Adenosquamous Carcinoma of the Tongue
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Adenosquamous Carcinoma of the Tongue Yeshwant B. Rawal1 · Kenneth M. Anderson2 Received: 29 November 2017 / Accepted: 8 December 2017 © Springer Science+Business Media, LLC, part of Springer Nature 2017
Abstract A 51-year-old white female presented with a painful ulcer of the left ventrolateral tongue. An incisional biopsy confirmed a diagnosis of adenosquamous carcinoma. The adenosquamous carcinoma is an uncommon malignant tumor with histopathological features of a squamous carcinoma and an adenocarcinoma. A definitive diagnosis requires histopathological examination of a deep biopsy involving the submucosal tissue. This malignant tumor shows aggressive behavior with early invasive growth and a poor prognosis. The histopathological findings and differential diagnosis of a case of adenosquamous carcinoma of the tongue are discussed. Keywords Oral · Tongue · Carcinoma · Squamous · Adenocarcinoma
History A 51-year-old white female presented to the dental emergency clinic with a painful ulcer of the left ventrolateral tongue. Reportedly, the ulcer was present for several weeks but had become recently painful. The pain affected tongue mobility, interfering with chewing and speech. There was no history of tobacco or alcohol use. Her medical history was uneventful other than occasional office visits for seasonal respiratory ailments.
Clinical Findings Extraoral examination was unremarkable and regional lymph nodes were not palpable. On intraoral examination, the left ventrolateral tongue showed an irregular ulcer surrounded by vague leukoplakia-like areas. The ulcer bed was * Yeshwant B. Rawal [email protected] Kenneth M. Anderson [email protected] 1
Department of Oral & Maxillofacial Surgery, School of Dentistry, University of Washington, B-204 Magnuson Health Sciences Center, 1959 NE Pacific Street, Box 357133, Seattle, WA 98195, USA
Diagnostic Sciences and Oral Medicine, College of Dentistry, University of Tennessee Health Science Center, Memphis, TN, USA
2
erythematous with a slight fibrinopurulent exudate (Fig. 1). The area was indurated and tender to palpation. The remainder of the oral cavity was within normal limits. The patient elected to undergo an incisional biopsy procedure.
Diagnosis Formalin fixed hematoxylin and eosin stained sections showed nests and islands of well-differentiated keratinizing squamous cells invading the lamina propria (Fig. 2). A transition to an adenocarcinoma (Fig. 3), with prolific glandular duct-like structures with lumens surrounded by dysplastic cells, many of who showed intracytoplasmic vacuoles was seen in the deeper submucosa. Occasional mucocytes were also seen (Fig. 4). The adenocarcinoma also showed dissection of the extrinsic skeletal muscle fiber bundles (Fig. 5), perineural involvement (Fig. 6) and intravascular tumor islands (Fig. 7). Based on the histopathological findings, a diagnosis of adenosquamous carcinoma was given.
Discussion The adenosquamous carcinoma is a tumor that demonstrates the presence of a true
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