|Ahead of print publication
Metastatic lesions of tongue
Department of Pathology, Sri Devaraj Urs Medical College, Kolar, Karnataka, India
|Date of Submission||06-Jun-2020|
|Date of Decision||09-Jul-2020|
|Date of Acceptance||20-Jul-2020|
Flat No: 5, Officers Quarters, Sri Devaraj Urs Medical College, Tamaka, Kolar, Karnataka
Source of Support: None, Conflict of Interest: None
One of the common sites of oral cancer is tongue and accounts for 2% of all cancer deaths. Patients usually present at a mean age of 61.1 years, and there is a 1.5:1 male-to-female ratio. Approximately half of the cancers were diagnosed at an advanced stage and most of them involve the base of the tongue.
Approximately 5%–10% of all cancer patients develop spinal metastasis; however, vertebral metastases are rare forms of distant metastasis from squamous cell carcinoma (SCC) of the oral cavity. Persistent back or neck pain should alert the surgeon, which warrants a detailed radiological examination in such patients.
Lee et al. reported two cases of lumbar vertebral metastasis from the SCC of the tongue. One case of delayed metastasis to the C3 vertebral body from primary adenoid cystic carcinoma of the tongue was reported by Feng et al. Metastasis to cervical vertebrae from oral SCC has also been reported by Carlson and Ord in 4 patients (0.7%) of 597 patients in their series. Although metastasis to the spine is usually extradural, intramedullary metastasis has also been reported by Törnwall et al. in one case.
It is very well known that if metastatic vertebral disease is left untreated, it may lead to paraplegia, which is one of the most serious complications of metastasis. Harrington described a classification guideline system based on both bone destruction and neurologic impairment and distinguishes five classes of vertebral metastatic lesions and suggested surgical intervention for Class IV and V lesions.
The prognosis for metastatic spine disease is dependent on several factors. Patients with single-level involvement have a better survival rate (average survival, 12.9 months) than patients with multiple-level involvement (average, 7.9 months). Age can also be considered as a prognostic factor for survival because patients younger than 60 years survive significantly longer than older patients (20.1 vs. 6.2 months; P = 0.028). The 5-year disease-specific survival rates for Stage IV disease reported by Gourin and Johnson was 48%.
Financial support and sponsorship
Sri Devaraj Urs Medical College.
Conflicts of interest
There are no conflicts of interest.
| References|| |
Gorsky M, Epstein JB, Oakley C, Le ND, Hay J, Stevenson-Moore P. Carcinoma of the tongue: A case series analysis of clinical presentation, risk factors, staging, and outcome. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2004;98:546-52.
Carlson ER, Ord RA. Vertebral metastases from oral squamous cell carcinoma. J Oral Maxillofac Surg 2002;60:858-62.
Lee KH, Halfpenny W, Thiruchelvam JK. Spinal cord compression in patients with oral squamous cell carcinoma. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2007;103:e16-8.
Feng H, Wang J, Guo P, Xu J, Feng J. C3 vertebral metastases from tongue adenoid cystic carcinoma: A rare case report. Medicine (Baltimore) 2015;94:e1135.
Törnwall J, Snäll J, Mesimäki K. A rare case of spinal cord metastases from oral SCC. Br J Oral Maxillofac Surg 2008;46:594-5.
Mones RJ, Dozier D, Berrett A. Analysis of medical treatment of malignant extradural spinal cord tumors. Cancer 1966;19:1842-53.
Harrington KD. Metastatic disease of the spine. J Bone Joint Surg Am 1986;68:1110-5.
Gourin CG, Johnson JT. Surgical treatment of squamous cell carcinoma of the base of tongue. Head Neck 2001;23:653-60.