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Clinical Problem Solving: Pathology
April 2004

Pathology Quiz Case 1

Author Affiliations
 

FREDERIC B.ASKINMDWILLIAM H.WESTRAMD

Arch Otolaryngol Head Neck Surg. 2004;130(4):474. doi:10.1001/archotol.130.4.474

A 79-year-old white man presented with an 8-month history of a painful, slowly enlarging facial mass. Several months earlier, he had developed persistent pain in the left facial and temporal regions that was unassociated with eating. He denied facial weakness, change in mass size with food intake, otalgia, otorrhea, fever, or chills. His medical history was significant for basal cell carcinoma on the skin of the shoulder and squamous cell carcinoma on the skin of the hand, both of which had been diagnosed and excised 6 years earlier, without recurrence. He had a 30 pack-year history of tobacco use and worked as a cook. Physical examination revealed a fixed, firm, nontender, 4 × 4-cm mass in the left parotid gland, with no overlying skin lesion. Medial bulging of the ipsilateral cartilaginous ear canal was noted on otoscopic examination. Cranial nerves II to XII were normal. No cervical lymphadenopathy or masses were palpated. Examination of the scalp, extremities, and trunk showed no skin lesions. A computed tomographic scan with contrast showed an ill-defined, hypodense lesion in the superficial parotid lobe, with no apparent involvement of the deep lobe or temporal bone (Figure 1). Because fine-needle aspirates were nondiagnostic, the patient underwent an open biopsy of the mass. The histopathologic features are shown in Figure 2.

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