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Rampi A, Tettamanti A, Bertotto I, Comini LV, Howardson BO, Luparello P, Di Santo D, Bondi S. Atypical Tongue Abscesses Mimicking Submucosal Malignancies: A Review of the Literature Focusing on Diagnostic Challenges. Cancers (Basel) 2023; 15:5871. [PMID: 38136415 PMCID: PMC10741429 DOI: 10.3390/cancers15245871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 12/06/2023] [Accepted: 12/14/2023] [Indexed: 12/24/2023] Open
Abstract
Tongue abscesses are rare conditions that usually follow mucosal disruption due to mechanical trauma or foreign body impaction. They typically manifest abruptly as a rapidly growing, hard mass or swelling in the context of tongue muscles; the patient frequently complains of pain, difficulties in swallowing or speaking, and fever. Nonetheless, the features of its presentation, together with accurate clinical evaluation, blood tests, and appropriate imaging tests, are usually sufficient to easily discern a tongue abscess from a malignancy. However, in rare cases, they may occur with slowly progressing and subtle symptoms, nuanced objective and laboratory findings, and inconclusive radiological evidence, leading to difficult differential diagnosis with submucosal malignancy. Herein, we review the literature, available on Pubmed, Embase, and Scopus, on publications reporting tongue abscesses, with atypical presentation suggesting an oral tumor. Our review confirms that tongue abscesses may manifest as a slowly growing and moderately painful swelling without purulent discharge and minimal mucosal inflammation; in this case, they may constitute an actual diagnostic challenge with potentially severe impact on correct management. Atypical tongue abscesses must therefore be considered in the differential diagnosis of tongue malignancy with submucosal extension, even when other diagnostic elements suggest a neoplasia; in this case, a deep biopsy under general anesthesia is essential for differential diagnosis, and simultaneous drainage of the necrotic and abscessual material may resolve the condition.
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Affiliation(s)
- Andrea Rampi
- Otorhinolaryngology Unit, Division of Head and Neck Department, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (A.R.); (A.T.); (B.O.H.)
- School of Medicine, Vita-Salute San Raffaele University, 20132 Milan, Italy
| | - Alberto Tettamanti
- Otorhinolaryngology Unit, Division of Head and Neck Department, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (A.R.); (A.T.); (B.O.H.)
- School of Medicine, Vita-Salute San Raffaele University, 20132 Milan, Italy
| | - Ilaria Bertotto
- Radiology Unit, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, 10060 Turin, Italy;
| | - Lara Valentina Comini
- Otorhinolaryngology Unit, Head and Neck Surgery, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, 10060 Turin, Italy; (L.V.C.); (P.L.); (D.D.S.)
| | - Bright Oworae Howardson
- Otorhinolaryngology Unit, Division of Head and Neck Department, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (A.R.); (A.T.); (B.O.H.)
- School of Medicine, Vita-Salute San Raffaele University, 20132 Milan, Italy
| | - Paolo Luparello
- Otorhinolaryngology Unit, Head and Neck Surgery, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, 10060 Turin, Italy; (L.V.C.); (P.L.); (D.D.S.)
| | - Davide Di Santo
- Otorhinolaryngology Unit, Head and Neck Surgery, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, 10060 Turin, Italy; (L.V.C.); (P.L.); (D.D.S.)
| | - Stefano Bondi
- Otorhinolaryngology Unit, Head and Neck Surgery, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, 10060 Turin, Italy; (L.V.C.); (P.L.); (D.D.S.)
