|Year : 2023 | Volume
| Issue : 1 | Page : 18-20
A nonhealing ulcer of the tongue involving the floor of the mouth
Arpan Manna, Tanha Khan, MK Sunil
Department of Oral Medicine and Radiology, Teerthanker Mahaveer Dental College and Research Centre, Bagadpur, Uttar Pradesh, India
|Date of Submission||12-Aug-2022|
|Date of Decision||21-Nov-2022|
|Date of Acceptance||27-Nov-2022|
|Date of Web Publication||8-Feb-2023|
Department of Oral Medicine and Radiology, Teerthanker Mahaveer Dental College and Research Centre, Bagadpur, Uttar Pradesh
Source of Support: None, Conflict of Interest: None
A diverse category of malignancies called oral squamous cell carcinomas (OSCCs) develops from the mucosal lining of the oral cavity. The bulk of these malignancies are linked to risky lifestyle behaviors such as smoking, binge drinking, and betel nut chewing. The majority of malignant epithelial tumors of the head and neck are OSCCs, which make up 80%–90% of all malignant tumors of the oral cavity. The fifth to eighth decade of life is when the incidence rate is highest. Less than 40-year-old age groups are an uncommon exception to the OSCC rule. Although it occasionally varies on the population and the habits of the people, the border of the tongue is the most common place for OSCC, followed by the lower lip, the floor of the mouth, the ventral tongue, and the alveolar mucosa/gingiva. There have been noticeably better results on recent improvements in diagnostic and therapy planning. Although the standard of care for OSCC remains surgery, adjuvant radiation, and chemotherapy, advancements in these therapeutic modalities have allowed for better prognoses and the saving of many lives. In the present case report, we evaluated an OSCC in a 53-year-old female patient.
Keywords: Head-and-neck squamous cell carcinoma, malignancies, metastasis, oral squamous cell carcinoma, oral squamous cell carcinomas
|How to cite this article:|
Manna A, Khan T, Sunil M K. A nonhealing ulcer of the tongue involving the floor of the mouth. J Prim Care Dent Oral Health 2023;4:18-20
|How to cite this URL:|
Manna A, Khan T, Sunil M K. A nonhealing ulcer of the tongue involving the floor of the mouth. J Prim Care Dent Oral Health [serial online] 2023 [cited 2023 Mar 29];4:18-20. Available from: http://www.jpcdoh.org/text.asp?2023/4/1/18/369380
| Introduction|| |
The most prevalent malignant epithelial tumor of the oral cavity, oral squamous cell carcinoma, accounts for 80%–90% of all malignant neoplasms of the oral cavity. Males are affected more frequently than females, making the male-to-female ratio 2:1, and the incidence rate for oral squamous cell carcinoma (OSCC) is greater in older persons, especially in the fifth decade of life. Smoking, drinking alcohol, Ultra Violate radiation (primarily for lip cancer), the human papillomavirus, Candida infection, genetic susceptibility, and nutritional inadequacies are the most frequent etiological and predisposing factors of OSCC., According to their size, location, and length of occurrence, OSCC's clinical appearance might vary, but generally speaking, it can seem like an ulcerated lesion with a necrotic center portion surrounding by rolled borders.
Although oral cancer is essentially a visible lesion, it can be difficult to detect early enough for successful treatment since many dental practitioners mistake it for other harmless lesions that exhibit clinically similar symptoms to oral cancer.
| Case Report|| |
The chief complaint of a 53-year-old female patient who visited the oral and maxillofacial radiology department was that she had been experiencing some slight tongue soreness and discomfort for the past 8 months. The patient described how the ulcerative mass was there when she first saw the lesion around 8 months ago and how its size grew over time. She first visited a local doctor, who prescribed her amoxicillin 500 mg and clavulanic acid 125 mg three times daily for 5 days, along with an analgesic. However, the lesion did not heal. She never went to see another doctor after that.
The medical background of the patients was not important. There is also no history of cancer in the family. She claimed that she had been chewing smokeless tobacco for 9-10 years.
