Bilateral tongue carcinoma 156

BILATERAL TONGUE CARCINOMA IN A YOUNG FEMALE PATIENT: A

RARE PRESENTATION

Malik P1*, Anuragi G1, Sharma DC1, Maheshwari R1, Varshney P1, Sharma BN1,
Sharma RG1
1.SMS Hospital, Jaipur, Rajasthan, India

Correspondence: Dr. Puneet Malik. SMS Hospital, Jaipur, Rajasthan, India

Email: dr.puneetmalik@gmail.com

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 26-
year-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 antero-
lateral 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. 156
 Bilateral tongue carcinoma 157

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.

Case Study and Case Report 2014; 4(4): 156 - 160. 157
 Bilateral tongue carcinoma 158

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 follow-
up, 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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 Bilateral tongue carcinoma 159

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.

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