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Arbune M, Padurariu-Covit MD, Niculet E, Chiscop I, Arbune AA, Tatu AL. Ulceration and a White Lesion of the Tongue in a Male HIV Positive Patient: A Journey on the Avenue of Differential Diagnoses in Search of a Solution. Life (Basel) 2023; 13:life13040901. [PMID: 37109430 PMCID: PMC10147043 DOI: 10.3390/life13040901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 03/21/2023] [Accepted: 03/24/2023] [Indexed: 03/31/2023] Open
Abstract
Oral lesions are early indicator of immunosuppression, leading to HIV new diagnoses. The type of oral lesions can reveal opportunistic diseases that are correlated with the severity of immune depletion. Highly active antiretroviral therapy decreases the incidence of opportunistic oral infections, whereas a large variety of lesions are frequently experienced in people with HIV. Overlapping pathogenic mechanisms and multiple contributing etiologies are related to unusual, atypical oral lesions that are challenging in the clinical practice. We present a rare case of eosinophilic granuloma of the tongue in an older male HIV patient with severe immunosuppression due to the failure of antiretroviral treatment. Differential diagnoses considered squamous carcinoma, lymphoma, viral, fungal or bacterial infections and autoimmune disorders, as well as the influence of HIV immune disfunctions or the influence of cannabidiol use. The histopathologic and immunohistochemistry examination clarified the inflammatory reactive benign substrate of the lesion, although future survey of the oral lesions is essential.
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Affiliation(s)
- Manuela Arbune
- Clinical Medical Department, Medicine and Pharmacy Faculty, “Dunarea de Jos” University of Galati, 800008 Galati, Romania; (M.A.); (A.-L.T.)
- Infectious Diseases Clinic Department I, Infectious Diseases Clinic Hospital “Sf. Cuv. Parascheva”, 800179 Galati, Romania
- Multidisciplinary Integrated Center of Dermatological Interface Research (MIC-DIR), “Dunarea de Jos” University, 800010 Galati, Romania;
| | - Monica-Daniela Padurariu-Covit
- The School for Doctoral Studies in Biomedical Sciences, “Dunarea de Jos” University of Galați, 800008 Galati, Romania
- Hematology Department, Emergency County Hospital “Sf. Apostol Andrei”, 800578 Galati, Romania
- Correspondence: (M.-D.P.-C.); (E.N.)
| | - Elena Niculet
- Multidisciplinary Integrated Center of Dermatological Interface Research (MIC-DIR), “Dunarea de Jos” University, 800010 Galati, Romania;
- The School for Doctoral Studies in Biomedical Sciences, “Dunarea de Jos” University of Galați, 800008 Galati, Romania
- Pathology Department, Emergency County Hospital “Sf. Apostol Andrei”, 800578 Galati, Romania
- Correspondence: (M.-D.P.-C.); (E.N.)
| | - Iulia Chiscop
- Oral and Maxillofacial Surgery Department, Emergency County Hospital “Sf. Apostol Andrei”, 800578 Galati, Romania;
- Clinical Surgery Department, Medicine and Pharmacy Faculty, “Dunarea de Jos” University of Galati, 800008 Galati, Romania
| | - Anca-Adriana Arbune
- Multidisciplinary Integrated Center of Dermatological Interface Research (MIC-DIR), “Dunarea de Jos” University, 800010 Galati, Romania;
- Neurology Department, Fundeni Clinical Institute, 022328 Bucharest, Romania
| | - Alin-Laurențiu Tatu
- Clinical Medical Department, Medicine and Pharmacy Faculty, “Dunarea de Jos” University of Galati, 800008 Galati, Romania; (M.A.); (A.-L.T.)
