narrow, whitish zone of regenerating papillae
Hairy tongue[11]
  • Tongue color changes
  • Hypertrophy of the filiform papillae
  • Tongue color will vary from yellowish-white to brown or black
Risk factors:
  • Tobacco
  • Radiation therapy
Metabolic Diabetes mellitus Dorsum
  • Throat swab
  • Blood glucose level
  • HBA1C
Hypothyroidism
Acromegaly[12] Generalized
Vitamin B deficiency[13] Dorsum
  • Redness in the tip and margins of the tongue
  • Swelling of the tongue
  • Indentations of the teeth
  • Associated neurological symptoms due to niacin and B12 deficiency
Amyloidosis[14] Lateral borders
  • Enlarged tongue
  • Decrease in lingual mobility
  • Difficulty in chewing, swallowing and speaking
  • Generalized induration
  • Yellowish nodules
Immunologic disorders Benign mucous membrane pemphigoid[15] Generalized
Erythema multiforme[16] Generalized
  • It occurs primarily in young men
The cause of this disorder is an infectious disease such as Herpes simplex, Coxsackie virus, or drug therapy
Pemphigus[17] Generalized

References

  1. Ajay GN, Laxmikanth C, Prashanth SK (2006). "Tuberculous ulcer of tongue with oral complications of oral antituberculosis therapy". Indian J Dent Res. 17 (2): 87–90. PMID 17051875.
  2. Kutsuna S, Hayakawa K, Ohmagari N (2014). "Scarlet fever in an adult". Intern Med. 53 (2): 167–8. PMID 24429462.
  3. Abdullaev AKh (1972). "[Characteristics of the clinical picture of syphilis in recent years]". Vestn Dermatol Venerol. 46 (2): 61–5. PMID 5036799.
  4. Agarwal R, Kumar V, Kaushal A, Singh RK (2013). "Intraoral lipoma: a rare clinical entity". BMJ Case Rep. 2013. doi:10.1136/bcr-2012-007889. PMC 3604517. PMID 23362064.
  5. Baden E, Doyle JL, Lederman DA (1994). "Leiomyoma of the oral cavity: a light microscopic and immunohistochemical study with review of the literature from 1884 to 1992". Eur J Cancer B Oral Oncol. 30B (1): 1–7. PMID 9135966.
  6. Abreu I, Roriz D, Rodrigues P, Moreira Â, Marques C, Alves FC (2017). "Schwannoma of the tongue-A common tumour in a rare location: A case report". Eur J Radiol Open. 4: 1–3. doi:10.1016/j.ejro.2017.01.002. PMC 5292651. PMID 28203620.
  7. Acampa O, Frojo M, Palomba F, Rullo R (1990). "[A case of solitary neurofibroma of the tongue]". Arch Stomatol (Napoli). 31 (4): 821–5. PMID 2100491.
  8. "Salivary Gland Neoplasms". Anticancer Res. 36 (8): 4372. 2016. PMID 27466575.
  9. Anbarasi K, Sathasivasubramanian S, Kuruvilla S, Susruthan (2011). "Alveolar soft-part sarcoma of tongue". Indian J Pathol Microbiol. 54 (3): 581–3. doi:10.4103/0377-4929.85099. PMID 21934227.
  10. Abensour M, Grosshans E (1999). "[Geographic tongue or benign migratory glossitis]". Ann Dermatol Venereol. 126 (11): 849–52. PMID 10612869.
  11. "HAIRY tongue". J Am Med Assoc. 156 (12): 1175. 1954. PMID 13211220.
  12. Anoun N, El Ouahabi H (2017). "[Acromegaly features in the aging population]". Pan Afr Med J. 27: 169. doi:10.11604/pamj.2017.27.169.11518. PMC 5579428. PMID 28904697.
  13. Spatz R, Thimm R, Heinze HG, Ross A, König M (1976). "[Changes in the clinical picture of vitamin B-12 deficiency diseases]". Nervenarzt. 47 (3): 169–72. PMID 1264303.
  14. Akin RK, Baron K, Walters PJ (1975). "Amyloidosis, macroglossia, and carpal tunnel syndrome associated with myeloma". J Oral Surg. 33 (9): 690–2. PMID 1056992.
  15. "[Diagnosis and therapy of mucous membrane pemphigoid. Results of the 1st International Consensus Conference]". Hautarzt. 53 (5): 371–2. 2002. PMID 12063752.
  16. Farthing PM, Maragou P, Coates M, Tatnall F, Leigh IM, Williams DM (1995). "Characteristics of the oral lesions in patients with cutaneous recurrent erythema multiforme". J Oral Pathol Med. 24 (1): 9–13. PMID 7722922.
  17. Apalla Z, Sotiriou E, Lazaridou E, Manousari A, Trigoni A, Papagarifallou I; et al. (2013). "Pemphigus vegetans of the tongue: a diagnostic and therapeutic challenge". Int J Dermatol. 52 (3): 350–1. doi:10.1111/j.1365-4632.2011.05277.x. PMID 23414160.


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