Tongue cancer classification

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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

As with other areas of the upper aerodigestive tract, more than 90% of oral cavity cancers are squamous cell carcinomas. Most of the other lesions are of minor salivary gland origin. Lymphomas, melanomas, and sarcomas rarely occur in the tongue.

Classification

• Squamous cell carcinoma

As with other areas of the upper aerodigestive tract, more than 90% of oral cavity cancers are squamous cell carcinomas. Most of the other lesions are of minor salivary gland origin. Lymphomas, melanomas, and sarcomas rarely occur in the tongue. Also, the 2 prominent variants of oral squamous cell carcinomas that may be present are referred to as verrucous carcinoma and sarcomatoid squamous cell carcinoma.

• • Verrucous carcinoma
    • Verrucous cell carcinomas have been described as a unique form of squamous cell carcinoma related to human papillomavirus infection. In its early phases, the tumor may be subclinical and asymptomatic as a verruciform growth phase that lasts several years. In other patients, the lesion may appear suddenly or as a slowly growing lesion that has a sudden and rapid growth phase.
  • Sarcomatoid squamous cell carcinoma
    • Sarcomatoid carcinomas are also referred to as pseudosarcoma, pseudosarcomatous squamous cell carcinoma, pleomorphic carcinoma, metaplastic carcinoma, and the spindle variant of epidermoid carcinoma. The tumor manifests as a rapidly growing, polypoid, and bulky mass, often in a site exposed to prior irradiation. The histogenesis of these tumors is not clear. In general, because of their heterogeneous nature, microscopic interpretation of these tumors is highly subjective. In addition, sampling limitations are inherent to any fine structural analysis. Electron microscopy findings from these tumors are likely to be of value only if epithelial features are present within the spindle cells.
• Nonsquamous cell carcinoma

Squamous cell carcinoma is by far the most common epithelial malignancy of the tongue, and nonsquamous cell cancers comprise fewer than 3% of all lingual malignancies. Also, the 2 prominent variants of oral squamous cell carcinomas that may be present are referred to as verrucous carcinoma and sarcomatoid squamous cell carcinoma. Malignancies of salivary gland origin also may occur, with adenoid cystic carcinomas and mucoepidermoid carcinomas predominating in histological subtypes. Relative to the palate, minor salivary gland malignancies of the tongue are rare. Oral mucosal melanomas to the tongue are rare relative to other oral cavity sites such as the palate, alveolar gingivae, and lips. Virtually any malignancy can metastasize to the tongue. Statistically, carcinomas of the breast, lung, kidney, and adrenal gland are the most common.