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Background: Failure rate of surgery for early tongue carcinoma remains high. We sought to identify patterns of failure and recurrence risk factors., Methods: Data review was carried out on 50 patients treated for early tongue carcinoma (T1/2N0M0); surgery was unsuccessful in 11 of these patients. All patients underwent transoral resection of the tongue tumor and prophylactic neck dissection (supraomohyoid)., Results: Tumor recurred within 3 to 18 months. Nine died of disease. Four had failure in neck level 4, 6 in level 1, and 1 simultaneously in level 1 and locally. Most tumors were moderately differentiated. Average depth was 6.64 mm., Conclusions: We report 11 patients with early tongue carcinoma who failed local excision with neck dissection. Failures occurred in level 4 (4 patients) and level 1 (7 patients). This group may benefit from extended neck surgery. Sex, age, stage, and depth of tumor were not significantly different in the group with treatment failure. Tumors in the group with treatment failure were more poorly differentiated., (Copyright © 2011 Wiley Periodicals, Inc.)

Background: Tobacco smoking and high alcohol consumption are considered major risk factors of oral tongue squamous cell carcinoma. This study compared disease outcome between patients with and without known risk factors., Methods: Patients with oral tongue squamous cell carcinoma treated at two major medical centers from 1994 to 2008 were identified by cancer registry search. The medical files were reviewed for background-and-disease-related data, risk factors, and outcome., Results: The study sample consisted of 291 patients: 175 had a history of heavy tobacco smoking and alcohol abuse and 116 did not. Comparison of the patients without risk factors between the two centers yielded no differences in background features. Men accounted for 74% of the total patients with risk factors and comprised 77% of the risk-factor group. The risk-factor group was characterized by a significantly higher mean tumor grade (p=0.0001) and greater tumor depth of invasion (p=0.022) than the non-risk-factor group. The 5-year local and regional control rates were 85.3% and 74%, respectively, with no significant difference between the groups. The 5-year overall survival rate was 68% in the risk-factor group and 64% in the non-risk-factor group (p=NS). Separate analysis of patients aged <40 years at diagnosis revealed a worse overall (p=0.015) and disease-free survival (p=0.038) in those without risk factors., Conclusions: The outcome of oral tongue carcinoma is similar in patients with and without risk factors. The worse prognosis in younger patients (<40 years) without risk factors suggests that the pathogenesis in these cases involves factors other than smoking and alcohol., (Copyright © 2010 Elsevier Ltd. All rights reserved.)

Background: Oral cancer is a common and lethal malignancy. Direct contact between saliva and the oral cancer lesion makes measurement of tumour markers in saliva an attractive alternative to serum testing., Methods: We tested 19 tongue cancer patients, measuring the levels of 8 salivary markers related to oxidative stress, DNA repair, carcinogenesis, metastasis and cellular proliferation and death., Results: Five markers increased in cancer patients by 39-246%: carbonyls, lactate dehydrogenase, metalloproteinase-9 (MMP-9), Ki67 and Cyclin D1 (CycD1) (P< or =0.01). Three markers decreased by 16-29%: 8-oxoguanine DNA glycosylase, phosphorylated-Src and mammary serine protease inhibitor (Maspin) (P< or =0.01). Increase in salivary carbonyls was profound (by 246%, P=0.012); alterations in CycD1 (87% increase, P=0.000006) and Maspin (29% decrease, P=0.007) were especially significant. Sensitivity values of these eight analysed markers ranged from 58% to 100%; specificity values ranged from 42% to 100%. Both values were especially high for the CycD1 and Maspin markers, 100% for each value of each marker. These were also high for carbonyls, 90% and 80%, respectively, and for MMP-9, 100% and 79%, respectively., Conclusion: The significance of each salivary alteration is discussed. As all alterations correlated with each other, they may belong to a single carcinogenetic network. Cancer-related changes in salivary tumour markers may be used as a diagnostic tool for diagnosis, prognosis and post-operative monitoring.

Squamous cell carcinoma (SCC) of the tongue is characterized by an unpredictable course, ranging from relatively benign to a high degree of locally aggressive growth and metastasis. Treatment guidelines have been developed according to TNM stage, but they do not always accurately predict clinical outcome. The aim of the present study was to evaluate the expression of the matrix metalloproteinases (MMPs) that degrade the extracellular matrices, their inhibitors (TIMPs), and angiogenic factors (factor-8 and CD-34) in tumor cells and to correlate these findings with the clinicopathological features and patient outcome. Tissue specimens from 23 patients with primary SCC of the tongue were immunohistochemically stained for these markers. High expressions of MMP-9 and TIMP-1 were detected in 60.9% and 65.2% of the specimens, respectively. Tumor invasion to adjacent muscle, lymph node metastasis, and disease status at the end of follow-up were positively correlated with the microvessel count using the CD-34 marker, but not with high expression of MMP-9 or TIMP-1. Expression of MMP-9 and TIMP-1 fails to predict aggressiveness in SCC of the tongue. However, the degree of vascularization in tumor tissue is indicative of disease aggressiveness and might be used as a basis for patient selection for more intensive therapy.

