Head & Neck Case Review 2023-12

Head & Neck Case Review

December, 2023


A 64-year-old male presents with a left sided neck mass that he had noticed one month ago. On ultrasonographic examination, the mass was 4.3 x 3.3 x 2.2 cm with heterogeneous appearance. An ultrasound guided needle biopsy was performed and displayed malignant cells compatible with metastatic squamous cell carcinoma.  A p16 immunostain was strongly positive, high risk human papillomavirus (HPV) E6/E7 mRNA in-situ hybridization was equivocal. A follow up 18F-fluorodeoxyglucose (FDG) PET/CT showed uptake in the left cervical level II lymph node, and symmetric mild uptake in bilateral palatine tonsils. A transoral robotic tonsillectomy and base of tongue resection was performed to localize the site of primary. A firm fibrotic area was noted in the left tonsil on palpation and cut surface.  A representative frozen section was taken:



1. Which of the following is most likely representative of the finding on frozen section?

  • A. Hamartoma
  • B. Teratoma
  • C. Choristoma
  • D. Pleomorphic adenoma

2. What is the most common cartilage producing parapharyngeal space tumor?

  • A. Pleomorphic adenoma
  • B. Teratoma
  • C. Chondroma
  • D. Chondrosarcoma



John Grove, DO
Resident Physician, Department of Anatomic & Clinical Pathology
University of Pittsburgh Medical Center

Raja R. Seethala, MD
Professor of Pathology and Otolaryngology
University of Pittsburgh Medical Center