Medical Emergencies · patient case question
What is the most appropriate biopsy technique for this 15 mm lateral tongue mass?
Patient case: COPD, a Black Tongue, and a Lateral Tongue Mass
Patient: 58-year-old male
Chief Complaint: “My tongue looks black and furry, and there’s a lump on the side of it.”
Background: Chronic obstructive pulmonary disease, GOLD stage III. 40 pack-year smoking history and still smoking one pack daily. Uses a chlorhexidine rinse intermittently. No cardiovascular disease.
Medications: Albuterol inhaler PRN · Tiotropium daily · Inhaled fluticasone
Vital Signs: BP 130/78 mmHg · HR 88 bpm · RR 22 · SpO₂ 92% on room air · T 98.4°F
Findings: Barrel chest, pursed-lip breathing, prolonged expiration. Dorsal tongue with markedly elongated, brown-black filiform papillae. A separate firm, nodular, exophytic mass approximately 15 mm across on the left lateral tongue, present for several months and slowly enlarging. Extensive restorative needs across three quadrants.
Show answer and explanation
Correct answer: A. Incisional biopsy
- A. Correct. For a lesion of this size, in a high-risk site, in a high-risk patient, an incisional biopsy establishes the diagnosis before any definitive surgery is planned. Include representative lesional tissue together with the adjacent margin, and sample the most clinically suspicious area.
- B. Incorrect. Fine-needle aspiration is valuable for deep masses and lymph nodes, but it does not preserve tissue architecture and is not the standard for an accessible mucosal lesion.
- C. Incorrect. Excisional biopsy is appropriate for small lesions, generally under about 1 cm, that can be removed completely with a margin. Excising this lesion before diagnosis risks an inadequate margin if it proves malignant.
- D. Incorrect. Exfoliative cytology samples only surface cells and cannot assess whether invasion through the basement membrane has occurred. It is a screening adjunct, never definitive for a submucosal mass.
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