Tongue cancer differential diagnosis: Difference between revisions

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__NOTOC__
__NOTOC__
{{Tongue cancer}}
[[Image:Home_logo1.png|right|250px|link=https://www.wikidoc.org/index.php/Tongue_cancer]]
{{CMG}}{{AE}}{{Simrat}}
{{CMG}};{{AE}} {{Simrat}} {{MAD}}
 
==Overview==
==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.<ref name="radio">Squamous cell carcinoma of the tongue. Radiopedia(2015) http://radiopaedia.org/articles/squamous-cell-carcinoma-of-the-tongue Accessed on November 16, 2015</ref>
Tongue cancer must be differentiated from other diseases that cause malignant lesions of the [[oral cavity]] and from non-[[Neoplastic disease|neoplastic]] lesions of the oral cavity, such as [[lymphoma]], [[sarcoma]],[[Metastatic tumor|, metastatic tumor]], [[malignant]] [[Salivary gland tumor|salivary gland tumors]], [[tuberculosis]], [[scarlet fever]], [[syphilis]], [[papilloma]], [[lipoma]], l[[Leiomyoma|eiomyoma]], [[neurofibroma]], s[[Schwannoma|chwannoma]], [[granular cell tumor]], b[[Migratory glossitis|enign migratory glossitis]], Hairy tongue, [[pemphigus]], [[erythema multiforme]], [[mucous membrane pemphigoid]], v[[Vitamin B deficiency|itamin B deficiency]], [[amyloidosis]], [[Diabetes mellitus|diabetes mellitus,]] [[hypothyroidism]], [[acromegaly]].
 
==Differential Diagnosis==
==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:<ref name="radio">Squamous cell carcinoma of the tongue. Radiopedia(2015) http://radiopaedia.org/articles/squamous-cell-carcinoma-of-the-tongue Accessed on November 16, 2015</ref>
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.  
*Other malignancy
It includes the following:
**[[Lymphoma]]
 
**Minor [[salivary gland]] [[tumors]]
Other [[malignancy|malignancies]]:
***[[Adenoid cystic carcinoma]]
*[[Lymphoma]]
***[[Adenocarcinoma]]
*[[Sarcoma]]
***[[Mucoepidermoid carcinoma]]
*[[Metastatic tumor]]
**[[Sarcoma]]
*Malignant [[Salivary gland tumor|salivary gland tumors]]
***[[Rhabdomyosarcoma]]
[[Infection|Infections:]]
***[[Liposarcoma]]
*[[Tuberculosis]]
*Infection: more a concern for floor of mouth lesions, or those with involvement of the [[mandible]]
*[[Scarlet fever]]
*Normal adenoidal [[tissue]]: for base of tongue [[lesions]]
*[[Syphilis]]
[[Benign neoplasm]]:
*[[Papilloma]]
*[[Lipoma]]
*[[Leiomyoma]]
*[[Neurofibroma]]
*[[Schwannoma]]
*[[Granular cell tumor]]
[[Idiopathic]]:
*[[Migratory glossitis|Benign migratory glossitis]]
*Hairy tongue
*[[Pemphigus]]
*[[Erythema multiforme]]
*[[Mucous membrane pemphigoid|Benign mucous membrane pemphigoid]]
[[Metabolism|Metabolic]] causes:
*[[Vitamin B deficiency]]
*[[Amyloidosis]]
*Diabetes mellitus
*Hypothyroidism
*[[Acromegaly]]
{| class="wikitable"
{| class="wikitable"
! colspan="2" rowspan="2" |
! colspan="2" rowspan="2" |
! rowspan="2" |Site
! rowspan="2" |Location
! colspan="2" |Clinical presentation
! colspan="2" |Clinical presentation
! rowspan="2" |Investigations
! rowspan="2" |Investigations
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!Signs
!Signs
|-
|-
| rowspan="3" |Infections
| rowspan="3" |[[Infections]]
|'''Tuberculosis'''
|'''[[Tuberculosis]] (TB)'''<ref name="pmid17051875">{{cite journal| author=Ajay GN, Laxmikanth C, Prashanth SK| title=Tuberculous ulcer of tongue with oral complications of oral antituberculosis therapy. | journal=Indian J Dent Res | year= 2006 | volume= 17 | issue= 2 | pages= 87-90 | pmid=17051875 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17051875  }}</ref>
|Dorsum
|Dorsum
|
|
* History of contact with TB patients
* Primary [[Tuberculosis|TB]] symptoms: night fever, sweating, bloody [[cough]], and loss of weight
* Primary TB symptoms: night fever, sweating, bloody cough, and loss of weight
* Painful tongue [[ulcers]]
* Painful tongue ulcers
|
|
* Ulcer: irregular outline, undulated borders, and covered with a yellowish-gray, and fibrinous layer 
* [[Ulcer]]: irregular outline, undulated borders, and covered with a yellowish-gray, and [[fibrinous]] layer 
|
|
* Culture and biopsy
* Culture and [[biopsy]]


