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Clinical Problem Solving: Pathology
September 2007

Pathology Quiz Case 1

Author Affiliations

Department of Otolaryngology–Head and Neck Surgery, Stanford University School of Medicine, Stanford, California



Arch Otolaryngol Head Neck Surg. 2007;133(9):946. doi:10.1001/archotol.133.9.946

An ex-term 2-day-old girl, born via normal spontaneous vaginal delivery without perinatal complications, was referred for evaluation of a large mass in the floor of the mouth. The mass, which was first noted at the time of delivery, was not obstructive and caused no respiratory symptoms. The patient had some difficulty breast-feeding but was able to bottle-feed well with an elongated nipple.

Physical examination revealed a cystic mass in the floor of the mouth that was displacing the tongue dorsally. The mass was soft and appeared to be filled with fluid. No other abnormalities were evident (Figure 1). Magnetic resonance imaging showed a 2.3 × 1.9 × 2.1-cm lesion arising in the midline, either within the inferior tongue or immediately below it. A T2-weighted coronal magnetic resonance image of the oral cavity is shown in Figure 2. The mass appeared cystic on all sequences, with a low signal on T1-weighted images, a high signal on T2-weighted images, and only a thin rim of peripheral enhancement. No fluid-fluid levels were seen. There was no evidence of fat within the lesion. The patient underwent surgical excision of the lesion at 2 months of age, after demonstrating poor weight gain. The mass was completely extirpated transorally. Histologic examination revealed a cyst with epithelium that had both glandular (Figure 3) and respiratory (Figure 4) differentiation.

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