Bilateral Ca Tounge.pdf

Bilateral tongue carcinoma

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BILATERAL TONGUE CARCINOMA IN A YOUNG FEMALE PATIENT: A RARE PRESENTATION Malik P1*, Anuragi G1, Sharma DC1, Maheshwari R1, Sharma RG1 1.SMS Hospital, Jaipur, Rajasthan, India

Varshney P1, Sharma BN1,

Correspondence: Dr. Puneet Malik. SMS Hospital, Jaipur, Rajasthan, India Email: [email protected] Malik P, Anuragi G, Sharma DC, Maheshwari R, Varshney P, Sharma BN, Sharma RG. Bilateral tongue carcinoma in a young female patient: a rare presentation. Case Study and Case Report 2014; 4(4): 156 - 160. ABSTRACT Carcinoma tongue is fortunately an uncommon problem in young patients. However, since it is so rare, when cases present they are often misdiagnosed and inappropriately treated leading to delay in definitive treatment. This may, in turn, lead to a poorer prognosis for these patients. Presentation of carcinoma tongue involving both sides at the initial presentation has not been reported yet in literature. We describe the case of a 26year-old woman, with a long history of tongue ulcers, finally presented to surgical oncology OPD with carcinoma tongue involving antero-lateral aspects of both sides of tongue. The absence of any previous report in the English-language literature about the bilateral occurrence of SCC in the tongue in a young patient is emphasized. Key words: Carcinoma, tongue, bilateral, anterolateral INTRODUCTION Carcinoma tongue (ICD-141) chiefly affects males in their older age. The median age at the diagnosis of the tongue’s cancer is 61 years. Only approximately 2% of patients are diagnosed before the age of 35 and another 7% before the age of 45, 1 - 4 this despite the fact that there is an increasing trend in the prevalence of tongue carcinoma. In the literature, very few cases of carcinoma tongue in young adults have been reported but none of them presented with bilaterality. We present a case of 26 year old woman with squamous cell carcinoma of the tongue presenting as ulcerative lesion on the anterolateral aspects of both sides of tongue. CASE REPORT A 26-year-old married female was referred to surgical oncology OPD complaining of two ulcers on both sides of her tongue of about 6 months duration. Ulcers on both sides progressively increased in size to attain their present size. They were painless. Initially she took treatment from a private medical practitioner, later when she didn’t responded she was referred to our tertiary care centre. She is a tobacco chewer for past 6 years. On

Case Study and Case Report 2014; 4(4): 156 - 160.

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intra oral examination, patient had trismus and leukoplakia. Two ulcero-proliferative lesions were noted on anterolateral aspect of both sides of tongue, of size 25x18x10mm on right side and 22x15x10mm on left side with an area between them appeared normal (Figure 1). Both lesions were exophytic, with a central ulcer appearing to infiltrate the tongue musculature. Margins were irregular and everted with surrounding area indurated.she had normal protrusion of tongue and there was no involvement of base of tongue or floor of mouth. She had right sided solitary, enlarged, firm 15x10mm size submandibular lymphnode. A biopsy was performed on each side and histopathological examination revealed moderately differentiated squamous cell carcinoma. MRI scan was performed (Figure 2). It showed two different tongue tumors with bilateral enlarged submandibular lymph nodes. Patient was given the option of total glossectomy for which she did not agree and hence she was administered radiotherapy. Figure 1. Intraoral view of bilateral carcinoma tongue.

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Figure 2. MRI image of bilateral carcinoma tongue.

DISCUSSION Carcinoma tongue is uncommon in young adults. Although the literature shows an overall increase in carcinoma tongue and oral cancers in young adults. Clinical manifestation of SCC in young patients has no distinguishing features from that of the older; nevertheless, literature reports that many clinicians tend not to include SCC as a diagnostic hypothesis in young patients, simply because such a disease is not compatible to the age range. In a review by the Armed Forces Institute of Pathology (AFIP), 20 cases of oral SCC in patients < 20 years of age were identified (mean age 15 years). Nine of these were in the tongue. The male to female ratio was 1:1. Of the 18 patients receiving long-term followup, 14 were treated with surgery only, while the remaining 4 patients received adjuvant radiotherapy for cervical lymph node metastasis. After a follow-up of at least five years, 14 patients were disease free, two had died of the disease with mean survival time of 0.7 years and two had died with no evidence of disease. The AFIP reports a good prognosis with adequate surgical treatment of these tumors5. Our patient had history of tobacco chewing from past six years, which is a well known risk factor for oral cavity malignancies. Kurikose et al in their study comparing the tongue cancer in young and older SCC patients in India concluded that in younger patients, SCC of tongue was associated with fewer etiologic factors, and in older patients,

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it was always seen in association with smoking, alcohol or chewing tobacco6. The exposure time for a carcinogenic agent in young adult is relatively very less than that of an adult, hence larger studies are needed to delineate the exact etio-pathogenesis of this disease in young adults. Conflicting report have also been reported regarding SCC prognosis in young patients. Several studies have shown that young patients tend to present a greater loco-regional recurrence rate and a smaller survival rate when compared to that of older patients 1,6 - 7 suggesting that it may be considered an distinct disease entity whereas others have described a similar prognosis for both age ranges8. Thus there are few recommendation for aggressive treatment in young adults while others follows same treatment in all age groups. CONCLUSION Our understanding regarding the etiology, natural history and optimal therapeutic management is limited due to rarity of this tumour. With this case report, we emphasises on the fact that oral squamous cell carcinoma can occur bilaterally even at a young age and must be considered in the differential diagnosis of suspicious lesions even in the young. CONSENT Written informed consent was obtained from the patient for publication of this case report. COMPETING INTERESTS The authors declare that they have no competing interests. REFERENCES 1. Friedlander PL, Schantz SP, Shaha AR, Yu G, Shah JP. Squamous cell carcinoma of the tongue in young patients: A matched-pair analysis. Head Neck. 1998; 20: 363 - 8. 2. Shiboski CH, Schmidt BL, Jordan RC. Tongue and tonsil carcinoma: increasing trends in the U.S. population ages 20–44 years. Cancer. 2005; 103: 1843 – 9. 3. Toner M, O'Regan EM. Head and neck squamous cell carcinoma in the young: a spectrum or a distinct group? Part 1. Head Neck Pathol. 2009; 3: 246 – 8. 4. Soudry E, Preis M, Hod R, Hamzany Y, Hadar T, Bahar G, Strenov Y, Shpitzer T. Squamous cell carcinoma of the oral tongue in patients younger than 30 years: clinicopathologic features and outcome.Clin Otolaryngol. 2010; 35: 307 – 12. 5. Thompson L, Castle J, Heffner DK. Oral squamous cell carcinoma in pediatric patients: A clinicopathologic study of 20 cases. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1999; 88: 204.

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6. Kuriakose M, Sankaranarayanan M, Nair MK, Cherian T, Sugar AW, Scully C, et al. Comparison of oral squamous cell carcinoma in younger and older patients in India. Eur J Cancer B Oral Oncol. 1992; 28:113 - 20. 7. Burzynski NJ, Flynn MB, Faller NM, Ragsdale TL. Squamous cell carcinoma of the upper aerodigestive tract in patients 40 years of age and younger. Oral Surg Oral Med Oral Pathol. 1992; 74: 404 - 8. 8. Atual S, Greman R, Laippala P, Syrjanen S. Cancer of the tongue in patients younger than 40 years. Arch Otolaryngol Head Neck Surg. 1996; 122: 1313 - 9.

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