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Clinical Problem Solving: Pathology
May 17, 2010

Pathology Quiz Case 1: Diagnosis

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Copyright 2010 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.2010

Arch Otolaryngol Head Neck Surg. 2010;136(5):524-525. doi:10.1001/archoto.2010.45-b

Diagnosis: Alveolar soft-part sarcoma (ASPS) of the anterior tonsillar pillar

Alveolar soft-part sarcoma is an extremely rare, distinctive sarcoma that typically occurs in teenagers and young adults. The median age at diagnosis is 26 years, with most patients (56%) presenting before the age of 30 years. The primary tumor is usually painless and may grow for years before medical attention is sought. The most common anatomical location is the lower extremities (44%). Twenty-seven percent of the cases involve the head and neck, with 41% of the lesions involving the orbit and 25% occurring in the oral cavity, especially the tongue.1Fewer tumors involve other parts of the head and neck region, including the buccal space, posterior aspect of the neck,2vallecula, parapharyngeal space, infratemporal fossa, larynx, maxilloethmoid complex, sphenoid sinus, middle cranial fossa, sublingual gland, skull, nasopharynx,1nasal fossa, and larynx.3do Nascimento Souza et al4reviewed cases of ASPS in the oral cavity and reported that 84.5% occurred on the tongue, with 46% involving the dorsum region and 23% the base region. According to our review of the literature, this is the first case of ASPS arising in the anterior tonsillar pillar.

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