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.[1]

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:[1]

Site Clinical presentation Investigations Others
Symptoms Signs
Infections Tuberculosis 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  Culture and

biopsy

Chest x-ray for primary infection

Scarlet fever
  • Fever, malaise, headache, pharyngitis Red skin rash
  • Swelling of tongue, white and red coating
  • Heavy gray-white coating
  • Enlargement of the fungiform papillae, which appear as multiple red dots
  • Dots disappear after that
Mainly in children due to B-streptococcal infection
Syphilis Dorsum
  • Single or multiple painless masses or ulcers according to the stage
  • White patches of leukoplakia
  • Symptoms of generalized syphilis in secondary and tertiary stages especially generalized lymphadenopathy

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:

  • The gumma appears as a painless, elastic mass that subsequently undergoes central necrosis and ulceration.
  • Atrophy of the papillae
  • Frequently associated with leukoplakia, which has a tendency to undergo malignant transformation
  • Dark-field illumination reveal the causative organisms
Benign neoplasms Papilloma Dorsum and lateral borders
  • Painless slowly growing mass
  • Warty surface or consist of hyperkeratotic finger-like projections
  • Sessile or pedunculated, pink to white color
Lipoma Dorsum and lateral borders
  • Painless slowly growing mass
  • Soft, sessile, and yellowish
Rhabdomyoma
Leiomyoma
  • Painless slowly growing mass
  • Small, single

or multiple, circumscribed mass

Schwannoma Dorsum and lateral borders
  • Painless slowly growing lesions, may be painful
  • Firm, submucosal mass
Neurofibroma 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
Granular cell tumor
Malignant neoplasms Squamous cell carcinotna
Malignant salivary gland tumors Ventral and dorsum
Metastatic tumor
Sarcoma
Idiopathic Benign migratory glossitis Dorsum
Hairy tongue
Metablic Diabetes mellitus
  • Burning and dryness
  • White plaques on the dorsum of tongue due to Candidal infection in uncontrolled cases
  • Lingual papillary atrophy
Hypothyroidism
  • Dry mouth
  • Difficulties in eating and speaking
  • Tongue swelling
  • Tongue protrusion
  • Macroglossia
Acromegaly
  • Swollen tongue
  • Lingual indentations
  • Hyperplasia of the epithelium and connective tissue
  • Macroglossia
  • Spacing and labial tilting of the teeth
Vitamin B deficiency 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
  • Atrophy of both the filliform and fungiform papillae
Amyloidosis Lateral borders
  • Enlarged tongue
  • Decrease in lingual mobility
  • Difficulty in chewing, swallowing and speaking
  • Generalized induration
  • Yellowish nodules

References

  1. 1.0 1.1 Squamous cell carcinoma of the tongue. Radiopedia(2015) http://radiopaedia.org/articles/squamous-cell-carcinoma-of-the-tongue Accessed on November 16, 2015


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