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Clinical Problem Solving: Pathology
February 2013

Pathology Quiz Case 2

JAMA Otolaryngol Head Neck Surg. 2013;139(2):197. doi:10.1001/jamaoto.2013.1280a

A 41-year-old man presented with a 3-month history of an enlarging mass on his uvula. His only complaint was an intermittent gagging sensation due to the mass resting on the back of his tongue. His medical history was notable only for a similar mass that had been excised from his right conjunctiva 3 years earlier.

Physical examination was remarkable for a 1.5-cm, pink, mucosally covered mass arising from the posterior surface of the uvula. Nasopharyngoscopy revealed that the mass extended from the tip of the uvula to the posterior soft palate. There were no other palpable lesions or lymphadenopathy. An incisional biopsy demonstrated that sheets of plasma cells had replaced the submucosal stroma (Figure 1 and Figure 2). On immunohistochemical staining, the cells showed κ immunoglobulin restriction represented by red cytoplasm, as only a few scattered cells exhibited brown cytoplasm from λ light-chain positivity (Figure 3).

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