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Abstract

A 52-year-old woman complained of something "stuck in her throat" for about three weeks. She did not drink alcohol or smoke and had no history of disease in the upper aerodigestive tract.On physical examination, a 1.2-cm mass protruded approximately 0.4 cm above the level of the mucosa of the base of the tongue. The mucosa was intact. The lesion was slightly to the left of center. A 1.5-cm lymph node was palpable in the left side of the neck. It was soft and freely movable.No other abnormalities were found. A biopsy was done of the lesion at the base of the tongue. Sections from the biopsy specimen are shown in Figs 1 through 3.What is your diagnosis?Alan F. Frigy, MD, Charlottesville, Va During a two-month interval, a 61\ x=r eq-\ year-old man was seen for recurrent episodes of epistaxis. Bleeding from the left ethmoid area had been controlled with deep anterior nasal packs but recurred following pack removal.He was treated with ethmoid artery ligation and subsequently underwent a left anterior ethmoidectomy and internal maxillary artery ligation. Persistent bleeding prompted a com¬ puted tomographic scan, which dem-onstrated extensive tumor of the left nasal area.The patient had a history of heavy alcohol ingestion and nodular cirrho¬ sis. The physical examination showed a mass in the right medial nasal cavi¬ ty and an enlarged, nontender liver associated with an abdominal fluid wave. Chest roentgenography dis¬ closed diffuse, bilateral, basilar nodu¬ lar infiltrates. A liver-spleen radionucleotide scan showed a pattern of cir-rhosis, with enlargement and mass effect of the right hepatic lobe. Liver enzyme levels were moderately in¬ creased, and the total bilirubin level was 2.3 mg/dL. A biopsy specimen of the nasal mass was obtained and submitted for histologie examination (Figs 1 and 2). A special stain is seen in Fig 3. What is your diagnosis?