* Chest x-ray for primary infection
* [[Chest X-ray|Chest x-ray]] for primary infection
* [[Tuberculin skin test]]


|
|
|-
|-
|'''Scarlet fever'''
|'''[[Scarlet fever]]'''<ref name="pmid24429462">{{cite journal| author=Kutsuna S, Hayakawa K, Ohmagari N| title=Scarlet fever in an adult. | journal=Intern Med | year= 2014 | volume= 53 | issue= 2 | pages= 167-8 | pmid=24429462 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24429462  }}</ref>
|Dorsum
|
|
|
* Fever, malaise, headache, [[pharyngitis]]
* Fever, malaise, headache, pharyngitis Red skin rash
* Red [[skin rash]]
* Swelling of tongue, white and red coating
* Swelling of tongue, white and red coating
|
|
* Heavy gray-white coating  
* Heavy gray-white coating  
* Enlargement of the fungiform papillae, which appear as multiple red dots  
* Enlargement of the [[Fungiform papilla|fungiform papillae]], which appear as multiple red dots  
* Dots disappear after that
* Dots disappear with time
|
|
|Mainly in children due to B-streptococcal infection
* Throat [[Swabbing|swab]] and culture
* Rapid streptococcal antigen tests 
|Mainly in children due to [[group A streptococcal infection]]
|-
|-
|'''Syphilis'''
|'''[[Syphilis]]'''<ref name="pmid5036799">{{cite journal| author=Abdullaev AKh| title=[Characteristics of the clinical picture of syphilis in recent years]. | journal=Vestn Dermatol Venerol | year= 1972 | volume= 46 | issue= 2 | pages= 61-5 | pmid=5036799 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=5036799  }}</ref>
|Dorsum
|Dorsum
|
|
* Single or multiple painless masses or ulcers according to the stage
* Single or multiple painless masses or ulcers according to the stage
* White patches of leukoplakia
* White patches of [[leukoplakia]]
* Symptoms of generalized syphilis in secondary and tertiary stages especially generalized lymphadenopathy
* Symptoms of generalized [[syphilis]] in secondary and tertiary stages especially [[generalized lymphadenopathy]]
|
|
The primary stage
The primary stage
* The lingual chancre is a solitary, painless, slightly raised, well-demarcated ulcer
* The lingual chancre is a solitary, painless, slightly raised, well-demarcated [[ulcer]]
* Enlarged, painless, regional lymph nodes
* Enlarged, painless, regional [[lymph nodes]]
The secondary stage:
The secondary stage:
* The mucous patches are slightly raised, grayish-white, and usually surrounded by a red halo.
* 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.
* If the lesion is scraped, it leaves a raw, [[bleeding]] surface
The third stage:
The third stage:
* The gumma appears as a painless, elastic mass that subsequently undergoes central necrosis and ulceration.
* The [[gumma]] appears as a painless, elastic mass that subsequently undergoes [[Necrosis|central necrosis]] and [[ulceration]]
* Atrophy of the papillae
* Atrophy of the [[papillae]]
* Frequently associated with leukoplakia, which has a tendency to undergo malignant transformation
* Frequently associated with [[leukoplakia]], which has a tendency to undergo [[malignant transformation]]
|
|
* Dark-field illumination reveal the causative organisms
* [[Dark field microscopy|Dark-field illumination]] reveal the causative [[organism]]
* [[Rapid plasma reagin]]
* [[Venereal disease research laboratory (VDRL) test|Venereal Disease Research Laboratory]]
|
|
* Dark-field illumination reveal the causative organisms
|-
|-
| rowspan="6" |Benign neoplasms
| rowspan="6" |[[Benign neoplasms]]
|'''Papilloma'''
|'''[[Papilloma]]'''
|Dorsum and lateral borders
|Dorsum and lateral borders
|
|
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* Warty surface or consist of hyperkeratotic finger-like projections
* Warty surface or consist of hyperkeratotic finger-like projections


