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Clinical Problem Solving: Pathology
February 2005

Pathology Quiz Case 2

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Copyright 2005 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.2005

Arch Otolaryngol Head Neck Surg. 2005;131(2):173. doi:10.1001/archotol.131.2.173

A 71-year-old woman presented with a 3-month history of nasal obstruction and epistaxis in June 2003. Eleven years earlier, she had undergone 8 weeks of radiotherapy to the nasopharynx and neck (dosage, 72 Gy; 2 Gy per fraction) for nasopharyngeal carcinoma. Physical examination revealed a fungating, gray-tan tumor mass occupying the entire nasal chamber. Laboratory tests demonstrated a lactate dehydrogenase level of 140 IU/L and an alkaline phosphatase level of 67 IU/L. Magnetic resonance imaging with intravenous gadolinium injection showed an extensive heterogeneous soft tissue mass in the ethmoidal sinuses, the sphenoidal sinus, and the nasal chamber, with invasion of the right orbit and skull base (Figure 1).

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