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.