* Sessile or pedunculated, pink to white color
* [[Sessile]] or [[pedunculated]], pink to white color
|
|
* Biopsy
* [[Biopsy]]
|
|
|-
|-
|Lipoma
|[[Lipoma]]<ref name="pmid23362064">{{cite journal| author=Agarwal R, Kumar V, Kaushal A, Singh RK| title=Intraoral lipoma: a rare clinical entity. | journal=BMJ Case Rep | year= 2013 | volume= 2013 | issue=  | pages=  | pmid=23362064 | doi=10.1136/bcr-2012-007889 | pmc=3604517 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23362064  }}</ref>
|Dorsum and lateral borders
|Dorsum and lateral borders
|
|
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|
|
|-
|-
|'''Leiomyoma'''
|'''[[Leiomyoma]]'''<ref name="pmid9135966">{{cite journal| author=Baden E, Doyle JL, Lederman DA| title=Leiomyoma of the oral cavity: a light microscopic and immunohistochemical study with review of the literature from 1884 to 1992. | journal=Eur J Cancer B Oral Oncol | year= 1994 | volume= 30B | issue= 1 | pages= 1-7 | pmid=9135966 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9135966  }}</ref>
|Dorsum
|Dorsum
|
|
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|
|
|-
|-
|'''Schwannoma'''
|'''[[Schwannoma]]'''<ref name="pmid28203620">{{cite journal| author=Abreu I, Roriz D, Rodrigues P, Moreira Â, Marques C, Alves FC| title=Schwannoma of the tongue-A common tumour in a rare location: A case report. | journal=Eur J Radiol Open | year= 2017 | volume= 4 | issue=  | pages= 1-3 | pmid=28203620 | doi=10.1016/j.ejro.2017.01.002 | pmc=5292651 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28203620  }}</ref>
|Dorsum and lateral borders
|Dorsum and lateral borders
|
|
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|
|
|-
|-
|'''Neurofibroma'''
|'''[[Neurofibroma]]'''<ref name="pmid2100491">{{cite journal| author=Acampa O, Frojo M, Palomba F, Rullo R| title=[A case of solitary neurofibroma of the tongue]. | journal=Arch Stomatol (Napoli) | year= 1990 | volume= 31 | issue= 4 | pages= 821-5 | pmid=2100491 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2100491  }}</ref>
|Dorsum and lateral borders
|Dorsum and lateral borders
|
|
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* Unilateral macroglossia
* Unilateral macroglossia
|
|
* Tongue may show multiple nodules or there may be a more diffuse involvement causing unilateral macroglossia
* Tongue may show multiple [[Nodule (medicine)|nodules]] or there may be a more diffuse involvement causing unilateral [[macroglossia]]
|
|
* Biopsy
* Biopsy
|
|
|-
|-
|'''Granular cell tumor'''
|'''[[Granular cell tumor]]'''
|Dorsum
|Dorsum
|
|
* Painless, firm, slwoly growing nodules
* Painless, firm, slwoly growing [[nodules]]
|
|
* Submucosal nodules with a yellowish or pinkish color 
* Submucosal nodules with a yellowish or pinkish color 
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|
|
|-
|-
| rowspan="4" |Malignant neoplasms
