A 23-year-old student with no relevant medical or surgical history.
Non-smoker, drinker, or other drug user
He was previously well, and began in June 2000 with a painful ulcerated lesion on the lateral border of the tongue of 3-4 mm in diameter, so he came for the first time to our consultation.
The lesion is diagnosed as oral aphtha and treated with various antiseptics and local aphtha without improvement.
Two months later the lesion persists, referring to the patient also moderate pain in the tongue, laterocervical and preauricular region.
The ulcer had been made of irregular edges and its base appeared indurated.
Laterocervical or submandibular lymphadenopathies were not observed.
Blood tests including complete blood count, biochemistry, and leukocyte count showed no significant changes.
Given the torpid evolution, it was decided to refer the patient to ENT for clinical evaluation and biopsy.
In ENT the patient continued with local treatment measures.
A new blood test and serology for hepatitis, HIV, syphilis and CMV were performed.
No significant alterations were observed in the laboratory and all serology was negative.
Two months later, the lesion appeared indurated but no longer ulcerated.
The surface of the perilesional tongue was thickened and discreetly irregular to the point of being obviously certain.
The patient's pain had increased and severe lancinating pain of a few seconds duration, two or three times a day appeared.
The clinical evolution was decided to perform a biopsy of the lesion and MRI.
MRI was reported as a right hemilingual lesion that could correspond to denervative or fat-free status.
There was no mass effect or extension through the midline and the lingual septum was affected.
Small lymph nodes in the retropharyngeal space
Given the degree of contrast uptake, other possibilities were proposed as a lesion of neoplasic or inflammatory origin.
Biopsy was reported as epidermoid carcinoma.
The patient was referred with the diagnosis of squamous cell carcinoma of the tongue T2N0M0 to the maxillofacial surgery service for evaluation of surgical intervention.
The patient underwent surgery in January 2001, performing total resection of the tongue with radical lymphadenectomy and cleaning of the floor of the mouth.
Later he received external radiotherapy.
Six months after surgery the patient is asymptomatic.
No local recurrence.
It is still trained by the geriatric service, although its language is already understandable.
