Presentation
Left-sided mass in the floor of the mouth.
Patient Data
Left-sided enhancing mass involving the floor of the mouth infiltrating the horizontal branch of the mandible with bone lysis on the bone window. It measures 62 x 43 x 38 mm.
The lesion crosses the midline for about 14 mm.
Thickening of the subcutaneous fat overlying the lesion, suggestive of invasion. Laterally, the mass appears to invade the depressor anguli oris muscle.
Superiorly, the lesion invades the ventral surface of the tongue. The lingual artery passes behind the lesion but does not appear to be invaded.
Bilateral cervical lymphadenopathies.
Atrophy of the left submandibular gland.
The patient was treated with chemotherapy and radiotherapy
Presents 6 months later with swallowing pain.
Complete regression of the left hypervascular mass
Irregular thickening and enhancement of the oral mucosa and the tongue: these features could represent oral mucositis, but a local recurrence could not be excluded.
No lymphadenopathy.
Atrophy of the left submandibular gland.
Reduction of the size of the right submandibular gland.
Biopsy of the floor of the mouth:
Macroscopy: a necrotic fragment of 2.5 x 1.5 cm, is included in the biopsy.
Microscopy: this biopsy was made in entirely necrotic tissue, with no viable cells within it.
Conclusion:
This tissue is entirely necrotic with no neoplastic cells.
Case Discussion
It is challenging to differentiate radiation-induced oral mucositis and healthy tissue necrosis following radiotherapy from local recurrence. A biopsy is sometimes required to confirm the absence of tumoral cells.
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