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Clinical Problem Solving: Pathology
December 2005

Pathology Quiz Case 1

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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(12):1120. doi:10.1001/archotol.131.12.1120

A 40-year-old Haitian man presented with a 1-year history of a slowly growing lesion in his left tonsil. He stated that he had dysphagia and odynophagia that had worsened in recent weeks. He denied any related personal or familial medical history as well as the use of alcohol, tobacco, or recreational drugs.

Physical examination revealed a 5-cm soft tissue mass centered in the left tonsillar fossa. The results of the rest of the head and neck examination were unremarkable. There were no signs or symptoms of deep muscle invasion, such as trismus. Computed tomography and magnetic resonance imaging showed a 5-cm lesion abutting but not invading the mandible (Figure 1). There was no evidence of significant cervical lymphadenopathy. The clinical diagnosis was a malignant tumor of the left tonsillar fossa. A metastatic workup, including laboratory tests and computed tomography of the patient’s chest, abdomen, and pelvis, revealed no abnormalities.

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