Clinical Problem Solving: Pathology
July 2009

Pathology Quiz Case 1

Author Affiliations



Copyright 2009 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.2009

Arch Otolaryngol Head Neck Surg. 2009;135(7):720-723. doi:10.1001/archoto.2009.62-a

A 66-year-old woman presented from an outside institution 1 week after undergoing an aborted thyroidectomy for locally aggressive cancer of the thyroid gland. Intraoperative findings were notable for extrathyroid extension involving the right cricotracheal complex and encasement of the right recurrent laryngeal nerve, which was sacrificed. She did report childhood exposure to radiation, presumably for treatment of acne. There was no palpable residual thyroid or lateral neck disease on physical examination. Flexible fiberoptic laryngoscopy demonstrated a paretic right true vocal cord. A fine-cut computed tomogram of the neck demonstrated soft-tissue density fullness of the subglottic larynx, which was consistent with either tumor invasion of the airway or postoperative edema (Figure 1). In the operating room, a firm submucosal soft-tissue fullness was identified on endoscopy. Findings from a biopsy confirmed malignancy, showing cribriform and glandular architecture composed of squamoid, mucous, and intermediate cell types beneath an unremarkable respiratory epithelium.

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