Chronic Ulcer of Lateral Tongue - A Case Report

Case Presentation

Austin J Dent. 2018; 5(5): 1119.

Chronic Ulcer of Lateral Tongue - A Case Report

Nair A, Jose AS, Kaushik H, Poonja P*, Kini R and Rao PK

Department of Oral Medicine and Radiology, Mangalore, Karnataka, India

*Corresponding author: Preethi Poonja, Department of Oral Medicine and Radiology, Mangalore, Karnataka, India

Received: September 27, 2018; Accepted: October 11, 2018; Published: October 18, 2018


Oral cancer is commonly known as mouth cancer. It can develop in any part of the mouth. More than one million cases arise per year in India itself. Risk factors include tobacco use, heavy alcohol consumption and human papilloma virus. Tongue is one of the most commonly affected site in the oral cavity. It usually develops in the squamous cells of the surface of the tongue which presents most commonly as squamous cell carcinoma. In the present case a sixty six year old male patient complains of ulcer in the lateral border of tongue which was histopathologically diagnosed as squamous cell carcinoma of tongue with metastasis in the left submandibular lymph node. The patient was subjected to surgical excision of lesion followed by radiotherapy.

Keywords: Oral Cancer; Papilloma Virus; Tongue; Squamous Cell Carcinoma


Carcinoma of tongue is the second most common malignancy of the oral cavity predominantly affecting males in the sixth and seventh decade of life [1]. The risk factors for this disease are primarily tobacco and ethanol abuse. The most prevalent site is the lateral border of anterior two-third of tongue [2].

Oral cancer is the eighth most commonest cancer in India with male female ratio as 1.7:1.2 Prevalence of carcinoma in the lateral border of tongue is 25-50 % [3]. Oral squamous cell carcinoma (OSCC) is a well-known malignancy that accounts for more than 90% of all oral cancers. Squamous cell carcinoma represents more than 95% of cancers in the head and neck region. It is present typically in elderly males between fifth to eighth decade. Squamous cell carcinoma cannot be diagnosed clinically, it should be supplemented with histological findings. The overall 5-year survival rate in OSCC has not significantly increased in the last few years. The overall and disease-free survival rates are 56% and 58%, respectively. The most important task is to establish an early diagnosis at the first stage of the disease [4].

The case report presents the case of a sixty six year old male patient with an ulcerative lesion on lateral border of tongue which was concluded as squamous cell carcinoma of tongue after histopathological examination.

Case Presentation

A sixty six year old male patient reported to our dental department with a chief complaint of ulcer in left side of tongue since one month. Pain was present on the same side of the tongue with difficulty in speech and chewing. Bleeding from the ulcer was also present. Ulcer grew from a size of a pea to the present size within one month. There was no history of trauma in the past. Initially the ulcer was asymptomatic. Since two weeks there was an intermittent episode of moderate pain. Patient had difficulty in speech and chewing hard food. Patient had a habit of smoking twenty beedis per day and alcohol consumption for the past 30 years. Patient gives a history of type II diabetes since 2 years and is being treated with Tablet Metformin 1000mg once a day that is taken with evening meal. On extra oral examination left submandibular lymph node was palpable, fixed, non tender and firm in consistency. Intra oral examination shows an ulcer on the left lateral border of the tongue extending from posterior one third of the tongue to the root of the tongue. Uvula was shrunken with restricted forward movements of tongue. Floor shows presence of pseudomembranous slough. Hypermelanosis was also present in the palate and buccal mucosa. Ulceroproliferative growth was seen which is 5x3 cm in diameter (Figure 1). Ulcer has an everted edge which is surrounded by an erythematous area. The ulcer was fixed to the underlying structures. Tenderness, induration and bleeding was present. Based on history and clinical examination a provisional diagnosis of malignant ulcer with TNM clinical staging of T3 N2b M0 was given. Investigations included USG of neck region which revealed enlarged lymph nodes in the left parotid region, jugular spaces and subclavicular region. Fine needle aspiration cytology of the lesion and left submandibular lymph node revealed smears showing good cellularity which were round and polymorphic malignant squamous epithelial cells with pleomorphic nuclei. Moderate to severe degree of pleomorphism and nuclear atypia were seen. Small clumps of eosinophillic keratin like material were seen in a slightly hemorrhagic background. These features confirmed the diagnosis of squamous cell carcinoma of the tongue with metastasis in left submandibular lymph node .Patient was advised for surgical excision of the lesion followed by radiotherapy. Follow up of the patient was not possible as the patient did not visit the oncology centre for further management.

Citation: Nair A, Jose AS, Kaushik H, Poonja P, Kini R and Rao PK. Chronic Ulcer of Lateral Tongue - A Case Report. Austin J Dent. 2018; 5(5): 1119.