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Clinical Problem Solving: Pathology
February 1, 2008

Pathology Quiz Case 1

Author Affiliations

Julia C.IezzoniMD

Arch Otolaryngol Head Neck Surg. 2008;134(2):214. doi:10.1001/archoto.2007.28-a

A 31-year old man presented with a 1-month history of a progressively enlarging, painless mass in the left side of his neck. He had no other clinical manifestations in the head and neck region, and he had no symptoms such as odynophagia, dyspnea, weight loss, night sweats, or fever. No significant personal or family medical history was noted. Physical examination revealed a 5×3-cm, elastic, immobile, nontender mass in the left submandibular triangle. Fine-needle aspiration cytology showed some epithelial cell nests with myxoid stroma in a bloody background, and no definite diagnosis could be made. Computed tomography demonstrated the presence of a well-defined tumor in proximity to the left submandibular gland with mild contrast enhancement and without associated adjacent lymph nodes (Figure 1). The resected tumor consisted of a 5.0×3.0×2.5-cm, circumscribed, white, homogeneous, elastic mass. Histopathologic examination revealed a well-circumscribed tumor composed of oval to spindle cells with irregular cellularity and thin-walled branching vessels (Figure 2). Immunohistochemical analysis showed that the tumor cells were diffusely positive for O13 (CD99) (Figure 3) and CD34 (Figure 4) and negative for S100 protein and smooth muscle actin.