A big ulcerative exophytic mass measuring 5–6 cm was discovered during a clinical evaluation in the left lateral edge of the tongue [Figure 1] and [Figure 2]. The ulceration's edges were indurated and uneven. The lesion was both firm and sensitive to the touch. The tooth's cuspal edge does not have a sharp edge next to the lesion. Moth opening was not a difficulty, and no palpable lymph nodes were seen. In addition, a clinical evaluation found no motor or neurosensory abnormalities in the tongue's normal mobility.
|Figure 1: Large ulceroproliferative mass in the left lateral border of the tongue and floor of the mouth|
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Staging of the tumor according to the tumor–node–metastasis classification was stage II (T2N0M0).
The patient was then sent to the department of oral and maxillofacial surgery for further care, and positron emission tomography and magnetic resonance imaging were performed to determine whether the tumor had spread to distant lymph nodes in the area.
The preliminary diagnosis of a malignant ulcer was made based on the clinical features of the lesion, site of the lesion, and patient history, and an incisional biopsy was performed.
H- and E-stained sections showed that neoplastic epithelial cells were proliferating in several islands and had penetrated deeply into the stroma of the connective tissue. Nuclear hyperchromatism, cellular and nuclear pleomorphism, aberrant mitotic patterns, and the production of numerous keratin pearls are characteristics of neoplastic cells.
Therefore, a well-differentiated squamous cell carcinoma is the final diagnosis.
Partial glossectomy was done, and the patient was under regular observation with essential medications.
| Discussion|| |
Oral cancer, more especially OSCC, is one of the most prevalent cancers in the Indian subcontinent and the leading cause of cancer-related mortality., Oral cancer develops more frequently in males than in women in developing nations. The Indian subcontinent has a high pan-tobacco use rate (a combination of betel leaf, lime, areca nut, and sun-dried tobacco).
The average age at which OSCC is diagnosed is 61 years, while 7% of diagnoses occur before age 45 and 2% occur before age 35. Recent studies have indicated a rise in OSCC in younger individuals. According to Kuriakose et al., OSCC is more aggressive, has an invasive character, and has a worse prognosis in the early stages compared to older patients. Patel et al. also confirmed that young individuals are developing oral tongue squamous cell carcinoma more often.
The causes of OSCC are complex. Both extrinsic and intrinsic factors are present. Extrinsic factors include tobacco use, alcohol consumption, betel nut use (paan), and sunlight, while intrinsic factors include malnutrition, iron deficiency anemia, bacteria, Candida, oncogenic viruses, immunosuppression, oncogenes, and tumor suppressor genes.,, A few heritable conditions, including dyskeratosis congenita and Fanconi anemia, have been documented to occasionally be linked to OSCC.
The most prevalent location for OSCC in industrialized nations is the tongue, while in underdeveloped countries, where a high percentage of the population uses tobacco and betel nut products, the most common site is the buccal mucosa, where the users deposit the products in the buccal pouch.,
OSCC often manifests as well-defined red or red and white spots that are well defined and feel slightly abrasive to the touch. Although there may initially be no pain, there could be a little discomfort. Advanced oral cancer has certain well-known characteristics such as ulceration, nodularity, and attachment to underlying tissue.,,
Incisional biopsy, brush biopsy, the ViziLite (highlighting of keratin), oral autofluorescence, photodynamic detection, toluidine blue, methylene blue, saliva, and optical coherence tomography are only a few of the techniques utilized for early cancer identification.,
Although the oral cavity is a common and simple site for clinical assessment, the majority of OSCCs are only discovered in advanced stages. This can be a result of patients' ignorance and inexperienced practitioners' lack of expertise, as OSCC's basic stage is painless.
| Conclusion|| |
OSCC may occasionally imitate an inflammatory lesion or a red-white lesion in the tongue or mucosa in its early stages. These lesions often persist for more than a few weeks. The right information is necessary for the doctor to diagnose an early lesion. To lower the morbidity and mortality associated with oral cancer, biopsy and other diagnostic tools should be performed as soon as a preliminary diagnosis has been obtained.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2]