Tongue biopsy - Large Biopsy 3-6 cm

Biopsy

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Histology of tongue lesion.

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Tongue Biopsy - Large Biopsy 3-6 cm

Why is it done?
- Definitive diagnosis of suspicious tongue lesions or masses that cannot be diagnosed through clinical examination alone
- Detection of malignancy including squamous cell carcinoma and other cancers of the tongue
- Identification of benign lesions such as cysts, lipomas, hemangiomas, or mucosal abnormalities
- Evaluation of chronic tongue conditions or persistent ulcers
- Assessment of inflammatory, autoimmune, or infectious conditions affecting the tongue
- Large biopsies (3-6 cm) are performed when larger tissue samples are needed for accurate diagnosis or when lesions require more extensive removal
Normal Range
- Normal Result: Benign tissue with normal histological architecture, normal epithelial cells, normal keratin layer, absence of dysplasia, absence of malignant cells, and absence of infectious organisms or inflammatory infiltrates
- Abnormal Result: Presence of malignant cells, dysplasia, metaplasia, inflammation, infection, or other pathological changes
- Units of Measurement: Histopathological examination is qualitative and descriptive; tissue specimen size is 3-6 cm; reported as benign, dysplastic, or malignant
- Interpretation: Normal means the tissue shows no evidence of cancer, severe inflammation, or other significant disease; abnormal findings are reported with specific diagnoses and clinical significance
Interpretation
- Benign Findings: Indicates absence of malignancy; specific benign diagnoses may include lipoma, hemangioma, mucocele, fibroma, or other non-cancerous lesions
- Squamous Cell Carcinoma: Most common malignancy of the tongue; confirms cancer diagnosis and may include grade (well-differentiated, moderately differentiated, or poorly differentiated)
- Mild to Moderate Dysplasia: Pre-malignant condition indicating abnormal cell growth; increased risk of progression to cancer; requires close follow-up and possible re-excision
- Severe Dysplasia or Carcinoma in Situ: High-grade pre-malignant lesion with significant cancer risk; requires aggressive treatment and close surveillance
- Inflammatory or Infectious Conditions: May indicate chronic inflammation, fungal infection, bacterial infection, or autoimmune conditions requiring specific treatment
- Factors Affecting Results: Specimen adequacy, tissue fixation, staining quality, pathologist expertise, smoking history, alcohol use, HPV status, and presence of margins in excisional biopsies
Associated Organs
- Primary Organ System: Oral cavity and pharyngeal structures; integumentary system
- Conditions Associated with Abnormal Results:
  - Oral squamous cell carcinoma (most common)
  - Oral verrucous carcinoma
  - Adenocarcinoma of salivary gland origin
  - Melanoma of the oral mucosa
  - Lymphoma of tongue tissue
  - Oral lichen planus and lichenoid reactions
  - Pemphigus vulgaris and other autoimmune blistering disorders
  - Oral candidiasis and other fungal infections
- Potential Complications/Risks: If malignancy is confirmed, risks include spread to regional lymph nodes, distant metastasis, requirement for aggressive treatment (surgery, radiation, chemotherapy), potential airway compromise, speech and swallowing difficulties, and reduced survival if not promptly treated
- Related Structures at Risk: Regional cervical lymph nodes, submandibular glands, floor of mouth, pharynx, and underlying musculature of the tongue
Follow-up Tests
- If Malignancy Confirmed:
  - CT or MRI of head and neck for staging and surgical planning
  - PET-CT scan to assess for metastatic disease
  - Neck ultrasound or CT with ultrasound-guided FNA biopsy of suspicious lymph nodes
  - HPV testing (p16 immunohistochemistry or HPV molecular testing)
  - Comprehensive metabolic panel and complete blood count before treatment
- If Dysplasia Detected:
  - Repeat biopsy or re-excision if margins are involved
  - Clinical surveillance with intraoral examination every 3 months
  - Consider additional diagnostic tools such as toluidine blue staining or autofluorescence imaging
- If Benign Findings:
  - Clinical follow-up as indicated by specific diagnosis
  - Specialty referral (infectious disease, rheumatology, or dermatology) if inflammatory or infectious pathology is present
  - Routine oral examination and hygiene maintenance
- Monitoring for Treated Malignancy: Monthly clinical examinations during first year, every 3 months in second year, every 6 months in years 3-5, then annually; imaging as clinically indicated
- Complementary Tests: Immunohistochemistry for specific markers, molecular testing for genetic mutations, and electron microscopy in selected cases
Fasting Required?
- Fasting: No fasting is required
- Anesthesia: If performed under general anesthesia, fasting for 6-8 hours prior to procedure is required; follow anesthesiologist's specific fasting instructions
- Medications to Avoid:
  - Aspirin and NSAIDs (ibuprofen, naproxen) for 7 days prior to procedure to reduce bleeding risk
  - Anticoagulants such as warfarin or dabigatran; discuss with provider before discontinuing
  - Herbal supplements (ginkgo, ginger, garlic) that may increase bleeding
- Pre-Procedure Preparation:
  - Brush teeth gently but thoroughly; avoid mouthwash for 24 hours prior if possible
  - Wear comfortable, loose clothing
  - Remove dentures, piercings, and other oral appliances prior to biopsy
  - Arrange for transportation if sedation or general anesthesia is used
  - Inform provider of any allergies, active infections, or bleeding disorders
  - Post-procedure: Avoid hot foods/drinks, smoking, alcohol, and vigorous mouth rinsing for 24 hours

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