| rowspan="4" |[[Malignant neoplasms]]
|'''Squamous cell carcinotna'''
|'''[[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
|
|
* Biopsy
* [[Computed tomography]]
|-
|-
|'''Malignant salivary gland tumors'''
|'''Malignant [[Salivary gland tumor|salivary gland tumors]]'''<ref name="pmid27466575">{{cite journal| author=| title=Salivary Gland Neoplasms. | journal=Anticancer Res | year= 2016 | volume= 36 | issue= 8 | pages= 4372 | pmid=27466575 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27466575  }}</ref>
|Ventral and dorsum
|Ventral and dorsum
|
|
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|
|
|
|
* Submueosal masses
* Submueosal mass
* May ulcerate in the later stages
* May ulcerate in the later stages
|
|
|-
|-
|'''Metastatic tumor'''
|'''[[Metastatic tumor]]'''
|Base of tongue
|Base of tongue
|
|
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* Symptoms of primary tumor
* Symptoms of primary tumor
|
|
[null Insert paragraph]
* Mass in tongue base
* Mass in tongue base
* Cachexia and loss of appetite
* Cachexia and loss of appetite
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* Adenocarcinomas
* Adenocarcinomas
|-
|-
|'''Sarcoma'''
|'''[[Sarcoma]]'''<ref name="pmid21934227">{{cite journal| author=Anbarasi K, Sathasivasubramanian S, Kuruvilla S, Susruthan| title=Alveolar soft-part sarcoma of tongue. | journal=Indian J Pathol Microbiol | year= 2011 | volume= 54 | issue= 3 | pages= 581-3 | pmid=21934227 | doi=10.4103/0377-4929.85099 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21934227  }}</ref>
|Palate and tongue  
|[[Palate]] and tongue  
|
|
* Painless slowly growing mass
* Painless slowly growing [[mass]]
* Dysphagia and weight loss
* Dysphagia and weight loss
|
|
* Reddish or bluisb macules that then coalesce to form purplish nodules and may get ulcerated
* Reddish or bluisb [[macules]] that then coalesce to form purplish [[nodules]] and may get [[Ulcer|ulcerated]]
|
|
*  
* Biopsy
|Subtypes:  
|Subtypes:  
* ''' '''Fibrosarcoma
* ''' '''[[Fibrosarcoma]]
* Alveolar soft-part sarcoma
* [[Alveolar soft part sarcoma|Alveolar soft-part sarcoma]]
* Rbabdomyosarcoma
* [[Myosarcoma|Rbabdomyosarcoma]]
* Leiomyosarcoma
* [[Leiomyosarcoma]]
* Synovial sarcoma
* [[Synovial sarcoma]]
* Chondrosarcoma
* [[Chondrosarcoma]]
* Neurogenic sarcoma
* [[Neurogenic|Neurogenic sarcoma]]
* Kaposi's sarcoma
* [[Kaposi's sarcoma]]
|-
|-
| rowspan="2" |Idiopathic
| rowspan="2" |[[Idiopathic]]
|'''Benign migratory glossitis'''
|'''[[Migratory glossitis|Benign migratory glossitis]]'''<ref name="pmid10612869">{{cite journal| author=Abensour M, Grosshans E| title=[Geographic tongue or benign migratory glossitis]. | journal=Ann Dermatol Venereol | year= 1999 | volume= 126 | issue= 11 | pages= 849-52 | pmid=10612869 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10612869  }}</ref>
|Dorsum
|Dorsum
|
|
 
