Anterior tongue metastasis from lung cancer.

To the Editor: Tongue metastasis during the natural course of many neoplasms, including lung cancer, is extremely rare, and the prognosis of these patients is rather poor. Reported incidences vary between 0.2 to 1.6%. (1,2) We herein describe a case of anterior tongue metastasis in a patient with squamous cell carcinoma of the lung.

A 57-year-old male smoker (82 pack years) was diagnosed with squamous cell lung cancer, clinically staged as T4N2M0. This patient was treated initially by concomitant chemoradiotherapy with cisplatin, followed by docetaxel/cisplatin combination. At the end of the third cycle, upon disease progression, the patient was switched to single agent gemcitabine (1,000 mg/[m.sup.2] on days 1, 8, and 15, repeated every 21 d). Following two cycles, he was admitted to our hospital with a nodular, nonulcerated, painful mass, measuring 2 cm, on the anterior part of the tongue (Fig. A). There was no cervical lymphadenopathy. A CT scan of the chest revealed progression of the primary disease with an increase in the size and number of metastatic parenchymal nodules and metastatic destruction of the T12 vertebral body. The tongue lesion was excised and pathologic examination revealed moderately differentiated squamous cell cancer (Fig. B). This was histologically identical with the primary tumor on bronchial forceps biopsy (Fig. C). No further treatment was recommended.

Metastatic spread to the tongue may occur in advanced stages of tumors. The prognosis of patients with tongue metastasis is poor because most of them have widespread disease. (2,3) Zegarelli et al (4) reported 12 patients with tongue metastasis and noted that in 66%, metastases were localized to the-base of the tongue. Similar to the primary tumors of the tongue, metastatic lesions to this organ may be ulcerated or polypoid. Since the tongue is a rare metastatic site, when a lesion is detected, a thorough evaluation to distinguish between metastasis or primary cancer should be made.

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Mevlut Kurt, MD

Department of Internal Medicine

Hacettepe University Faculty of Medicine

Ankara, Turkey

Nilufer Bulut, MD

Sercan Aksoy, MD

Department of Medical Oncology

Hacettepe University Institute of Oncology

Ankara, Turkey

Kemal Kosemehmetoglu, MD

Department of Pathology

Hacettepe University Faculty of Medicine

Ankara, Turkey

Ayse Kars, MD

Department of Medical Oncology

Hacettepe University Institute of Oncology

Ankara, Turkey

References

1. Terashima T, Matsuzaki T, Kawada I, et al. Tongue metastasis as an initial presentation of a lung cancer. Intern Med 2004;43:727-730.

2. Mui S, Smith AE. Lingual metastasis as the initial presentation of a large cell lung carcinoma. Otolaryngol Head Neck Surg 1999;121:305-306.

3. Kim RY, Perry SR, Levy DS. Metastatic carcinoma to the tongue: a report of two cases and a review of the literature. Cancer 1979;43:386-389.

4. Zegarelli DJ. Tsukada Y, Pickren JW, et al. Metastatic tumor to the tongue: report of twelve cases. Oral Surg Oral Med Oral Pathol 1973;35:202-211.