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Clinical Challenge
February 2018

Dysphagia and Pharyngeal Obstruction in a Nonsmoker

Author Affiliations
  • 1Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California
  • 2Department of Pathology and Laboratory Medicine, Stanford University School of Medicine, Stanford, California
JAMA Otolaryngol Head Neck Surg. 2018;144(2):171-172. doi:10.1001/jamaoto.2017.2436

A man in his 60s presented with a 6-month history of dysphagia, a 3-month history of a 2.268-kg weight loss (to convert to pounds, divide by 0.454), and a right neck mass. Tobacco history was minimal and distant, and alcohol use was social only. Physical examination, including flexible nasolaryngoscopy, was notable for a large smooth nonulcerated right base of tongue mass with almost complete pharyngeal airway obstruction, and a 4-cm right level II lymph node. Computed tomography (CT) imaging revealed a 3-cm base of tongue–lingual tonsil mass with multiple right Ib, IIa, and II/III nodes, the largest of which was 2.0 cm by 3.0 cm. Awake tracheotomy and direct laryngoscopy with biopsy of right base of tongue mass lesion was performed.