Clinical Problem Solving: Pathology
January 2013

Pathology Quiz Case 2

JAMA Otolaryngol Head Neck Surg. 2013;139(1):89. doi:10.1001/jamaoto.2013.1145a

A 55-year-old man presented with a 6-week history of persistent dysphonia that developed after a recent intubation during an endoscopic sinus procedure for chronic sinus disease. The anesthesiologist noticed a lesion on his left vocal cord. His medical history was remarkable for hypertension, asthma, and previous multiple endoscopic sinus procedures. He was referred to our ear, nose, and throat department for further examination.

Fiberoptic endoscopic assessment of the larynx showed a hyperemic swelling of the left true vocal cord that extended to the anterior commissure. Diagnostic microlaryngoscopy was scheduled, and the lesion was removed under microscopic guidance. The specimen, which measured 10 × 6 mm, was sent for histopathologic examination. The histologic findings demonstrated a nonradically removed lesion (Figure 1). Intermediate-power magnification revealed a stroma of oval to spindlelike mononuclear mesenchymal cells uniformly interspersed with multinucleated osteoclast-type giant cells (Figure 2). The nuclei of the giant cells were histologically identical to those of the stromal spindle cells. Mitotic figures were identified, though not increased in number or atypical. There was no observation of osteoid formation.

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