Tongue cancer differential diagnosis

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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

Tongue cancer must be differentiated from other diseases that cause malignant lesions of the oral cavity and from few non-neoplastic lesions of the oral cavity, such as lymphoma, adenoid cystic carcinoma, adenocarcinoma, mucoepidermoid carcinoma, rhabdomyosarcoma, liposarcoma, infections at the floor of mouth and mandible, and normal adenoid tissue for lesions at base of tongue.

Differential Diagnosis

The differential diagnosis for a squamous cell carcinoma of the tongue is essentially that of other malignant lesions of the oral cavity as well as a few non-neoplastic lesions. It includes the following:

• Other malignancy
  • Lymphoma
  • Minor salivary gland tumors
    • Adenoid cystic carcinoma
    • Adenocarcinoma
    • Mucoepidermoid carcinoma
  • Sarcoma
    • Rhabdomyosarcoma
    • Liposarcoma
• Infection: more a concern for floor of mouth lesions, or those with involvement of the mandible
• Normal adenoidal tissue: for base of tongue lesions

		Site	Clinical presentation		Investigations	Others
			Symptoms	Signs
Infections	Tuberculosis	Dorsum	History of contact with TB patients Primary TB symptoms: night fever, sweating, bloody cough, and loss of weight Painful tongue ulcers	Ulcer: irregular outline, undulated borders, and covered with a yellowish-gray, and fibrinous layer	Culture and biopsy Chest x-ray for primary infection
	Scarlet fever		Fever, malaise, headache, pharyngitis Red skin rash Swelling of tongue, white and red coating	Heavy gray-white coating Enlargement of the fungiform papillae, which appear as multiple red dots Dots disappear after that		Mainly in children due to B-streptococcal infection
	Syphilis	Dorsum	Single or multiple painless masses or ulcers according to the stage White patches of leukoplakia Symptoms of generalized syphilis in secondary and tertiary stages especially generalized lymphadenopathy	The primary stage The lingual chancre is a solitary, painless, slightly raised, well-demarcated ulcer Enlarged, painless, regional lymph nodes The secondary stage: The mucous patches are slightly raised, grayish-white, and usually surrounded by a red halo. If the lesion is scraped, it leaves a raw, bleeding surface. The third stage: The gumma appears as a painless, elastic mass that subsequently undergoes central necrosis and ulceration. Atrophy of the papillae Frequently associated with leukoplakia, which has a tendency to undergo malignant transformation		Dark-field illumination reveal the causative organisms
Benign neoplasms	Papilloma	Dorsum and lateral borders	Painless slowly growing mass	Warty surface or consist of hyperkeratotic finger-like projections Sessile or pedunculated, pink to white color
	Lipoma	Dorsum and lateral borders	Painless slowly growing mass		Soft, sessile, and yellowish
	Rhabdomyoma
	Leiomyoma		Painless slowly growing mass		Small, single or multiple, circumscribed mass
	Schwannoma	Dorsum and lateral borders	Painless slowly growing lesions, may be painful		Firm, submucosal mass
	Neurofibroma	Dorsum and lateral borders	Slowly growing multiple nodules Unilateral macroglossia		Tongue may show multiple nodules or there may be a more diffuse involvement causing unilateral macroglossia
	Granular cell tumor
Malignant neoplasms	Squamous cell carcinotna
	Malignant salivary gland tumors	Ventral and dorsum
	Metastatic tumor
	Sarcoma
Idiopathic	Benign migratory glossitis	Dorsum
	Hairy tongue
Metablic	Diabetes mellitus		Burning and dryness White plaques on the dorsum of tongue due to Candidal infection in uncontrolled cases	Lingual papillary atrophy
	Hypothyroidism		Dry mouth Difficulties in eating and speaking Tongue swelling	Tongue protrusion Macroglossia
	Acromegaly		Swollen tongue Lingual indentations	Hyperplasia of the epithelium and connective tissue Macroglossia Spacing and labial tilting of the teeth
	Vitamin B deficiency	Dorsum	Redness in the tip and margins of the tongue Swelling of the tongue Indentations of the teeth Associated neurological symptoms due to niacin and B12 deficiency	Atrophy of both the filliform and fungiform papillae
	Amyloidosis	Lateral borders	Enlarged tongue Decrease in lingual mobility Difficulty in chewing, swallowing and speaking	Generalized induration Yellowish nodules

References

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