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Clinical Problem Solving: Pathology
February 2006

Pathology Quiz Case 2

Author Affiliations

Cleveland Clinic Foundation, Cleveland, Ohio (Drs Shipchandler and Akst), and Cleveland Clinic Foundation, Naples, Fla (Drs Greene and Henry)

 

FREDERIC B.ASKINMDWILLIAM H.WESTRAMD

Arch Otolaryngol Head Neck Surg. 2006;132(2):221. doi:10.1001/archotol.132.2.221

A 73-year-old man presented with a 12-year history of a slowly enlarging mass on the left side of the mobile tongue. He had no decrease in tongue mobility, no change in taste, and no pain or other associated symptoms. On physical examination, the lesion appeared submucosal, with the overlying mucosa showing marked attenuation. There was no erythema, ulceration, or necrosis of the tongue or lesion.

The lesion, which measured 2.0 × 1.5 × 1.0 cm on gross inspection (Figure 1), was firm to palpation, without elicited pain or tenderness. It was excised en bloc. Histologic examination showed a well-circumscribed lesion within the musculature of the tongue, extending to the lateral margins (Figure 2). The overlying mucosa was normal. The lesion consisted of mature adipose cells in a fibrous matrix. High-power magnification showed connective tissue cells interspersed throughout the specimen, containing nuclei with mild pleomorphism. Mitotic figures were not observed (Figure 3). Numerous mast cells were present throughout the lesion. Immunohistochemical staining was positive for CD34 (Figure 4).

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