Head & Neck Case Review 2020-02

Head & Neck Case Review

February, 2020

History

A 73-year-old man presented with right nasal obstruction and epiphora for about a year. On nasal endoscopy a smooth submucosal mass attached to the anterior part of the inferior turbinate and extending to the septum was identified. CT imaging also confirmed the presence of an ill-defined soft tissue mass confined to the nasal cavity. The patient subsequently underwent resection. H&E slides and immunostains are shown. The following stains were negative: cytokeratin AE1/AE3, CD34, S-100, SOX10, and myogenin.

Images

Virtual H&E slide

Quiz

Q1. The following genetic syndromes have been associated with this disease in children except:

  • A. Li-Fraumeni syndrome
  • B. Costello syndrome
  • C. Neurofibromatosis type 1
  • D. Beckwith-Wiedemann syndrome
  • E. Cowden syndrome

Q2. The most common site of disease outside the Head and Neck is the paratesticular region.

  • A. True
  • B. False

Diagnosis

Contributor

Mitra Mehrad, M.D.
Assistant Professor
Department of Pathology, Microbiology and Immunology
Vanderbilt University Medical Center, Nashville, TN

Head & Neck Case Review 2020-01

Head & Neck Case Review

January, 2020

History

A 74-year-old woman presented with respiratory failure. The patient had a 3-month history of cough and progressive dyspnea with rapidly increasing neck swelling. CT Imaging revealed massive thyromegaly and lymphadenopathy with metastases to the lung, liver, kidney, and iliac bone. Patient underwent thyroid surgical resection to relieve the airway compression. Gross examination of the thyroid showed diffuse replacement by multiple masses, the largest measuring 7.6 × 5.3 × 2.7 cm, with infiltrative borders and extension into surrounding adipose tissue. H&E slides and immunostains are shown.

Images

Virtual H&E slide

Quiz

Q1. What is the characteristic genetic alteration in this tumor?

  • A. t(12;15)(p13,q25) ETV6-NTRK3
  • B. t(2;22)(q33;q12) FEV-EWS
  • C. t(11;19)(q21;p13) CRTC1-MAML2
  • D. BRAF V600E mutation

Q2. Adjuvant therapy with radioactive iodine would be effective.

  • A. True
  • B. False

Diagnosis

Contributor

Mitra Mehrad, M.D.
Assistant Professor
Department of Pathology, Microbiology and Immunology
Vanderbilt University Medical Center, Nashville, TN