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Clinical Challenge
October 2015

Base of Tongue Mass

Author Affiliations
  • 1University of Miami Miller School of Medicine, Miami, Florida
  • 2Department of Otolaryngology–Head and Neck Surgery, University of Miami Miller School of Medicine, Miami, Florida
  • 3Departments of Pathology and Urology, University of Miami Miller School of Medicine, Miami, Florida

Copyright 2015 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.

JAMA Otolaryngol Head Neck Surg. 2015;141(10):935-936. doi:10.1001/jamaoto.2015.1727

A woman in her 40s with no significant medical history presented with a 4-year history of intermittent left-sided throat pain, which eventually progressed to left ear pain approximately 1 year prior to her presentation. She had not experienced any dysphagia, dysphonia, dyspnea, fevers, or weight loss. She had no significant use of tobacco or alcohol in the past. Findings from an otoscopic examination was unremarkable. Nasopharyngoscopy was performed and failed to reveal any masses, ulcerations, or mucosal lesions. A magnetic resonance image (MRI) revealed an enhancing 1 × 6-mm lesion in the left side of the posterolateral tongue base (Figure, A). A biopsy of the mass revealed an intermediate-grade infiltrating neoplasm forming solid sheets and glandular structures (Figure, B). The tumor cells stained positive for CK7 and p63, and negative for CK20, p16, and S-100 by immunohistochemical analysis. Stain for mucicarmine was positive in glandular areas (Figure, C). After establishing the diagnosis, the patient was taken to the operating room for a left base of tongue resection via suprahyoid approach along with a left-sided neck dissection of levels I to IV. The tumor was removed with negative margins, and no positive cervical lymph nodes were found on final pathologic analysis.