A 45-year-old African-American man presented to an outpatient clinic for evaluation of nontender bilateral masses in the temporomandibular region, which had increased in size over the previous 2 months. He denied human immunodeficiency virus (HIV) behavioral risk factors (homosexual activity, intravenous drug use, or unsafe sexual practices), but he had received a blood transfusion 2 years before, when he underwent cervical fusion after a motorcycle accident.
Otherwise his medical history was unremarkable. He took no medications, rarely drank alcohol, and smoked 1 pack of cigarettes per day. Review of systems revealed dryness of the mouth and blurred vision but was otherwise noncontributory. He had no history of fever, anorexia, or recent weight loss.
On physical examination, golf ball—sized, nontender, preauricular masses were palpated bilaterally (Figure 1), as well as several small, nontender, cervical lymph nodes.
Pertinent laboratory data included a hemoglobin level of 127 g/L, normal white blood cell count
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