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Report of a case of mixed tumor of the tongue
REPORT OF A CASE OF MIXED TUMOR GREGORY
L.
ROBILLARD,
M.D.,
F.A.C.S.
AND
SurgicaI Director, BrookIyn Cancer Institute; Attending Surgeon, Norwegian HospitaI
FRANK CHISENA,M.D. CIinicaI Assistant Visiting Physician, Kings County and Norwegian HospitaIs
BROOKLYN,
M
OF THE TONGUE
NEW
YORK
viousIy. The patient’s attention was caIIed to the deveIopment of this tumor after an inIaid Ming in the Ieft first upper moIar had dropped
IXED
tumors of the tongue have been cIarified by the review of the ten cases in the Iiterature by
FIG. I. Low power. Cross section of the entire tumor, showing epitheIia1 elements (gIands) in lower right corner; and, mesothelia1 structures (ova1 area of cartiIage, foIIicIes, and fibrous septa).
Brunschwig,l who estabIished certain criteria for such tumors, nameIy-epithehal eIements in any arrangement, and mesotheIia1 structures as cartiIage, muscuIar tissue, and fibrous connective tissue. .We present the evidence in the foIIowing case as in favor of another instance of such very rare tumors of the tongue. C. K., a dentist, was admitted to the Norwegian HospitaI for removal of a smaI1 mass on the tongue which had appeared one year pre-
out. He Iater had it removed because of the considerabIe irritation to the tongue produced during chewing. The tumor, on inspection, was white, round, hard and fibrous, the size of a pea, and was Iocated on the. anteroIatera1 aspect of the Ieft b or der of the tongue, I inch from the tip. It was embedded in the margin, invoIving the entire thickness of the tongue, and it remained constant in size after its appearance. At operation under IocaI anesthesia, a wedgeshaped piece of tongue was removed, the incisions extending we11 wide of the growth.
794
NEW
‘a.
XLIII.
No. 3
RobilIard,
FIG. z. Area of cartiIage
FIG. 3. Area
Chisena-Tongue
and Iymphoid
of oId hemorrhage
foIli&
and pigmentation
Tumor
with intervening
bordering
American
~~~~~~~ of surgery
fibrous
septa.
on muscle
layer.
795
796
American Journalof Surgery
RobiIIard,
Chisena-Tongue
The microscopic picture showed a Iayer of beneath which were flattened epitheIium several coIIections of hyperpIastic Iymphoid foIIicIes separated by fibrous connective tissue. Beneath the Iymphoid Iayer was a group of gIanduIar acini, with an area of cartiIage surrounded by fibrous tissue interposed between the two. In the deeper portions of the tumor appeared an area of hemorrhage and pigmentation. A recent examination of the patient disclosed a scarring of the tongue at the site of operation and area of anesthesia the size of a quarter, with no evidence of IocaI or regiona metastasis. DISCUSSION
Mixed tumors of the tongue are very rare, and as Wood2 states, they resembIe mixed tumors of the sahvary gIands. ApparentIy onIy a smaI1 proportion undergoes maIignancy. They do not grow very rapidIy and tend to produce regiona metastasis 0nIy. From the very nature of the growth, such tumors are expected to vary wideIy in their histologic architecture. AI1 the structures enumerated may be found normaIIy in the tongue. The question arises as to
MAHCH, ,939
Tumor
whether this tumor represents a simpIe hyperpIasia of the Iymphoid eIements with a concomitant fibrosis, Iocated in proximity to an area of cartiIage and a coIIection of mucous gIands; or, possessing the two essentia1 characteristics described by Brunschwig, it is a mixed tumor. SUMMARY I. Mixed tumors of the tongue are diagnozed on certain criteria estabIished by Brunschwig. 2. The histoIogic structure found in mixed tumors of the tongue may vary wideIy, but the essentia1 characteristics wiI1 determine the nature of the growth. 3. Tumors of the tongue shouId be as in many cases cIoseIy scrutinized, divergence of opinion wiI1 exist as to whether the pathoIogy be one of mere hyperpIasia of normaIIy found tissues or rea1 tumor formation. REFERENCES I. BRUNSCHWIG, A. Mixed tumors of the tongue and subIingua1 gIand. Surg., Gynec. CY Ok. so: 407,
1930. z. WOOD. Mixed tumors of salivary gtands. Ann. Surg., 39:
57; 207,
1904.
