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Clinical Problem Solving: Pathology
May 18, 2009

Pathology Quiz Case 2

Author Affiliations
 

JULIA C.IEZZONIMD

Arch Otolaryngol Head Neck Surg. 2009;135(5):520-523. doi:10.1001/archoto.2009.38-a

A 54-year-old man presented with a 2-month history of a submandibular swelling on the left side of his jaw. The swelling, which was insidious in onset, had not enlarged and did not change in size when the patient was eating or drinking. It was tender but did not cause nocturnal pain. There was no history of trauma, and the patient's medical history was unremarkable.

Physical examination revealed a hard, tender swelling measuring approximately 3 cm in greatest dimension attached to the body of the mandible on the left side. The overlying skin was intact and normal. There was no cervical lymphadenopathy. An intraoral examination showed no abnormalities. A dental panoramic tomogram (Figure 1) demonstrated a fairly well-defined radiolucent lesion with an associated radiopacity involving the inferior cortex of the left side of the mandible. The inferior border of the mandible showed indistinct erosion without sclerosis. There was no obvious underlying dental cause. An urgent excisional biopsy (Figure 2) was performed with the patient under general anesthesia, and the histopathologic findings are shown in Figure 3and Figure 4.

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