Verrucous Tongue Lesion
A 67-year-old woman presented with a 2-month history of tongue pain, dysphagia, and dysarthria. She was a nonsmoker and did not drink alcohol, but she had diabetes, hypertension, and atherosclerotic cardiovascular disease. On examination, an exophytic mass with a whitish surface and multiple papillary projections was seen, involving the right half of the tongue. The tongue showed limited mobility and was indurated and tender to palpation. No enlargement of the cervical lymph nodes was detectable. Histopathological examination confirmed the clinical diagnosis of verrucous carcinoma, but in situ hybridization was negative for p16 as a surrogate marker of human papillomavirus infection. Verrucous carcinoma is a well-differentiated variant of squamous-cell carcinoma that is locally destructive, although it grows slowly and rarely metastasizes. Human papillomavirus infection and smoking are the main recognized etiologic factors. The patient was given methotrexate to reduce the size of the tumor before surgical excision. The patient had a favorable response, and there was no recurrence at 6 months of follow-up.