L.
ROBILLARD,
M.D.,
F.A.C.S.
AND
SurgicaI Director, BrookIyn Cancer Institute; Attending Surgeon, Norwegian HospitaI
FRANK CHISENA,M.D. CIinicaI Assistant Visiting Physician, Kings County and Norwegian HospitaIs
BROOKLYN,
M
OF THE TONGUE
NEW
YORK
viousIy. The patient’s attention was caIIed to the deveIopment of this tumor after an inIaid Ming in the Ieft first upper moIar had dropped
IXED
tumors of the tongue have been cIarified by the review of the ten cases in the Iiterature by
FIG. I. Low power. Cross section of the entire tumor, showing epitheIia1 elements (gIands) in lower right corner; and, mesothelia1 structures (ova1 area of cartiIage, foIIicIes, and fibrous septa).
Brunschwig,l who estabIished certain criteria for such tumors, nameIy-epithehal eIements in any arrangement, and mesotheIia1 structures as cartiIage, muscuIar tissue, and fibrous connective tissue. .We present the evidence in the foIIowing case as in favor of another instance of such very rare tumors of the tongue. C. K., a dentist, was admitted to the Norwegian HospitaI for removal of a smaI1 mass on the tongue which had appeared one year pre-
out. He Iater had it removed because of the considerabIe irritation to the tongue produced during chewing. The tumor, on inspection, was white, round, hard and fibrous, the size of a pea, and was Iocated on the. anteroIatera1 aspect of the Ieft b or der of the tongue, I inch from the tip. It was embedded in the margin, invoIving the entire thickness of the tongue, and it remained constant in size after its appearance. At operation under IocaI anesthesia, a wedgeshaped piece of tongue was removed, the incisions extending we11 wide of the growth.
794
NEW
‘a.
XLIII.
No. 3
RobilIard,
FIG. z. Area of cartiIage
FIG. 3. Area
Chisena-Tongue
and Iymphoid
of oId hemorrhage
foIli&
and pigmentation
Tumor
with intervening
bordering
American
~~~~~~~ of surgery
fibrous
septa.
on muscle
layer.
795
796
American Journalof Surgery
RobiIIard,
Chisena-Tongue
The microscopic picture showed a Iayer of beneath which were flattened epitheIium several coIIections of hyperpIastic Iymphoid foIIicIes separated by fibrous connective tissue. Beneath the Iymphoid Iayer was a group of gIanduIar acini, with an area of cartiIage surrounded by fibrous tissue interposed between the two. In the deeper portions of the tumor appeared an area of hemorrhage and pigmentation. A recent examination of the patient disclosed a scarring of the tongue at the site of operation and area of anesthesia the size of a quarter, with no evidence of IocaI or regiona metastasis. DISCUSSION
Mixed tumors of the tongue are very rare, and as Wood2 states, they resembIe mixed tumors of the sahvary gIands. ApparentIy onIy a smaI1 proportion undergoes maIignancy. They do not grow very rapidIy and tend to produce regiona metastasis 0nIy. From the very nature of the growth, such tumors are expected to vary wideIy in their histologic architecture. AI1 the structures enumerated may be found normaIIy in the tongue. The question arises as to
MAHCH, ,939
Tumor
whether this tumor represents a simpIe hyperpIasia of the Iymphoid eIements with a concomitant fibrosis, Iocated in proximity to an area of cartiIage and a coIIection of mucous gIands; or, possessing the two essentia1 characteristics described by Brunschwig, it is a mixed tumor. SUMMARY I. Mixed tumors of the tongue are diagnozed on certain criteria estabIished by Brunschwig. 2. The histoIogic structure found in mixed tumors of the tongue may vary wideIy, but the essentia1 characteristics wiI1 determine the nature of the growth. 3. Tumors of the tongue shouId be as in many cases cIoseIy scrutinized, divergence of opinion wiI1 exist as to whether the pathoIogy be one of mere hyperpIasia of normaIIy found tissues or rea1 tumor formation. REFERENCES I. BRUNSCHWIG, A. Mixed tumors of the tongue and subIingua1 gIand. Surg., Gynec. CY Ok. so: 407,
1930. z. WOOD. Mixed tumors of salivary gtands. Ann. Surg., 39:
57; 207,
1904.