Oncology (General Cancer)/Tongue biopsy results

Advertisement


Question
QUESTION: Hi,
My husband had a biopsy on the right lateral border of his tongue a few weeks ago. He had a red spot that his dentist saw durning his cleaning. His dentist uses a velescope which I guess made the area more apparent. He also has geographic tongue so he gets Apis all over that area of his tongue which normally show darker under the velescope. He had him come back to reevaluate two weeks later. The spot was still there but getting lighter and smaller under the velescope. He sent him to an oral surgeon. We did go back the day before the oral surgeon appt and the area was still present but smaller and lighter under the velescope. The problem is the area was only really seen under the velescope light. I had the dentist point the spot out to me but I couldn't rally see it. He did send pics of the velescope to the oral surgeon but they were so close up i don't know how anyone could really tell where he was talking about. The dentist and oral surgeon also talked over the phone. We went in the next day for the biopsy the surgeon looked and saw a small red spot on the back bottom side of his tongue almost underneath and he cut that out. I asked if he saw the pics and he said he did. He was very arrogant. I took a pic of the biopsy and emailed it to the dentist. He said from what he can tell the biopsy was done in the general area of the dark spot under the velescope. If it was off it would only be a few mm. I am hoping it was in the correct area. I assume now that it was bc we got the report back. It says. Fragments of squamous mucosa showing mild chronic inflammation, squamous epithelial hyperplasia and parakertosis. No definitive evidence of dysplasia or malignancy identified. My question is what condition would cause these cell changes? Could geographic tongue cause this? I tried to ask the oral surgeon these questions but he wasn't very nice about answering them. Also what does "no definitive evidence" mean exactly? I have had biopsies done and normally it just says no dysplasia or malignancy identified. I was just wandering why the pathologist worded it this way and does this mean anything  significant other than " no cancer was identified in this sample?"?

I am hoping since this sample showed some inflammation that this is just another geographic tongue lesions which is pretty much never ending on the right side if his tongue and the tip of his tongue. I am also hoping that the oral surgeon biopsied the right place the dentist saw. He said he did when I asked him but who knows. Should I still be worried that he has cancer? Also before I forget he had a tongue biopsy on the rift side farther back of his tongue in jan 2012 which showed chronic glossitis consistent with geographic tongue. So we know for sure that the lesions are geographic tongue. Here is a pic of the biopsy two weeks later. Do you see anything to worry about on his tongue? Thanks .

Biopsy 10-15
http://i1209.photobucket.com/albums/cc393/kkingery83/DE86C156-38B9-4E0D-B697-9FE

Two weeks later

http://i1209.photobucket.com/albums/cc393/kkingery83/02FA0586-B651-457C-BB15-07E

Velescope image( not sure what or where on the tongue I am looking at) the dentist said the spot was low on the back border of his tongue almost underneath the tongue. A small red area.

http://i1209.photobucket.com/albums/cc393/kkingery83/473E2665-FB63-4192-8604-694

ANSWER: Bottom line is that nothing you sent looks like cancer to me.  Geographic tongue is a description of the tongue. There are several possible causes; usually when it is a chronic problem it is due to some sort of inflammation.  Smokers get them.  Sometimes it is related to a chronic infection.  It can also be seen in some types of vitamin deficiencies.  And there are some cases where no one knows why.  At this point your husband needs to have an oral examination maybe every six months.  A good dentist can often do a fine exam.  Biopsies should be done if something new is found, or if some sort of lesion seems to be getting bigger.  I wouldn't do more biopsies at this point based on what happened so far,  

---------- FOLLOW-UP ----------

QUESTION: Thanks for answering. My main question is wth the results of the biopsy, the chronic inflammation, squamous epthelial hyperplasia, parakertosis, are these findings consistent with geographical tongue? He visit his dentist every 6 months for cleanings. In September he went for his appt and his dentist checked him over with the velescope and noticed a dark area on the side of his tongue almost underneath.when he looked without the velescope he saw a little red area. He assumed it was trauma and asked him to come back in two weeks to recheck. I guess the area was very hard to discern with the naked eye but the velescope made it and out. He went back two weeks later and the area was still present and dark under the velescope but he said it had gotten a little lighter and smaller. He wanted him to see an oral surgeon to get a biopsy done. The thing is only the dentist rally knows what area was dark under the velescope bc he is the only who had the velescope. He did send pics to the oral surgeon and spoke worth him over the phone but the pics were so up close it's nearly impossible to tell exactly the spot on the tongue that he was talking about. The oral surgeon was very arrogant and hard to talk to. when I asked if the results were gt he said maybe but it could be a bite but a bite wouldn't last for two months. I had nothing to do with. Him having this biopsy taken. His dentist found an area and watched it and referee him on to oral surgeon. He hasn't seen the dentist since the biopsy but I did send him a pic and he said it looked like it was in the general area maybe a few millimeters off. That worries me that they didn't take the sample from the correct location and may have missed cancer or precancerous if present.

ANSWER: Maybe you should ask the dentist to take another look to see whether there is anything there.  Otherwise wait a while; if it's a problem it will show up again.  I know that's not as reassuring as you want, but sometimes the best course of action is to wait a bit.  Even if this is cancer, it is unlikely to become "incurable" before it is detected.  

---------- FOLLOW-UP ----------

QUESTION: So what if it's inflammation? Won't it still show up and be there too? You said even if it's a problem it will show up but if it's something harmless won't it also be there if is chronic inflammation? He goes for his yearly physical in a few months and his dentist appt in March will wait and have them recheck then. Is that too much time to wait?

Answer
I don't think it will hurt to wait. However, if he notices anything new he should obviously see someone sooner.  Chronic inflammation can cause little bumps and things; generally they come and go.  little bumps that become bigger should definitely be investigated.  Make sure he has his doctor thoroughly check the mouth and tongue when he has his physical.  Hope this helps.  

Oncology (General Cancer)

All Answers


Answers by Expert:


Ask Experts

Volunteer


Donald Higby, M.D.

Expertise

I can answer almost all questions related to the treatment and natural course of most kinds of cancer, especially cancers of prostate, colon, lung and breast.

Experience

I have been a practicing medical oncologist for 36 years, and have been chief of service at a major medical center for 25 years. I've also done research in cancer treatments.

Organizations
American Society of Clinical Oncology

Publications
New England Journal of Medicine American Journal of Medicine Journal of the American Society of Clinical Oncology Hematology Transfusion Medicine

Education/Credentials
MD, Stanford University Internal Medicine residency, St. Louis University School of Medicine, St. Louis, MO Medical Oncology Fellowship, Roswell Park Cancer Institute, Buffalo, NY

Awards and Honors
America's Best Physicians, last 14 years

©2016 About.com. All rights reserved.