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Images of Memorable Cases: Case 131

Module by: Herbert L. Fred, MD, Hendrik A. van Dijk

http://rup.rice.edu/memcases-button.jpg

Case_131-pres1-1.jpg

The lesion on the neck of this homeless man had been slowly enlarging for 18 months, unaccompanied by fever, weight loss, or other systemic signs. On examination, the lesion was hard and nodular with redness of the overlying skin; however, it was not painful, tender, or warm. There were no other physical abnormalities, and results of conventional laboratory tests were normal. Findings from computed tomography (CT) of the neck were interpreted as those of an abscess. The same study performed on the patient at another hospital one year earlier had prompted the same interpretation. Yet no infection was established at that time, and the patient had left the hospital before any therapy could be administered.

131. Squamous cell carcinoma

Site of origin unknown. Given this patient’s indolent course and absence of systemic manifestations, the main diagnostic considerations were malignancy vs. chronic infection, particularly actinomycosis or tuberculosis. Surgical biopsy of the lesion settled the issue.

This case illustrates an important point — as with all tests, CT can be misinterpreted, and consequently misleading.

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