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A 59-year-old man was seen at the dental clinic for evaluation of ill-fitting dentures and oral pain. He had experienced an 18-kg weight loss over 2 to 3 months and reported subjective fevers and chills. His medical history was significant for tuberculosis, which had been treated 15 years earlier, and testicular cancer, which had been treated when he was 34 years old. He had a 50 pack-year cigarette smoking history and drank 6 beers a week. On examination, he was pale and cachectic. A lesion in the floor of the mouth and the inferior alveolar ridge was noted to be highly suggestive of a malignant process. Because of the patient's clinical frailty and pallor, he was sent to the emergency department for further evaluation. Workup revealed pancytopenia and renal insufficiency. He was admitted to the internal medicine service for a head and neck service consultation.
Armin BB, Nabili V, Wang MB. Pathology Quiz Case 2. Arch Otolaryngol Head Neck Surg. 2011;137(3):307. doi:10.1001/archoto.2011.22-a