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Clinical Problem Solving: Pathology
June 21, 2010

Pathology Quiz Case 1

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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(6):634. doi:10.1001/archoto.2010.66-a

An 89-year-old white woman with a history of schizophrenia presented with a 1-year history of progressive left facial swelling accompanied by local bleeding, pain, and dysphagia. A review of systems revealed a 9-kg unintentional weight loss and lower lip paresthesias. She denied trismus, fever, trauma, and recent dental work. She did not use tobacco or alcohol. Physical examination revealed a 6-cm deforming mass in the left mandibular alveolar ridge that extended into the floor of the mouth and overlying skin, causing ulceration and bleeding. There were several “floating” teeth in the left anterior and posterior mandible and anesthesia over the left mental nerve distribution. The results of the rest of the head and neck examination were normal. Computed tomography revealed an expansile, ill-defined lytic lesion in the body of the left mandible, with extensive erosion into the buccal cortex (Figure 1).

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