Pathologic Quiz Case 1
Philomena Mufalli Behar, MD; Andrea Williams, MD; David Donaldson, MD; Mark K. Wax, MD; Lucia L. Balos, MD; Buffalo, NYA 78-year-old black woman presented to the emergency department with a 6-month history of progressive dysarthria and dysphagia. She denied odynophagia or dyspnea but complained of a swollen, painful tongue. She also complained of diffuse myalgias. Her medical history was significant for congestive heart failure, chronic renal insufficiency, and multiple myeloma.Physical examination revealed an obese black woman in no airway distress. She had garbled but intelligible speech. A cranial nerve examination revealed no abnormalities. The findings of aural, nasal, and laryngeal examinations were normal. Oral examination revealed an enlarged, firm tongue that was painful to palpation. Dental impressions were noted on the lateral borders of the tongue (Figure 1). The patient was unable to fold or curl the tongue. There was decreased range of motion of the tongue. Examination of the buccal mucosa revealed dry mucous membranes with patches of enlarged minor salivary glands. There were no ulcerations.
FREDERIC B. ASKIN, WILLIAM H. WESTRA. RESIDENT'S PAGE: PATHOLOGY. Arch Otolaryngol Head Neck Surg. 1997;123(10):1136–1139. doi:10.1001/archotol.1997.01900100112016