Abstract
Adenocarcinoma of the minor salivary gland more commonly involves the palate and base of tongue but rarely presents in the anterior tongue. We report a rare case of adenocarcinoma of the minor salivary gland located in the anterior togue of a 74-year-old man. Furthermore, we discuss the histopathological features of this neoplasm, the treatment plan, and a literature review of the current standard of care.
1
Introduction
The most common site of minor salivary gland tumors is the palate, followed by the tongue . Among the malignant minor salivary gland tumors of the tongue, adenocarcinoma is the second most common type and occurs mainly in the base of tongue; adenocarcinoma of the anterior tongue is exceedingly rare. Here, we report a case of adenocarcinoma of the anterior tongue and the management technique employed to treat the disease.
2
Case report
A 74-year-old Caucasian male presented with a 2-month history of an enlarging mass of the anterior ventral tongue with paresthesia of the lesion. He denied pain or bleeding associated with the mass. He had a history of alcohol and tobacco use; however, he had quit 30 years prior to presentation. His past medical history was otherwise non-contributory.
On examination, a 4 × 3 cm well-circumscribed nodular lesion arising from the ventral surface of the anterior tongue was identified ( Fig. 1 ). The lesion was firm with smooth overlying mucosa and no ulceration. The tongue was completely mobile but the lesion was so large that it was interfering with the patient’s ability to articulate and swallow normally. No other oral lesions were noted and no cervical lymphadenopathy was appreciated. Fine needle aspiration was obtained and the cytopathology was consistent with adenocarcinoma.
The patient subsequently underwent partial glossectomy with primary closure. Negative margins were confirmed with intraoperative frozen section analysis. Permanent histopathologic analysis of the specimen revealed multifocal submucosal involvement by adenocarcinoma ( Fig. 2 ), malignant glands lined by cribriform and stratified cells ( Fig. 3 ) and evidence of angiolymphatic invasion. After further discussion with the patient regarding this high risk feature for neck metastasis, bilateral supraomohyoid neck dissections were performed in a second operation. All extirpated lymph nodes were negative for malignancy.
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