Squamous cell carcinoma of the tongue during twin pregnancy – a challenging therapy approach

We report on a 41-year-old female patient who presented in November 2022 with a lesion on the left tongue margin. In 2015, she had undergone therapy for a cT2 cN+triple-negative breast carcinoma on the right side. The examination revealed an exophytic mass measuring up to 2.5 cm on the left tongue margin. At the time of presentation, the patient was in the 15th week of a twin pregnancy after many years of fertility treatment. After staging with MRI of the neck and thorax, panendoscopy revealed squamous cell carcinoma on the left tongue margin with cervical lymph node metastasis, but without distant metastases. From an oncological point of view, transoral tumour resection with defect coverage via a radial forearm flap and ipsilateral neck dissection was to be favoured. After interdisciplinary discussion of the case with the gynaecology department, the patient opted for surgical therapy. A PEG was not performed because of the pregnancy. The patient did not wish to undergo further human genetic examination after the diagnostics in 2015 and 2020 failed to produce any conclusive findings. In December, surgery was performed without complications and the patient was extubated afterwards. A tracheotomy was not necessary. The histopathological examination revealed a pT2 pN1 (1/35) M0 L0 V0 Pn0 R0 p16-negative left tongue margin carcinoma. After renewed discussion in the tumour board, adjuvant radiotherapy was recommended. The patient rejected this after obtaining a second opinion. The control MRI 6 months after therapy showed a lymph node on the genioglossus muscle with a slight increase in size. The control endoscopy and lymph node extirpation showed no malignancy. In March a caesarean section was performed. The patient is currently cancer-free.