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Outside the Lab Training and education, Histology

Case of the Month

A 50-year-old woman presented with a single painless lesion to the left side of the base of the tongue. Gross evaluation revealed a nodular lesion measuring 0.7x0.5 cm that was whitish and firm.

What is your diagnosis?

a. Pleomorphic adenoma
b. Osseous choristoma
c. Peripheral ossifying fibroma
d. Oral torus

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We will reveal the answer in next month's issue!

Do you have a case that you would like us to feature? Email it to edit@thepathologist.com

Answer to last issue’s Case of the Month…

B. Particulate matter aspiration

The images posted last month showed pathologic findings diagnostic of aspiration of microscopic particulate matter into the pulmonary parenchyma (1). The tissue reaction in this case – a combination of organizing pneumonia and granulomatous inflammation with foreign body giant cells – is typical. The aspirated material shown was a combination of microcrystalline cellulose (colorless) and crospovidone (purple, coral-like). These particles are more commonly encountered in patients who inject oral pills intravenously (talc granulomatosis), but in those cases they are found within the interstitium around small blood vessels (2). Less commonly, these particles can enter the lung due to aspiration of oral pills. The presence of organizing pneumonia is a clue to the correct diagnosis, as is the location of the material adjacent to bronchioles.

Submitted by Sanjay Mukhopadhyay, Staff Pathologist, Cleveland Clinic, Cleveland, USA.

References

  1. S Mukhopadhyay, AL Katzenstein, “Pulmonary disease due to aspiration of food and other particulate matter: a clinicopathologic study of 59 cases diagnosed on biopsy or resection specimens”, Am J Surg Pathol, 31, 752–759 (2007). PMID: 17460460.
  2. S Mukhopadhyay, AA Gal, “Granulomatous lung disease: an approach to the differential diagnosis”, Arch Pathol Lab Med, 134, 667–690 (2010). PMID: 20441499.  

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