Basaloid Squamous Cell Carcinoma of the Midline Dorsal Tongue: Case Report and Review of the Literature

BACKGROUND: Squamous cell carcinoma (SCC) of the dorsal tongue accounts for only 2%-5% of tongue cancers; midline dorsal tongue cancers account for less than 1% of these tumors. Basaloid SCC (BSCC) is usually associated with more aggressive features than conventional SCC. There are fewer than 30 reported cases of lingual BSCC. METHODS: A 76-year-old woman presented with irregular, exophytic, rugated, and furrowed changes of the midline dorsal tongue, which was initially misdiagnosed as mucoepidermoid carcinoma on an outside institution biopsy. Other than mild linear enhancement of the oropharyngeal tongue, MRI was unremarkable. A midline partial glossectomy with primary closure was performed with the aid of intraoperative frozen section analysis. RESULTS: Final pathology was rediagnosed as pT2 invasive BSCC, with depth of invasion of 2.43 mm, worst pattern of invasion of WPOI-3, and negative final margins. The decision was made to proceed with surveillance without any adjuvant therapy. CONCLUSIONS: This is the first reported case of BSCC of the midline dorsal tongue. This case report highlights the diagnostic challenges of BSCC and underscores the importance of comprehensive evaluation of all histological features using immunohistochemistry studies, as BSCC can mimic other pathologic entities but may confer a different prognosis. Early and definitive diagnosis of this disease has implications for management decisions and prognosis.