Squamous cell carcinoma of the tongue

Case contributed by Dr Bruno Di Muzio

Presentation

Not available.

Patient Data

Age: 79
Gender: Male
Modality: CT

Ulcerated lesion involving the left posterolateral tongue and measures 2.7 centimetres in AP and 2.5 centimetres in craniocaudal dimension at the depth of 12 mm. No further sites of asymmetric mucosal thickening in the aerodigestive tract.

13 x 9 x 8 mm left jugulogastric lymph node has an apparent hypodense component, however this is confirmed on axial images to be beam hardening artefact rather than a real finding. Left level II B lymph node is mildly prominent measuring 5.5 x 10 x 10 mm. No enlarged submental or submandibular lymph nodes.

Edentulous mandible and maxilla. No osseous destruction.

The canal for the left inferior alveolar nerve is expanded with intact sclerotic rim suggesting a benign process. There is no permeative lucency in the surrounding mandibular body to suggest an aggressive process, and this region is separate from the tongue primary.

No mediastinal or hilar lymph node enlargement. No pleural effusion. No suspicious pulmonary nodule or mass.

Conclusion:

2.7 centimetres a left posterolateral tongue lesion measures 12 mm in depth.

Expanded canal for the left inferior alveolar nerve has non-aggressive CT appearances is not thought to be due to perineural spread of tumour.

Modality: MRI

Ulcerated left lateral tongue mass measures 2.5 x 2.5 cm with depth of 13 mm. Tumour involves the most superior fibres of hyoglossus is well distended from genioglossus and mylohyoid. There was no evidence of extension onto the floor of mouth on previous CT puffed cheek acquisition.

No mandibular or maxillary bone marrow infiltration. The canal for the inferior alveolar nerve on the left is expanded and contains abnormal enhancing soft tissue, however margins of the canal remains corticated with no surrounding marrow infiltration. Appearance is consistent with a neuroma. This region is distant to the tongue mass, and is not thought to represent perineural involvement by tumour.

No enlarged cervical lymph nodes.

Right mastoid fluid signal.

Conclusion:

Large left lateral tongue ulcerated mass consistent with the history of SCC. The most superior fibres of hyoglossus are involved by the inferior portion of the tumour. A morphologically abnormal lymph nodes or evidence of perineural or osseous spread of disease. The lesion expanding the canal for the left inferior alveolar nerve is consistent with a neuroma.

 

Case Discussion

Squamous cell carcinoma of the tongue has epidemiology and risk factors similar to squamous cell carcinomas elsewhere in the upper aerodigestive tract, with tobacco smoking and alcohol ingestion being major risk factors.

PlayAdd to Share

Case Information

rID: 35647
Case created: 15th Apr 2015
Last edited: 10th Sep 2015
System: Head & Neck
Tag: rmh
Inclusion in quiz mode: Included

Updating… Please wait.
Loadinganimation

Alert accept

Error Unable to process the form. Check for errors and try again.

Alert accept Thank you for updating your details.