Pathology · patient case question
During examination you note purple-red macules on the palate of a different patient with advanced HIV. This is most likely:
Patient case: A lump behind the tonsil
demo: 56-year-old male
chief: A painless lump in the right side of the neck that he first noticed two months ago.
history: Never smoked. Modest alcohol intake. Reports multiple lifetime sexual partners.
meds: None.
findings: A firm, non-tender 3 cm level II cervical node on the right. Examination of the oropharynx shows an ulcerated, slightly raised lesion of the right tonsil. Elsewhere the mucosa is unremarkable.
Show answer and explanation
Correct answer: C. Kaposi sarcoma
- A. An amalgam tattoo is a solitary blue-grey macule adjacent to a restored tooth or an extraction site, and metal fragments are sometimes visible radiographically.
- B. A pyogenic granuloma is a solitary red pedunculated mass that bleeds readily, arising from local irritation or hormonal change, not multiple flat palatal macules.
- C. Correct. Kaposi sarcoma is a vascular neoplasm driven by human herpesvirus 8. Intraorally it favours the hard palate and gingiva, starting as flat purple macules that coalesce and later become nodular and may ulcerate. It is an AIDS-defining illness.
- D. A haemangioma is usually a solitary developmental lesion present from early life that blanches on pressure. Multiple new palatal macules in advanced HIV do not fit.