Patient's Query
Hi doctor,
I am a 28-year-old woman with a history of smoking. I have had a lump inside my tongue for the past two years. The lump is not reaching the surface; it is just inside.
I think it got bigger over time, but not rapidly. It is 6 mm big. I went to a doctor and they made a sonogram. The lump is in the middle of the tongue; it is not painful, and it is hard. I am in my first trimester of pregnancy.
Doctors want to wait if it gets bigger to perform a fine needle biopsy. I am scared it can somehow put me in danger. They want to do it without any local anesthesia. Sonogram doctor told me in his opinion that the lump is not cancerous.
I am scared that it will metastasize to my lymph nodes. Should I wait, or should I insist on that needle biopsy? Do you think it's cancerous?
Please advise.
Hi,
Welcome to icliniq.com.
May I examine the lesion for better diagnosis and treatment, which includes many differential diagnoses? White or red oral lesions include benign lesions (e.g., morsicatio buccarum and frictional keratosis, white sponge nevus [WSN]), benign lesions with malignant potential (e.g., erythroplakia, leukoplakia, oral lichen planus and other lichenoid lesions, submucous fibrosis, and actinic cheilitis).
For an oral lesion of less than three weeks duration, the acronym rule has been proposed as a practical clinical prediction rule for early detection of oral SCC (squamous cell carcinoma), red or red and white lesions, and ulcers or lumps, especially when in combination or if indurated (firm on palpation). Any lesions meeting these criteria should be regarded with suspicion and biopsied.
The main modifiable risk factors for oral SCC are tobacco use (smoked and smokeless), areca nut use, and alcohol consumption. The combined effect of alcohol and tobacco is greater than multiplicative for oral cavity cancer. However, oral cancer has been increasingly observed among subjects without any of the known modifiable risk factors.
For all patients with an oral lesion, we perform a focused clinical history, with attention to the
Physical examination:
Extraoral examination:
Oral candidiasis, a common opportunistic infection caused by the intraoral commensal yeast, is a probable cause.
The differential diagnosis in your case is:
Follow up with the answers to the above questions and pictures of the photo taken.
I hope this helps you.
Thank you.
Patient's Query
Thank you, doctor, for the reply.
It is not seen outside; it is seen inside. It has been firm and present for more than two years and has grown over time.
It was 3 mm before, but now it is 6 mm large. We know it is not a cyst, so we are following the sonogram. It showed well-described borders like a small oval ball.
I am pregnant now. Should I do a needle biopsy, or should I wait? I have been to specialists, and they told me that I should wait until 11 weeks of my pregnancy. But I am scared it is malignant. On the other hand, they told me that if it were something aggressive, it should grow a lot faster than this.
Please advise.
Hi,
Welcome back to icliniq.com.
With the growth rate, as told by you over many years, the chances of it being malignant are very low. Nonetheless, the biopsy is warranted for confirmation of the nature. The best option is to get it done now and get relieved of the stress.
As I enumerated in my previous answer, there are various non-malignant causes of it. I suggest doing the biopsy now, as it will relieve the stress in your mind. The only way to confirm the nature of the lesion is by biopsy.
Kind regards.
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Answered byDr. Vikas T. Talreja
Medically reviewed byDr. Vinodhini J.
Same symptoms don't mean you have the same problem. Consult a doctor now!
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