Squamous cell carcinoma masquerading as focal myositis of the tongue

The diagnosis of squamous cell carcinoma of the head and neck is not usually a problem for the otolaryngologist/head and neck surgeon. However, we describe a patient whose ultimate diagnosis of squamous cell carcinoma required 16 months and eluded several clinicians, despite an aggressive diagnostic regimen. The diagnostic difficulty was due to the fact that the small, centrally located tumor was surrounded by an intense inflammatory reaction that histologically mimicked a recently described rare entity of the head and neck, focal myositis. Our purpose is to make the otolaryngologist/head and neck surgeon aware of this previously unreported presentation of squamous cell carcinoma of the tongue; to review the pertinent findings associated with focal myositis; and to reinforce the need to maintain a constant vigil for the diagnosis of cancer, in spite of negative pathologic confirmation, when dictated by the clinical situation.