Hi Everyone,

I thought I should ask your opinion on small bumps that I have found in the back of my tongue (on both sides) a few weeks ago. The lesions are right at the base of my tongue on BOTH SIDES around the lingual tonsil area and have a hard structure. One of them looks like a little cauliflower. They are raised & pink in color and there is no white areas or red patches around them on the tongue.

I have no pain at all, the lymph nodes in my neck, under my jaw line and under my chin are NOT enlarged and the lesions are not painful to touch. The bumps themselves are numerous (possibles 3/4 on each side) with the largest being 1cm long, 0.5cm wide and maybe 0.25cm thick. They have never bled, I have no issues with swallowing and no sore throat at all. I have no pain in my teeth and my gums are fine with no pain and/or discoloration. FYI, I had my tonsils removed when I was a child.

In terms of time, I only noticed them about 3 weeks ago but they may have been there for a longer period. They are in an area of the mouth that are difficult to see with normal brushing/flossing. I have good oral hygiene and brush and use the dental sticks daily. I don't smoke and drink occasionally.

I am a Hodgkins Lymphoma survivor (5 years remission on Tuesday !!), so I know what is like to get the "C" diagnosis and am obviously worried that this could be SCC. I am getting a biopsy on Friday but thought I would ask you guys a few questions:

1. Is it normal to have SCC on BOTH sides of the tongue?
2. Does SCC predominantly present it self as a single lump, rather than multiple lumps?
3. Can I post a picture on this forum so you can see it?
4. Tongue biopsy - is it painful, how many days before back to normal, will it affect speech / eating etc?? Should I ask to be sedated?

Thanks in advance for your help.

Sami

Bilateral presentation of the disease is very unusual. Also people that develop lesions that the find on their own do so before this gets so far out of hand that there are multiple lesions, it does get larger with time, but "in general" is not a disease that produces lots of lesions in various locations at the same time.

You have normal structures in those areas that might be mistaken by a non professional for something dangerous. For instance there are definitely lingual tonsils, located on the very posterior edges of your tongue, usually flame shaped, but can take other more subtle forms. New students (and patients) often are surprised to see these, as most of us never notice them. What you describe as cauliflower shaped, is likely a papilloma, some of which are significant and part of a malignant formation, others are benign and of no concern. It will take a professional to look at them in real life to tell you if those are something of importance, and if they warrant biopsy.

Posting images here, is not a good idea, as we are not doctors, and we do not wish to lead you in a wrong direction. Please have a professional take a look.

Should someone you see think that they are deserving of biopsy, most of the time this is a simple process, done by any oral surgeon or many ENT's, who will send it on to an oral pathology department for a black and white, gold standard telling of exactly what it is. If you are an extremely anxious person, you could be given a tablet of some anti-anxiety med to take an hour before your procedure, but to be honest, they will just give you a small injection of lidocane to numb the area, and in 5 minutes it will be all over. For most, it is far less unpleasant experience than things you have likely already had done in the course of normal dental procedures in your mouth.

Congratulations on your 5 year anniversary being free of Hodgkin's. 5 years NED is the landmark in most cancers, where people breath a bit easier.

First of all congratulations on your five year anniversary.

I'm a bit confused as you said that you are scheduled for a biopsy on Friday, yet you don't mention having been checked by a dentist or physician. I assume that it was looked at as I would be surprised that anyone would schedule a biopsy without first examining you.

That being said, from your description, it wouldn't surprise me that what you are seeing and feeling are "circumvalate papilae" which are bilateral bumps that occur on the top of the tongue. However, I could never tell you that for sure over the internet, and I would hope that whoever has looked at them or will look at them, will find that that is what they are.

Please let us know what you find out and again I am curious if someone has looked at you already.

Thank you both for your prompt and informative replies. These message boards are certainly a godsend!

I live in Prague as an expat (I am from Australia). I mention this because I saw my local Czech GP who dismissed the bumps as nothing sinister but also said to mention my findings to my dentist "the next time I visit". Due to my previous medical history and experience with dismissive GPs (my Hodgkins was diagnosed at Stage 4B even though I was complaining about symptoms for the previous 6 months!!), I decided to see a local dentist the same day, who refererred me to a Czech oral surgeon. The OS spoke very little English but did say he wanted to do a biopsy. I must note that at this stage (and I know this will sound strange) but the dentist, surgeon AND myself did not check the other side of my tongue. I only showed the lumps on one side. It was not until I went home and re-examined by tongue that I noticed that I had similar anatomy on the other side. I have booked an appointment at a private London hospital next Friday to do the biopsy (I feel more comfortable being able to communicate to my doctors !!). The Dr in London has not seen me at all so it will be his decision on whether or not he feels that a biopsy is warranted. I suspect he will err on the side of caution given my previous history and go ahead with the biopsy.

Just for clarification, the lumps are NOT on the top of my tongue. They are on the sides right at the back. They are irregular shaped with some protruding out like a branch of a tree and the others like a round cauliflower which are pink but have defined borders and harder than the skin of the tongue.

I have found something on the internet that somewhat resembles what I have.

http://www.dentalmedsoft.com/OralPathBookdemo/OralPathText/Chapter%201.htm

Figure1.40 (described as reactive foliate papillae) is an example of the "tree like structure I mentioned above" and Figure 1.38 with the GREEN arrow is the cauliflower looking lesion (described in the article as a prominent foliate papilla (tonsillar tissue)). Hopefully, this is what I have.

Thanks again and feel free to share further thoughts on the extra information.

Sami

Sami,

How in the world did you see your BOT enough to describe in detail what you saw or even felt?

Hi David,

A difficult question to answer. I use a tongue scraper so just noticed it "by accident" a few weeks ago since i dont scrape the sides of my tongue usually. To be honest, I have no clue if they have been there a few weeks, months or years!

Sami

Welcome aboard Sami. I sure can't add to the answers you just got. This is a very caring site with a lot of well informed memebers. You just heard from some of the best informed. Good luck.

Sami,

From your first post it was not clear to me where you areas were located. Several people here as well a many of my patients over the years have discovered the papilaes that Imnetioned and thought they were cancer. Fig 1.38 shows exactly what I was referring to.

Good luck on Friday and I'm sure that if the surgeon feels that a biopsy is indicated, he would do it right then and there and save you a return trip.

Thank you all for your advice & support. I will keep you informed.

I am hoping that biopsy results will be released quickly.

Cheers

Sami

Best of luck with the biopsy and results Sami.
Will you stay in London while you wait for them?