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Clinical Problem Solving: Pathology
June 2013

Pathology Quiz Case 3

JAMA Otolaryngol Head Neck Surg. 2013;139(6):655. doi:10.1001/jamaoto.2013.3257a

A male patient who was 34 years old, a smoker, and human immunodeficiency virus (HIV)-seropositive for the past 15 years visited this service complaining of an oral lesion. His medical record disclosed seropositivity for hepatitis C virus (HCV) and a history of oral candidiasis, neurocryptococcosis, and herpes zoster. The patient was using stavudine, lamivudine, tenofovir, and lopinavir. His CD4 cell count was 406 cells/mm3, and he had an undetectable HIV viral load. From the clinical perspective, the patient exhibited a painless red spot that was approximately 3 cm in diameter on the right side of the cheek mucosa that had appeared 3 years earlier (Figure 1). An incisional biopsy was performed, followed by histopathological analysis (Figure 2), p53 immunohistochemical analysis (Dako Inc), and human papillomavirus (HPV) in situ hybridization (ISH) (Dako Inc) (Figure 3).