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Clinical Problem Solving: Pathology
February 2013

Pathology Quiz Case 1

Author Affiliations


JAMA Otolaryngol Head Neck Surg. 2013;139(2):193. doi:10.1001/jamaoto.2013.1268a

A 70-year-old man presented with a recurrent right parotid mass. Five months earlier, he had presented at an outside hospital with a 4.3 × 3.2 × 2.6-cm level 2 mass in the right side of his neck. Two months after the excision, the mass recurred. Magnetic resonance imaging of the neck showed a 6 × 5-cm ill-defined mass of low signal intensity in superficial and deep parotid lobes, with infiltration of the surrounding soft tissues (Figure 1). A chest radiograph revealed multifocal opacities. Positron emission tomography–computed tomography showed diffuse hypermetabolic lymphadenopathy throughout the body and hypermetabolic activity in the right parotid gland. An excisional biopsy specimen of a level 2 lymph node on the right side demonstrated follicular hyperplasia, increased immunoblasts, germinal centers, and mantle zones, with no evidence of lymphoma.