Purpose: The clinical course of patients with squamous cell carcinoma (SCC) of the tongue is often unpredictable. Some patients have a fair course with good response to treatment, whereas others have aggressive locoregional disease despite diagnosis at an early stage. The purpose of the present study was to determine if histochemical staining for cytokeratins of the negative neck nodes obtained in prophylactic neck dissection could predict treatment failure in patients with SCC of the tongue., Materials and Methods: Between 1990 and 2000, 18 patients with early squamous cell carcinoma of the tongue (T1,T2N0M0) underwent partial glossectomy with neck dissection at the Rabin Medical Center in Israel. All had clear resection margins and no evidence of neck metastasis and were expected to do well. Nevertheless, 6 patients had an aggressive course and died of disease shortly after presentation because of local or regional failure. In an attempt to predict failure of treatment and patients' outcome, paraffin-embedded blocks from the pathologically negative lymph nodes were subjected to immunohistochemical staining for cytokeratin using polyclonal antibodies. The antigen-antibody complex was identified by using the biotinylated secondary antibody and followed by the streptavidin-peroxidase detection method., Results: None of the 142 sections from pathologically negative lymph nodes stained positive for keratin. On multivariate analysis, a statistically significant relationship was found between disease-free survival, early recurrence (P =.03), and metastasis to the neck (P =.008)., Conclusions: Keratin staining failed to yield evidence of micrometastasis. Further studies with more samples are needed to confirm these findings.

Squamous cell carcinoma (SCC) of the tongue is sometimes associated with local recurrence and regional metastases despite adequate surgical excision. The present study sought to determine if epidermal growth factor receptor (EGFR) and Cerb-B2 expression has prognostic or predictive value in SCC of the tongue, as with other epithelial malignancies. The study sample comprised of 27 patients with carcinoma of the tongue who underwent partial glossectomy and neck dissection between 1990 and 1999. Average follow-up was 54 months. Specimens from 23 patients were analyzed for growth factor expression using monoclonal antibodies specific for EGFR and Cerb-B2. Findings were correlated with the clinical course. EGFR and Cerb-B2 were expressed in 34% and 17% of the specimens, respectively. There was a statistically significant correlation between EGFR expression and tumor differentiation, and a borderline correlation between Cerb-B2 expression and T stage. No association was found between growth factor expression and tumor depth, lymph node status, extracapsular invasion, recurrence, or survival. Overexpression of EGFR and Cerb-B2 cannot serve as a prognostic factor or predictor of survival and treatment success in SCC of the tongue.

Tongue resection has significant influence on the patient's quality of life, because it interferes with masticatory and speech functions and affects facial aesthetics. To avoid the disadvantages of the traditional lip-splitting used to approach partial tongue reconstruction for resection (40% of the tongue or more), we recommend a completely transoral approach, with the radial forearm free flap as a donor flap. Between 1999-2001, the suggested technique was applied in 11 patients with squamous-cell carcinoma of the mobile tongue. A follow-up of 6-30 months showed good to excellent oral function, with preservation of tongue volume, motion, and facial aesthetics. This approach seems to be preferable over the lip-split approach for the reconstruction of mobile tongue defects., (Copyright 2003 Wiley-Liss, Inc.)

Objective: To evaluate the relationship between tumor angiogenesis and the subsequent development of cervical node metastases in patients with stage 1 carcinoma of the oral tongue., Methods: The study group consisted of 25 patients with T1 carcinoma with no evidence of neck disease at presentation. Paraffin blocks from 10 patients, in whom neck node metastases were found shortly after surgery, were stained for factor VIII and compared with those from 10 randomly chosen patients in whom no evidence of recurrent disease was observed during prolonged followup. Microvessels were counted in each group., Results: The microvessel counts correlated with metastatic disease. The mean +/- SD count was 103.41 +/- 40.72 per X 250 field in the patients with positive lymph node metastases and 50.03 +/- 13.74 per X 250 field in those with no lymph node metastases during follow-up (P < or = .05)., Conclusions: The number of microvessels per X 250 field in the area of most intensive neovascularization in early oral tongue carcinoma may be an independent predictor of nodal metastases. Assessment of tumor angiogenesis may therefore prove valuable in selecting patients with early oral tongue carcinoma for aggressive therapy.

Papillary endothelial hyperplasia is an exuberant, intravascular, endothelial proliferation bearing some similarities to angiosarcoma. To the best of our knowledge, it has never been described in the tongue. A case of such a lesion is herein reported. The lesion, despite its benign nature, may be clinically and histopathologically mistaken for an angiosarcoma and, thus, lead to inappropriate treatment. Papillary endothelial hyperplasia differs from angiosarcoma in its being confined entirely within large vascular lumens and in its lacking of mitosis, necrosis, and true, solid, cellular areas devoid of vascular differentiation.

The tongue is an unusual site for metastases of cutaneous malignant melanoma. A review of the literature revealed only 16 such cases. The discovery of metastases in the tongue usually indicates widespread dissemination of the melanoma and a terminal phase of the disease. Two patients with metastatic malignant melanoma of the tongue are presented. The primary tumors were excised 10 and four years respectively prior to the discovery of the lingual metastases. In one of the patients the lingual metastasis was the first evidence of a disseminated stage of the disease. The histopathological differentiation between primary and secondary melanoma of the tongue is discussed. Such differentiation may have an important therapeutic implication.

A case of a monomorphic adenoma of the minor salivary glands situated at the base of the tongue in a 49-year-old female is reported. The patient had a prolonged clinical course of eight years' duration. The histopathologic, immunohistologic and ultra-structural findings are described. A review of the literature concerning minor salivary gland tumors and their location in the oral cavity is presented. This is the first case, to our knowledge, of a monomorphic adenoma presenting at the base of the tongue. The difficulties in its diagnosis are discussed specifically in regard to its location.