A 62-year-old man comes to the office due to worsening difficulty with swallowing food over the last 3 months. He has smoked a pack of cigarettes daily for the past 45 years. On examination, there is a firm, palpable mass at the base of tongue. Cervical lymph nodes are also palpable. Which of the following histologic features is most likely to be seen on biopsy of the tongue lesion?

Question

A 62-year-old man comes to the office due to worsening difficulty with swallowing food over the last 3 months.  He has smoked a pack of cigarettes daily for the past 45 years.  On examination, there is a firm, palpable mass at the base of tongue.  Cervical lymph nodes are also palpable.  Which of the following histologic features is most likely to be seen on biopsy of the tongue lesion?

Quizplus · Accepted Answer

11ec160b_3907_b3a8_9249_1780d7f39e33_MD0001_00 This patient with dysphagia, a base of tongue mass, and cervical lymphadenopathy likely has mucosal head and neck squamous cell carcinoma (HNSCC). HNSCC arises from the mucosa of the upper aerodigestive tract after accrual of multiple somatic mutations, often caused by the mutagens found in tobacco. Other risk factors for HNSCC include age >40, alcohol use, and immunocompromised status. There has also been a dramatic increase in HNSCC due to human papillomavirus (HPV), which may be seen in younger, nonsmoking patients. Characteristic pathologic findings of HNSCC include nests and sheets of polygonal cells with abundant eosinophilic cytoplasm that invade the submucosa and surrounding structures; intercellular bridges and keratin pearls (ie, foci of keratinization) may be seen on light microscopy. (Choice A) Squamous papillomas are benign tumors that have fibrovascular cores surrounded by squamous epithelium. They can occur in the mucosa of the upper aerodigestive tract but would not spread to regional lymph nodes as they are not malignant. (Choice B) Adenocarcinomas arise due to mutation of glandular cells and often retain glandular features and some glandular functions, including the production of mucin. The mucosa of the head and neck is made of stratified squamous cells; therefore, cancers arising from this region often retain some features of squamous cells (eg, production of keratin). (Choice C) Oral candidiasis (ie, thrush) often has an inflammatory infiltrate with pseudohyphae and can present with oral lesions. However, oral candidiasis characteristically appears as white plaques on an erythematous base throughout the mucosa. It does not form a palpable mass or cause firm cervical adenopathy. (Choice E) Although non-Hodgkin lymphoma, such as follicular lymphoma (characterized by nodular proliferation of lymphocytic follicles), can rarely present in a tonsil, it is unlikely to occur in the base of tongue and is overall much less common than HNSCC, especially in a patient age >60 with a long history of tobacco use. Educational objective: Head and neck squamous cell carcinoma is likely in a patient with cervical adenopathy and a base of tongue mass, especially with a history of tobacco use. Classic histologic findings include intercellular bridges and keratin pearls.

A 62-Year-Old Man Comes to the Office Due to Worsening