A 92-year-old white native Dutch man presented with a several-month history of persistent swallowing complaints. He also had a minor right-sided odynophagia, right-sided otalgia, and occasional dysphagia for both solid and liquid substances. No weight loss was noted. His medical history was remarkable for an aneurysm of the abdominal aorta, thrombocytopenia, and reduced kidney function. Endoscopic clinical examination revealed an ulcerating lesion with multiple granulations on the right side of the nasopharynx. The irregular lesion had an average diameter of 2.5 cm and extended into the right posterior side of the palatum molle, the right Rosenmüller fossa, and the right posterior nasopharyngeal wall. There was no cervical lymphadenopathy.
Additional radiologic and histopathologic examinations were performed. A T2-weighted magnetic resonance image showed minor irregularity and mild enhanced signal intensity of the right posterior nasopharyngeal wall. The nasopharyngeal biopsy specimens were characterized by a marked inflammatory infiltrate composed primarily of lymphocytes and to a lesser extent plasma cells (Figure 1). Also, there were several aggregates of epitheloid histiocytes and multinucleated giant cells (Figure 2and Figure 3) with multiple foci of necrosis, which were not typically located in the center of the granulomas (Figure 4). A conventional chest x-ray film showed minor cardiomegaly. A total-body computed tomogram with contrast showed no other abnormalities.
What is your diagnosis?
Bittermann AJN, Straetmans JMJAA, Huysentruyt CJR, Kross KW. Pathology Quiz Case 1. Arch Otolaryngol Head Neck Surg. 2010;136(7):744. doi:10.1001/archoto.2010.85-a