16 Head and Neck
1 A 55-year-old man visited his dentist for a routine dental examination. The dentist noticed lesions with the clinical and histologic appearance shown in the figure. The past medical history showed no major medical problems. Which of the following etiologic factors most likely contributed to the development of these lesions?
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(E) 2 After a bout of the flu, a 25-year-old man notices several 0.3-cm, clear vesicles on his upper lip. The vesicles rupture, leaving shallow, painful ulcers that heal over the course of 4 weeks. Several months later, after a skiing trip, similar vesicles develop, with the same pattern of healing. Which of the following findings is most likely to be associated with these lesions?
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(E) 3 For the past 4 months, a 50-year-old man has had difficulty breathing through his nose and has experienced dull facial pain. On physical examination, there is a mass filling the right nasal cavity. CT scan of the head shows a 4-cm mass in the nasopharynx on the right that erodes adjacent bone. The mass is excised, and microscopic examination shows that it is composed of large epithelial cells with indistinct borders and prominent nuclei. Mature lymphocytes are scattered throughout the undifferentiated neoplasm. Which of the following etiologic factors most likely played the greatest role in the development of this lesion?
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(E) 4 Over the past 10 years, a 60-year-old man has had progressive difficulty hearing, particularly with the left ear. Audiometric testing shows that he has a bone conduction type of deafness. CT scan of the head shows no abnormal findings. The patient’s brother and mother are similarly affected. What is the most likely diagnosis?
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(E) 5 A 35-year-old, HIV-positive man complains that he has had a “bad” taste in his mouth and discoloration of his tongue for the past 6 weeks. On physical examination, there are areas of adherent, yellow-tan, circumscribed plaque on the lateral aspects of the tongue. This plaque can be scraped off as a pseudomembrane to show an underlying granular, erythematous base. What is the most likely diagnosis?
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(G) 6 Over the past 3 years, a 65-year-old woman has noticed a slowly enlarging nodule on her face. On physical examination, a 3-cm, nontender, mobile, discrete mass is palpable on the left side of the face, anterior to the ear and just superior to the mandible. The mass is completely excised, and histologic examination shows ductal epithelial cells in a myxoid stroma containing islands of chondroid and bone. This patient is most likely to have which of the following neoplasms?
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(F) 7 A 23-year-old man has had difficulty breathing through his nose for 2 years. This problem has become progressively worse over the past 2 months. Physical examination shows glistening, translucent, polypoid masses filling the nasal cavities. Histologic examination of the excised masses shows respiratory mucosa overlying an edematous stroma with scattered plasma cells and eosinophils. Which of the following laboratory findings is most likely to be present in this patient?
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(E) 8 A 56-year-old man notices a lump on the right side of his face that has become larger over the past year. On physical examination, a 3- to 4-cm firm, mobile, painless mass is palpable in the region of the right parotid gland. The oral mucosa appears normal. He does not complain of difficulty in chewing food or talking. The mass is completely excised, and histologic examination shows spaces lined by a double layer of superficial columnar and basal cuboidal epithelial cells that are surrounding a lymphoid stroma. What is the most likely diagnosis?
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(F) 9 Over the past 3 months, a 6-year-old boy has had increased difficulty breathing, and the character of his voice has changed. Endoscopic examination shows three soft, pink excrescences on the true vocal cords and in the subglottic region. The masses are 0.6 to 1 cm in diameter. Microscopic examination of the excised masses shows finger-like projections of orderly squamous epithelium overlying fibrovascular cores. Immunostaining for human papillomavirus 6 antigens is positive. Based on these findings, which of the following statements is the best advice to give the parents of this boy?
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(E) 10 A 95-year-old man has noted swelling of his lower lip for the past month. On examination, there is a fluctuant, 1-cm nodule with a blue, translucent hue just beneath the oral mucosa on the inside of his lip. The lesion is excised, and on microscopic examination shows granulation tissue. What is the most likely etiology for this lesion?
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(F) 11 A 70-year-old man who has experienced increasing hoarseness for almost 6 months has recently had an episode of hemoptysis. On physical examination, no lesions are noted in the nasal or oral cavity. There is a firm, nontender anterior cervical lymph node. The lesion shown in the figure is identified by endoscopy. The patient undergoes biopsy, followed by laryngectomy and neck dissection. Which of the following etiologic factors most likely played the greatest role in the development of this lesion?
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(B) 
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(E) 12 A 49-year-old man has used chewing tobacco and snuff for many years. During a visit to his dentist, a lesion is seen on the hard palate (see figure). It cannot be removed by scraping. A biopsy is performed, and microscopic examination of the lesion shows a thickened squamous mucosa. Several years later, a biopsy specimen of a similar lesion shows carcinoma in situ. Which of the following is the most likely diagnosis?
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(F) 13 A 60-year-old woman noticed an enlarging “bump” beneath her tongue for the past year. She does not smoke or use alcohol. On physical examination, there is a 2.5-cm, movable, submucosal mass arising in the minor salivary glands on the buccal mucosa beneath the tongue on the right. Histologic examination of the excised mass shows that it is malignant and locally invasive. The tumor recurs within 1 year. Which of the following is the most likely diagnosis?
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(F) 14 A 17-year-old girl notices a small, sensitive, gray-white area forming along the lateral border of her tongue 2 days before the end of her final examinations. On examination by the physician’s assistant, the girl is afebrile. There is a shallow, ulcerated, 0.3-cm lesion with an erythematous rim. No specific therapy is given, and the lesion disappears within 2 weeks. The past history shows that the girl “does not smoke or chew tobacco and does not go out with boys who do.” Which of the following is the most probable cause of this lesion?
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(B) Stay updated, free articles. Join our Telegram channel
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