Clinical Pathologic Conference

Baylor College of Medicine

Room M-112 DeBakey Building

July 14, 2005

12:15-1:15 PM

         Case Discussant: Daniel P. Hunt, M.D.

         Pathologist: Linda Green, M.D.

         Case Preparation: Jeffrey Giullian, M.D.

         Resident: Christopher Nguyen, M.D.

Chief Complaint: Cheek swelling

History of Present Illness:  

35 year old white female recently moved to Houston from South Carolina . She presented to her doctor complaining of swelling on the right side of her cheek. The swelling began approximately 6 months ago and has grown slowly over time. She was previously told that it was a "benign salivary gland tumor." She states that it has become hard and is slightly tender.

She denies erythema over the area, nor has she had pain with chewing or swallowing. She denies weight loss but does complain about intermittent night sweats over the past year.

Prior to the beginning of these symptoms, the patient had been healthy. She does state she had an "eye problem" in 2003, for which she sought care in South Carolina . She is unsure of the exact details of this problem but states her eye "went blind and was painful." She was treated in a hospital and her symptoms resolved with six months of steroids, though she is unsure of the dose. She also had an MRI of the brain during that visit and, per her report, it was "normal."

Review of Systems:

GEN:      Denies fever, chills or weight loss. + Night sweats

HEENT: Occasional headaches

CV:        No chest pain, palpitations or orthopnea

PULM:   No shortness of breath or cough

GI:          No nausea, vomiting or abdominal pain. No diarrhea or constipation.

GU:         No dysuria. No abnormal vaginal discharge or bleeding. LMP not documented.

MS:        Occasional arthralgias. No joint swelling. No morning stiffness

PSYCH: Stable depression. No suicidal ideation. Minimal anhedonia

Past Medical History:

Hypertension

Hyperlipidemia

Eye problem in 2003

Depression-stable on medication

Past Surgical History:

C-section

VSD repair (childhood)

Health Maintenance:

Recent normal PAP smear

No prior mammogram

No prior colonoscopy

Medications:

Hydrochlorothiazide 25 mg daily

Aspirin 81 mg daily

Sertaline 100 mg daily

Simvastatin 40 mg daily

Naproxen 500 mg prn

Allergies: No known drug allergies

Family History:

Maternal aunt with cervical cancer

Grandmother with Diabetes Mellitus Type 2

Social History:

Tobacco: One pack per day for 17 years, quit 3 months prior.

Alcohol:   Occasional

Drugs:      None

Sexual:     Not sexually active for past six years

Travel:      No recent travel, but patient was stationed in Korea in the 1990s

Family:     Single, 10 year son (healthy)

Work:      Department store

Physical Exam:

GENERAL: Alert and oriented x 3, no acute distress

HEENT:      Normlocephalic, pupils equal and reactive to light. Funduscopic exam within normal limits. Oropharynx clear without lesions or erythema.   Right parotid gland is firm, minimally tender and enlarged. The salivary duct drains normal appearing, clear fluid.

NECK:       Few small, mobile lymph nodes bilateral anterior cervical chain. No bruits or jugular venous distention

BREAST:   Normal breast exam without palpable masses. No nipple discharge. No dimpling.

PULM:      Clear bilaterally without rhonchi, rales or wheezes.

CV:            Regular rate and rhythm. Normal S1 and S2. No murmurs or rubs.

ABD:         Soft, non-tender, non-distended. No hepatosplenomegaly. Normal bowel sounds. No rigidity or rebound. Scar from C-section well healed.

RECTAL:   Deferred

EXT:          No edema, peripheral pulses intact

JOINTS:    Neck: Good range of motion.

                  Shoulders: Full range of motion

                  Hands/Feet: No synovitis or nail pitting. No deformities. Full range of motion

                  Hips: Non-tender. Full range of motion

                  Knees/Ankles: No effusions or tenderness. Full range of motion

NEURO:    CN II-XII intact. Normal gait. Sensory and motor grossly intact.