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Pathology Quiz Case 2

Pathology Quiz Case 2 A 33-year-old woman presented with a 1-month history of voice change and swallowing dysfunction. She said that her voice had become weak and muffled. She also stated that she had progressive dysphagia with solids and odynophagia after she tried to swallow foods that she was accustomed to eating. Over the past 2 months, she had gained 8 kg. Furthermore, she said that she has to sleep upright because she becomes short of breath when she is lying supine. Her medical history was remarkable for hypothyroidism and a 40 pack-year smoking history. Physical examination revealed a firm mass to bimanual palpation on the base of the tongue (BOT), without palpable cervical lymphadenopathy. Nasopharyngoscopy demonstrated a smooth, midline, 2-cm-diameter BOT mass. Laboratory workup was significant only for an elevated thyrotropin level (6.9 mIU/L). Computed tomography with contrast revealed a 2.1-cm-diameter, high-attenuation, nodular BOT lesion (Figure 1). Because of her symptoms, the patient was scheduled for laryngoscopy and transoral carbon dioxide laser excision of the mass. During surgery, a midline, smooth, submucosal mass was found in the BOT (Figure 2) and was removed en bloc. Microscopic examination of the specimen revealed nonkeratinized lingual mucosa with unremarkable submucosal lymphoid tissue and mucous salivary glands. Deeper in the submucosa, there was an encapsulated nodular mass that was composed of spherical to oval follicles lined with simple cuboidal to columnar epithelium and filled with a homogeneous, deeply eosinophilic material (Figure 3[original magnification ×20] and Figure 4[original magnification ×200]). Figure 1. View LargeDownload Figure 2. View LargeDownload Figure 3. View LargeDownload Figure 4. View LargeDownload What is your diagnosis? http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Otolaryngology - Head & Neck Surgery American Medical Association

Pathology Quiz Case 2

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Pathology Quiz Case 2

Abstract

A 33-year-old woman presented with a 1-month history of voice change and swallowing dysfunction. She said that her voice had become weak and muffled. She also stated that she had progressive dysphagia with solids and odynophagia after she tried to swallow foods that she was accustomed to eating. Over the past 2 months, she had gained 8 kg. Furthermore, she said that she has to sleep upright because she becomes short of breath when she is lying supine. Her medical history was remarkable for...
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Publisher
American Medical Association
Copyright
Copyright © 2010 American Medical Association. All Rights Reserved.
ISSN
0886-4470
eISSN
1538-361X
DOI
10.1001/archoto.2010.9-a
Publisher site
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Abstract

A 33-year-old woman presented with a 1-month history of voice change and swallowing dysfunction. She said that her voice had become weak and muffled. She also stated that she had progressive dysphagia with solids and odynophagia after she tried to swallow foods that she was accustomed to eating. Over the past 2 months, she had gained 8 kg. Furthermore, she said that she has to sleep upright because she becomes short of breath when she is lying supine. Her medical history was remarkable for hypothyroidism and a 40 pack-year smoking history. Physical examination revealed a firm mass to bimanual palpation on the base of the tongue (BOT), without palpable cervical lymphadenopathy. Nasopharyngoscopy demonstrated a smooth, midline, 2-cm-diameter BOT mass. Laboratory workup was significant only for an elevated thyrotropin level (6.9 mIU/L). Computed tomography with contrast revealed a 2.1-cm-diameter, high-attenuation, nodular BOT lesion (Figure 1). Because of her symptoms, the patient was scheduled for laryngoscopy and transoral carbon dioxide laser excision of the mass. During surgery, a midline, smooth, submucosal mass was found in the BOT (Figure 2) and was removed en bloc. Microscopic examination of the specimen revealed nonkeratinized lingual mucosa with unremarkable submucosal lymphoid tissue and mucous salivary glands. Deeper in the submucosa, there was an encapsulated nodular mass that was composed of spherical to oval follicles lined with simple cuboidal to columnar epithelium and filled with a homogeneous, deeply eosinophilic material (Figure 3[original magnification ×20] and Figure 4[original magnification ×200]). Figure 1. View LargeDownload Figure 2. View LargeDownload Figure 3. View LargeDownload Figure 4. View LargeDownload What is your diagnosis?

Journal

Archives of Otolaryngology - Head & Neck Surgery – American Medical Association

Published: Mar 15, 2010

Keywords: smoking,hypothyroidism,computed tomography,dyspnea,physical examination,deglutition disorders,deglutition,hair follicle,laryngoscopy,lymphoid tissue,mucus,ovarian follicle,supine position,surgical procedures, operative,voice,medical history,mucous membrane,salivary glands,sleep,surgery specialty,thyrotropin,tongue,swallowing painful,cervical lymphadenopathy,magnification,bimanual examination,carbon dioxide lasers,nasopharyngoscopy,root of tongue,excision,homogeneity,columnar epithelium,eating

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