Painless redish [[Ulcer|ulcerative]] lesions
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
* The lesions appear as one or more irregularly shaped, reddish areas of depapillation surrounded by a narrow, whitish zone of regenerating [[Papilla|papillae]]
|
|
|
|
|-
|-
|'''Hairy tongue'''
|'''Hairy tongue'''<ref name="pmid13211220">{{cite journal| author=| title=HAIRY tongue. | journal=J Am Med Assoc | year= 1954 | volume= 156 | issue= 12 | pages= 1175 | pmid=13211220 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=13211220  }}</ref>
|
|
|
|
* Tongue color change
* Tongue color changes
|
|
* Hypertrophy of the filiform papillae
* Hypertrophy of the [[Filiform papilla|filiform papillae]]
* Tongue color will vary from yellowish-white to brown or black
* Tongue color will vary from yellowish-white to brown or black
|
|
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* Radiation therapy  
* Radiation therapy  
|-
|-
| rowspan="5" |Metablic
| rowspan="5" |[[Metabolic]]
|'''Diabetes mellitus'''
|'''[[Diabetes mellitus]]'''
|
|Dorsum
|
|
* Burning and dryness
* Burning and dryness
* White plaques on the dorsum of tongue due to Candidal infection in uncontrolled cases
* White [[plaques]] on the dorsum of tongue due to [[Candidal|Candidal infection]] in uncontrolled cases
|
|
* Lingual papillary atrophy
* Lingual [[papillary]] [[atrophy]]
|
|
* Throat swab
* Blood glucose level
* [[HBA1|HBA1C]]
|
|
|-
|-
|'''Hypothyroidism'''
|'''[[Hypothyroidism]]'''
|
|
|
|
* Dry mouth
* [[Dry mouth]]
* Difficulties in eating and speaking
* Difficulties in eating and speaking
* Tongue swelling
* [[Tongue swelling]]
|
|
* Tongue protrusion
* Tongue protrusion
* Macroglossia
* [[Macroglossia]]
|
|
* [[TSH]] level
* [[T3]] and [[T4]] levels
|
|
|-
|-
|'''Acromegaly'''
|'''[[Acromegaly]]'''<ref name="pmid28904697">{{cite journal| author=Anoun N, El Ouahabi H| title=[Acromegaly features in the aging population]. | journal=Pan Afr Med J | year= 2017 | volume= 27 | issue=  | pages= 169 | pmid=28904697 | doi=10.11604/pamj.2017.27.169.11518 | pmc=5579428 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28904697  }}</ref>
|Generalized
|
|
|
* [[Tongue swelling|Swollen tongue]]
* Swollen tongue
* Lingual indentations
* Lingual indentations
|
|
* Hyperplasia of the epithelium and connective tissue  
* [[Hyperplasia]] of the epithelium and connective tissue  
* Macroglossia
* [[Macroglossia]]
* Spacing and labial tilting of the teeth
* Spacing and labial tilting of the teeth
|
|
* Serum [[Insulin-like growth factor-I|IGF-1]] concentration
* [[Glucose tolerance test|Oral glucose tolerance test]] 
|
|
|-
|-
|'''Vitamin B deficiency'''
|'''[[Vitamin B deficiency]]'''<ref name="pmid1264303">{{cite journal| author=Spatz R, Thimm R, Heinze HG, Ross A, König M| title=[Changes in the clinical picture of vitamin B-12 deficiency diseases]. | journal=Nervenarzt | year= 1976 | volume= 47 | issue= 3 | pages= 169-72 | pmid=1264303 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1264303  }}</ref>
|Dorsum
|Dorsum
|
|
* Redness in the tip and margins of the tongue
* Redness in the tip and margins of the tongue
* Swelling of the tongue
* [[Tongue swelling|Swelling of the tongue]]
* Indentations of the teeth
* Indentations of the teeth
* Associated neurological symptoms due to niacin and B12 deficiency
* Associated neurological symptoms due to niacin and B12 deficiency
|
|
* Atrophy of both the filliform and fungiform papillae
* Atrophy of both the filliform and [[Fungiform papilla|fungiform papillae]]
|
|
* Serum [[vitamin B12]] and [[folate]] levels
* [[Complete blood count|CBC]] and [[blood smear]] 
|
|
|-
|-
|'''Amyloidosis'''
|'''[[Amyloidosis]]'''<ref name="pmid1056992">{{cite journal| author=Akin RK, Baron K, Walters PJ| title=Amyloidosis, macroglossia, and carpal tunnel syndrome associated with myeloma. | journal=J Oral Surg | year= 1975 | volume= 33 | issue= 9 | pages= 690-2 | pmid=1056992 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1056992  }}</ref>