- Multidisciplinary Integrated Center of Dermatological Interface Research (MIC-DIR), “Dunarea de Jos” University, 800010 Galati, Romania;
- Dermato-Venerology Clinic Department, Infectious Diseases Clinic Hospital “Sf. Cuv. Parascheva”, 800179 Galati, Romania
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Hong SA, Simpson MC, Du EY, Ward GM. Epidemiology and Prognostic Indicators of Survival in Tongue Lymphoma. Ann Otol Rhinol Laryngol 2023; 132:190-199. [PMID: 35373599 DOI: 10.1177/00034894221088175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVES Lymphoma, categorized as either non-Hodgkin's lymphoma or Hodgkin's lymphoma, is the second most common malignancy in the head and neck. Primary tongue lymphoma is exceedingly rare, with only case reports or small case series in the literature. This population-based analysis is the first to report the epidemiology and prognostic factors of survival in patients with primary tongue lymphoma. METHODS The Surveillance, Epidemiology, and End Results 18 database from the National Cancer Institute was queried for patients diagnosed between the years 2000 and 2016 with tongue lymphoma. Outcomes of interest were overall and disease-specific survival. Independent variables included age at diagnosis, sex, race, marital status, primary subsite, histologic subtype, stage, and treatment type. RESULTS AND CONCLUSION Seven hundred forty patients met criteria; the male-female ratio was 1.5:1 and the mean age at diagnosis was 67.8 years. The majority of lesions localized to the base of tongue (90.0%), were histologically diffuse large B-cell lymphoma (59.5%), and presented at stage I or II (77.9%). Most early-stage lymphomas were treated with chemotherapy only (40.5%) or a combination of both chemotherapy and radiation (31.3%), while late-stage cancers were primarily treated with chemotherapy alone (68.5%). In multivariate analysis, younger age at diagnosis, female sex, married/partnered marital status, mucosa-associated lymphoid tissue histologic subtype, and earlier cancer stage were found to be associated with improved survival. Chemotherapy treatment with or without radiation was also associated with better survival compared to no treatment or radiation alone, though data regarding immunotherapy was unavailable.
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Affiliation(s)
- Scott A Hong
- Department of Otolaryngology - Head and Neck Surgery, St. Louis University Hospital, St. Louis, MO, USA
| | - Matthew C Simpson
- Department of Otolaryngology - Head and Neck Surgery, St. Louis University Hospital, St. Louis, MO, USA
| | - Eric Y Du
- Saint Louis University School of Medicine, St. Louis, MO, USA
| | - Gregory M Ward
- Department of Otolaryngology - Head and Neck Surgery, St. Louis University Hospital, St. Louis, MO, USA
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MacDonald A, Gross A, Jones B, Dhar M. Muscle Regeneration of the Tongue: A review of current clinical and regenerative research strategies. TISSUE ENGINEERING PART B-REVIEWS 2021; 28:1022-1034. [PMID: 34693743 DOI: 10.1089/ten.teb.2021.0133] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Various abnormalities of the tongue, including cancers, commonly require surgical removal to sequester growth and metastasis. However, even minor resections can affect functional outcomes such as speech and swallowing, thereby reducing quality of life. Surgical resections alone create volumetric muscle loss whereby muscle tissue cannot self-regenerate within the tongue. In these cases, the tongue is reconstructed typically in the form of autologous skin flaps. However, flap reconstruction has many limitations and unfortunately is the primary option for oral and reconstructive surgeons to treat tongue defects. The alternative, but yet undeveloped strategy for tongue reconstruction is regenerative medicine, which widely focuses on building new organs with stem cells. Regenerative medicine has successfully treated many tissues, but research has inadequately addressed the tongue as a vital organ in need of tissue engineering. In this review, we address the current standard for tongue reconstruction, the cellular mechanisms of muscle cell development, and the stem cell studies that have attempted muscle engineering within the tongue. Until now, no review has focused on engineering the tongue with regenerative medicine, which could guide innovative strategies for tongue reconstruction.
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Affiliation(s)
- Amber MacDonald
- The University of Tennessee Knoxville College of Veterinary Medicine, 70737, Large Animal Clinical Sciences, 2407 River Drive, Knoxville, Tennessee, United States, 37996-4539;
| | - Andrew Gross
- The University of Tennessee Medical Center, 21823, Knoxville, Tennessee, United States;
| | - Brady Jones
- The University of Tennessee Medical Center, 21823, Knoxville, Tennessee, United States;
| | - Madhu Dhar
- University of Tennessee Knoxville College of Veterinary Medicine, 70737, Large Animal Clinical Sciences, College of Veterinary Medicine, 2407 River Drive, Knoxville, Tennessee, United States, 37996.,University of Tennessee;
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