Sarcoma of the tongue is rare, and is sometimes met with in children. The round-cell type is the most common; it grows rapidly, and tends to ulcerate and fungate, pain becoming severe when the growth has broken down. The diagnosis is always difficult, and is seldom made until a portion of the growth has been removed and examined microscopically. The more slowly growing forms, if removed before ulceration has taken place, show little tendency to recur, but those which grow rapidly and break down, not only recur locally, but are liable to give rise to metastases. The treatment is the same as for cancer; the use of radium is more likely to be beneficial than in epithelioma.
Innocent Tumour and Cysts.—Lipoma, fibroma, and various forms of angioma ([Fig. 258]) are occasionally met with. They are all of slow growth, and give rise to inconvenience chiefly by their bulk, and should be removed.
Fig. 258.—Papillomatous Angioma of left side of tongue in a woman aged 26.
Papilloma may occur on any part of the tongue, and at any age. It may be single or multiple, pedunculated or sessile, and is liable to become malignant, especially when associated with leucoplakia. It should be freely removed by excising a wedge-shaped portion of the tongue.
Dermoid cyst is met with beneath the tongue, lying in the middle line, between the genio-glossi (genio-hyoglossi), and on the upper surface of the mylo-hyoid muscles. It may be noticed soon after birth, or may only attract attention during adult life. The cyst usually projects under the chin, forming a soft swelling of putty-like consistence, which varies in size from a pigeon's to a turkey's egg ([Fig. 259]). When it bulges towards the mouth it is liable to be mistaken for a retention cyst of one of the salivary glands. It is distinguished by its medial position, its yellow colour, and its opacity, the retention cyst being to one side of the middle line, purplish in colour, translucent and fluctuating. The cyst should be dissected out, either from the mouth or from under the chin, according to circumstances.
Fig. 259.—Dermoid Cyst in middle line of neck.
(Mr. J. W. Struthers' case.)