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Clinical Problem Solving: Pathology
August 2005

Pathology Quiz Case

Author Affiliations


Arch Otolaryngol Head Neck Surg. 2005;131(8):735. doi:10.1001/archotol.131.8.735

A 73-year-old man presented with a 3-week history of rapidly progressing painful swelling of the left side of his face. He had no history of trauma or dental disease. He had smoked and used alcohol for more than 50 years but denied chewing betel quid. His medical and family histories were unremarkable.

On physical examination, bulging was evident around the area of mandibular angle and body on the left side of the face. The overlying skin was intact but bruised. Scattered ecchymoses were noted on the left buccal mucosa. A panoramic x-ray film showed an osteolytic lesion at the left mandibular angle and body. A contrast-enhanced computed tomographic scan of the head and neck was also performed (Figure 1). Because the results of fine-needle aspiration cytology were inconclusive, an incisional biopsy was performed. Some fragile tissue was obtained and sent for pathologic examination. Representative hematoxylin-eosin–stained sections of the biopsy specimen are shown in Figure 2 and Figure 3. Immunohistochemical analysis of the specimen (Figure 4) revealed the presence of α-fetoprotein.

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