Head & Neck Case Review 2021-10

Head & Neck Case Review

October, 2021

History

An adult woman with a significant smoking history presented to the emergency department with chronic unilateral otalgia and worsening odynophagia causing decreased appetite and weight loss. The patient denied fevers or B symptoms. Physical exam demonstrated a firm, exophytic, non-ulcerated mass in the palatine tonsil. CT scan showed a tonsillar mass with bilateral lymphadenopathy throughout the neck. The patient underwent bilateral tonsillectomy.

Images

Quiz

Q1. What is the diagnosis?

  • A. Extramedullary plasmacytoma
  • B. Systemic lupus erythematosus
  • C. T. pallidum infection
  • D. Granulomatosis with polyangiitis

Q2. What is the most specific confirmatory test?

  • A. c-ANCA
  • B. Flow cytometry, serum protein electrophoresis and bone marrow biopsy
  • C. Direct immunofluorescence
  • D. Serum RPR and VDRL
  • E. Serum RPR and FTA-ABS

Diagnosis

Contributors

Igor Damasceno Vidal, MD, PGY-2 resident
Pathology Residency Program
University of Alabama at Birmingham School of Medicine

Manuel Lora Gonzalez, MD, Assistant Professor
Department of Pathology
University of Alabama at Birmingham Hospital & School of Medicine

Head & Neck Case Review 2021-07

Head & Neck Case Review

July, 2021

History

A 50-year-old man presents with a 6-month history of a left tongue lesion which was biopsied. Characteristic H&E stained sections and one immunostain are shown.

Images

Quiz

Q1. Which of the following is true regarding this lesion?

  • A. It is the result of a proliferation of histiocytes.
  • B. The lesional cells are filled with PAS+, diastase resistant granules.
  • C. The overlying mucosal process is characteristic of basal cell carcinoma.
  • D. Leukoplakia and erythroplakia are precursors of this lesion.

Q2. Which immunohistochemical stain is used to help diagnose this lesion and is shown here?

  • A. CK5/6
  • B. SOX10
  • C. S100
  • D. Desmin

Diagnosis

Contributor

Qiuying Shi, MD, MS (Assistant Professor, Lead author)
Oluwaseun Ogunbona, MD, PhD (PGY3 resident)
Department of Pathology
Emory University Hospital Midtown
Emory University School of Medicine, Atlanta, GA