Tongue abscesses are rare conditions that usually follow mucosal disruption due to mechanical trauma or foreign body impaction. They typically manifest abruptly as a rapidly growing, hard mass or swelling in the context of tongue muscles; the patient frequently complains of pain, difficulties in swallowing or speaking, and fever. Nonetheless, the features of its presentation, together with accurate clinical evaluation, blood tests, and appropriate imaging tests, are usually sufficient to easily discern a tongue abscess from a malignancy. However, in rare cases, they may occur with slowly progressing and subtle symptoms, nuanced objective and laboratory findings, and inconclusive radiological evidence, leading to difficult differential diagnosis with submucosal malignancy. Herein, we review the literature, available on Pubmed, Embase, and Scopus, on publications reporting tongue abscesses, with atypical presentation suggesting an oral tumor. Our review confirms that tongue abscesses may manifest as a slowly growing and moderately painful swelling without purulent discharge and minimal mucosal inflammation; in this case, they may constitute an actual diagnostic challenge with potentially severe impact on correct management. Atypical tongue abscesses must therefore be considered in the differential diagnosis of tongue malignancy with submucosal extension, even when other diagnostic elements suggest a neoplasia; in this case, a deep biopsy under general anesthesia is essential for differential diagnosis, and simultaneous drainage of the necrotic and abscessual material may resolve the condition.
舌部脓肿是一种罕见病症，通常由机械性创伤或异物嵌顿导致黏膜破损后引发。其典型表现为舌肌内突发性快速增长的硬质肿块或肿胀，患者常主诉疼痛、吞咽或言语困难，并伴有发热。然而，结合其临床表现特征、准确的临床评估、血液检测及适当的影像学检查，通常足以将舌部脓肿与恶性肿瘤明确区分。但在极少数情况下，舌部脓肿可能呈现缓慢进展的隐匿症状，客观体征与实验室检查结果微妙，影像学证据亦不明确，导致与黏膜下恶性肿瘤的鉴别诊断困难。本文通过检索Pubmed、Embase及Scopus数据库中关于舌部脓肿的文献，系统回顾了临床表现疑似口腔肿瘤的非典型舌部脓肿病例。本综述证实，舌部脓肿可表现为缓慢增长、中度疼痛的肿胀，无脓性分泌物且黏膜炎症反应轻微；此类情况可能构成实际的诊断挑战，并对正确诊疗产生潜在的严重影响。因此，在鉴别诊断伴有黏膜下浸润的舌部恶性肿瘤时，即使其他诊断要素提示肿瘤性病变，仍需将非典型舌部脓肿纳入鉴别范畴；此时全身麻醉下进行深部组织活检对鉴别诊断至关重要，同时引流坏死及脓肿物质可能使病情得到缓解。
肿瘤(癌症)患者之家