Lymphoma of the tongue, diagnosed with dysarthria

<p>Introduction: The lymphomas in the ENT area usually appear at the level of the Waldeyer's ring, especially in the palatine and lingual tonsils. Although they are very infrequent, they can appear in other locations of the oral cavity, as we shall see below. The diagnosis is usually delayed due to the anodyne clinic in its initial phases since they usually do not generate pain. Only when the size of the lesion is considerable, we can observe other signs such as dysarthria due to mass effect.</p><p>Material and methods: A 93-year-old woman slightly disoriented and with severe hearing loss that makes it difficult to explore, who goes to the emergency department for dysarthria and sudden repetitive falls in recent days, without previous dizziness. On examination there are no significant findings except a right malar hematoma and a tumor in the left side of the tongue. A cranial CT is requested: cortico-subcortical atrophy, normal for his age (93 years). Chronic left frontoparietal subdural hematoma 10 mm thick which does not block the adjacent cortical grooves. Midline centered and free basal cisterns. Small soft tissue hematoma on the high right posterior parietal region. The neurosurgeons do not consider the patient an object of urgent surgical treatment and refer it to consultations with control CT and corticoids in a descending pattern. From the emergency room they make a consultation to ENT in which we see a tumor on the left side of the tongue with months of evolution of approximately 4 cm, hard, rounded, elastic, well defined and painful on palpation. A preferred FNA and cervical MRI are requested.</p><p>Results: The result of the FNA was: positive cytology for malignant cells compatible with atypical lymphoproliferative process. The patient refused to undergo MRI. He was referred to hematology clinics where he also refused any type of invasive treatment or biopsy to make a definitive diagnosis. With corticoid treatment the lesion decreased in size. In the last revision it was about 2.5 cm.</p><p>Conclusions: In the patient of the case, the history of recurrent falls, advanced age, severe hearing loss and cognitive deterioration masks the main sign that presented for its correct diagnostic orientation, dysarthria. The most common causes of dysarthria include disorders of the nervous system (neurological), such as strokes, brain injuries or brain tumors. Certain medications can also cause dysarthria. However, as we have seen in our patient, you should never stop exploring the oral cavity before diagnosing a dysarthria. FNA is required as first diagnostic test in lingual submucosal lesions due to its low morbidity and high sensitivity. Nevertheless, we should know that in lymphoproliferative syndromes it is just illustrative. In order to make the definitive diagnosis of certainty, it is critical to perform a wedge biopsy of the lingual lesion to know the tumor lineage. It is imperative to request imaging tests to do an extension study, with the MRI of choice. Without the definitive diagnosis we cannot plan the corresponding hematological treatment, but it is the patient who finally decides whether to treat himself or not.