Differential diagnosis, investigations and treatment
The clinical aspect of the lesions guided the diagnosis toward a squamous cell carcinoma on oral lichen planus, despite the young age of the patient and the absence of tobacco and alcohol history. What was surprising was the concomitance of pregnancy with the appearance of this tongue lesion. Biopsies were performed on three different areas of the lesion and the anatomopathological result was requested urgently. It was obtained after 48 hours and confirmed the SCC diagnosis.
A complete local and general radiological examination was carried out to explore the tumor lesion and its extension. A CT scan and Magnetic Resonance Imaging (MRI) of the tongue and the cervicothoracic region showed the absence of local extension of the tumor and the presence of bilateral submandibular adenomegaly of inflammatory type.
The Multidisciplinary Consultation Meeting, with the participation of gynecologists, decided to induce delivery at 35 weeks of amenorrhea before treating the cancer. Our patient gave birth to a girl through a cesarean procedure. The baby weighed 2,400 gr, her Apgar score was 10 and pH equal to 7,4.
The Positron Emission Tomography (PET scan), performed just after the early-induced delivery, showed an intense focal hyper uptake at the right lateral edge of the tongue with hypermetabolic lymph-node formation at the right subdigastric level.
The surgical decision was to perform a right lateral partial glossectomy, associated with a right lymph node dissection - according to the PET scan results - two weeks after delivery. The anatomopathological examination of the partial glossectomy specimen showed a well-differentiated infiltrating squamous cell carcinoma measuring 2 cm in long axis, with the presence of perineural sheaths and a few lymphatic emboli (Figure 2). No lymph-node metastasis was found after right lymph-node dissection. Human papillomavirus (HPV) infection was investigated by immunostaining with the P16 protein and was negative, but PCR was not done to confirm the presence of the viral DNA. The tumor was classified: T1N0M0. The post-surgery healing was favorable.