A case of Stage I exophytic tongue cancer with early poor prognosis

Abstract

T1/T2 exophytic tongue cancer is supposed to be in the favorable prognosis group and has a relatively high 5-year recurrence-free survival rate. Here we reported a case of Stage I exophytic tongue cancer that metastasized to the cervical lymph nodes and the liver within a short period after removal of the primary tumor. The patient was a 79-year-old male who visited our hospital with a chief complaint of a pain in the left side of the tongue. An exophytic mass, 19 × 19 × 7mm in size, was found on the posterior left lateral border of the tongue. The mass was excised by a partial glossectomy with clinical diagnosis of Stage I tongue cancer. Histopathological diagnosis was squamous cell carcinoma of WHO Grade 2 and YK classification 4C. Three months after the removal of the primary tumor, a modified radical neck dissection was conducted due to a late metastasis in the neck lymph node. Five months later, the patient had recurrence in the neck and liver metastases. Thirteen months after his first examination, he died. In relation to the occurrence of lymph node and distant metastases of this exophytic tongue cancer, histopathological examination of the primary lesion showed that the tumor lesion was well-circumscribed without invasion into the deeper muscular layer but clusters of carcinoma cells had infiltrated into lymphatic vessels in the intra-tumor region. Immunohistochemistry further indicated malignant phenotypic indicators of this exophytic tongue cancer, characterized by down-regulation of E-cadherin and overexpression of p53 for carcinoma cells and accumulation of D2-40-positive lymphatic endothelial cells and αSMA/S100A4 double-positive myofibroblasts in the intra-tumor stroma. To improve prognostic diagnosis of early exophytic tongue cancer, it is of importance to establish histopathological indicators of malignancy.