Tumor Board Conference from the University of Pittsburgh

The patient is a 64-year-old woman with a nonhealing oral ulcer.

Karen T. Pitman, MD: We will be discussing the case of a 64-year-oldwoman who was referred to the Department of Otolaryngology, Universityof Pittsburgh Medical Center, with the chief complaint of a nonhealingulcer in the oral cavity that had been present for 2 months. Upon furtherquestioning, the patient noted the recent onset of right otalgia and a10-pound weight loss. She denied experiencing trismus or odynophagia.

The patient's social history was remarkable for alcohol and tobaccoabuse. Her past medical and surgical history was remarkable only for periodontaldisease and the subsequent loss of all dentition 10 years ago. An otolaryngologistin the community had seen her 2 weeks prior to referral, and a biopsy ofthe oral ulcer disclosed squamous cell carcinoma.

On physical examination, the patient appeared to be adequately nourishedand to be her stated age. Inspection of the oral cavity revealed that thepatient was edentulous and had an ulcerative lesion of the right retromolartrigone, which extended into the soft palate, buccal mucosa, and base ofthe tongue. Leukoplakia was noted along the floor of the mouth and theright ventral surface of the tongue. Figure1 depicts the location of the lesion, which had its epicenter on thealveolar process of the ascending ramus of the mandible.

Flexible fiberoptic examination of the nasopharynx, hypopharynx, andlarynx was normal. There was no palpable cervical adenopathy.

Our pathologists reviewed the biopsy specimens obtained at the outsideinstitution and confirmed the diagnosis of moderately differentiated squamouscell carcinoma.

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