A 34-year-old man presented with a 6-month history of an enlarging mass in the right side of his neck. The mass was not tender, but the patient had considerable arm and neck pain. He also complained of a 4-year history of an itchy rash on the posterior aspect of his neck and on his left wrist. He had no shoulder or tongue weakness and was otherwise asymptomatic. He stated that he did not have night sweats, constant fatigue, loss of appetite, or recent substantial weight loss. The patient also denied any risk factors for human immunodeficiency virus, and serologic tests were negative for human immunodeficiency virus. He had a 9 pack-year smoking history.
Lott DG, Cook JR, Lorenz RR. Pathology Quiz Case 2. Arch Otolaryngol Head Neck Surg. 2007;133(7):729. doi:10.1001/archotol.133.7.729