|Lateral borders
|Lateral borders
|
|
* Enlarged tongue
* [[Enlarged tongue]]
* Decrease in lingual mobility
* Decrease in lingual mobility
* Difficulty in chewing, swallowing and speaking
* Difficulty in chewing, swallowing and speaking
|
|
* Generalized induration
* Generalized induration
* Yellowish nodules
* Yellowish [[nodules]]
|
* Tongue biopsy
* Abdominal fat pad biopsy 
* [[Monoclonal]] pattern on [[serum protein electrophoresis]] ([[SPEP]])
|
|-
| rowspan="3" |[[Immunological|Immunologic disorders]]
|'''[[Mucous membrane pemphigoid|Benign mucous membrane pemphigoid]]'''<ref name="pmid12063752">{{cite journal| author=| title=[Diagnosis and therapy of mucous membrane pemphigoid. Results of the 1st International Consensus Conference]. | journal=Hautarzt | year= 2002 | volume= 53 | issue= 5 | pages= 371-2 | pmid=12063752 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12063752  }}</ref>
|Generalized
|
* Women over the age of 50
* Painful bullae or [[ulcerations]]
|
* Yellow or hemorrhagic bullae on an [[erythematous]] background
* Bullae rupture leaving a fibrin-covered [[ulceration]]
|
* Biopsy
* Indirect immunofluorescence
* [[Autoantibodies]] against BP180, BP230, [[Laminin|laminin 332]] 
|
|-
|'''[[Erythema multiforme]]'''<ref name="pmid7722922">{{cite journal| author=Farthing PM, Maragou P, Coates M, Tatnall F, Leigh IM, Williams DM| title=Characteristics of the oral lesions in patients with cutaneous recurrent erythema multiforme. | journal=J Oral Pathol Med | year= 1995 | volume= 24 | issue= 1 | pages= 9-13 | pmid=7722922 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7722922  }}</ref>
|Generalized
|
* It occurs primarily in young men
|
* Small, [[erythematous]] [[plaque]] that then becomes a [[vesicle]], quickly rupture and become confluent, shallow [[Erosion (dental)|erosions]] covered by a pseudomembrane of [[necrotic tissue]]
|The cause of this disorder is an infectious disease such as [[Herpes simplex]], [[Coxsackie virus]], or drug therapy
|
|-
|'''[[Pemphigus]]'''<ref name="pmid23414160">{{cite journal| author=Apalla Z, Sotiriou E, Lazaridou E, Manousari A, Trigoni A, Papagarifallou I et al.| title=Pemphigus vegetans of the tongue: a diagnostic and therapeutic challenge. | journal=Int J Dermatol | year= 2013 | volume= 52 | issue= 3 | pages= 350-1 | pmid=23414160 | doi=10.1111/j.1365-4632.2011.05277.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23414160  }}</ref>
|Generalized
|
|
* Bullae rupture soon after formation to produce ulcers ([[pemphigus vulgaris]])
* Fungoid [[Vegetation (pathology)|vegetations]] develop on the base of these ulcers ([[pemphigus vegetans]]'')''
|
|
* [[Enzyme linked immunosorbent assay (ELISA)|ELISA]] for antibodies to the BP180 NC16A
* [[Biopsy]]
|
|
|}
|}
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==References==
==References==
{{reflist|2}}
{{reflist|2}}
{{WH}}
{{WS}}


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[[Category:Otolaryngology]]

Latest revision as of 21:57, 7 February 2019

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Simrat Sarai, M.D. [2] Mohammed Abdelwahed M.D[3]

Overview

Tongue cancer must be differentiated from other diseases that cause malignant lesions of the oral cavity and from non-neoplastic lesions of the oral cavity, such as lymphoma, sarcoma,, metastatic tumor, malignant salivary gland tumors, tuberculosis, scarlet fever, syphilis, papilloma, lipoma, leiomyoma, neurofibroma, schwannoma, granular cell tumor, benign migratory glossitis, Hairy tongue, pemphigus, erythema multiforme, mucous membrane pemphigoid, vitamin B deficiency, amyloidosis, diabetes mellitus, hypothyroidism, acromegaly.

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 malignancies:

Infections:

Benign neoplasm:

Idiopathic:

Metabolic causes:

Location Clinical presentation Investigations Others
Symptoms Signs
Infections Tuberculosis (TB)[1] Dorsum
  • 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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