Contributed by Sarah B. Hugar, MD and A. William Pasculle, ScD.
An approximately 60-year-old man presented to his dentist with a slow growing mass on the right side of his neck. The man first noticed the mass approximately 10 months ago, at which time he said it was about the size of a kernel of corn. However, he reported that over time, the mass had grown slowly to the size of a large grape. The mass was located on the right side of the neck, just below the mandible. The patient denied pain on palpation, weight loss, fevers or chills, decreased energy, or drainage of the mass. The patient had a history of multiple dental fillings, was a former cigarette smoker, and reported drinking 3-4 beers daily. His dentist suspected a salivary stone and prescribed a two-week course amoxicillin, and recommended the patient follow up with his primary care physician.
At follow-up with his primary care physician two weeks later, the mass had not decreased in size. The primary care physician was concerned for malignancy, particularly given the patient's history of smoking and alcohol use, and a CT neck was performed. CT revealed a 2.3 x 1.8 cm soft tissue mass in the right neck with surrounding inflammation (performed at an outside institution; images not available). At this point the gentleman was referred to ENT with concern for possible carcinoma, and an incisional biopsy was performed. Tissue was sent for surgical pathology and aerobic culture.
DIAGNOSIS and DISCUSSION