A 59-year-old man with a history of benign prostatic hyperplasia (BPH) presents with fatigue, decreased appetite, and a lump in his neck. The patient has smoked 1 to 2 packs of cigarettes per day for the past 30 years. On physical examination, a 2.5 cm firm and fixed nontender left submandibular mass is palpated. The rest of the examination is unremarkable. A complete blood count and comprehensive metabolic panel are within normal limits.
Which of the following is likely to be the underlying diagnosis?
A. Hodgkin lymphomaSquamous cell carcinoma. The patient in this question has an extensive history of smoking. Given the firm and nontender submandibular mass on physical examination, he likely has squamous cell carcinoma, which causes the majority of head and neck cancers. Lymph nodes that are suggestive of malignancy are hard, unilateral, and nontender. The next step in management is lymph node biopsy. (A) In chronic smokers, squamous cell carcinoma is by far the most common head and neck cancer – definitely more common than Hodgkin lymphoma. Furthermore, a patient with Hodgkin lymphoma would likely present with generalized lymphadenopathy. (B) Infectious mononucleosis would cause a painful mass in the neck, not painless. Infectious mononucleosis usually causes lymphadenopathy in the posterior cervical lymph node chain. (D) This patient is not presenting with a thyroid nodule. Papillary thyroid cancer is the most common cause of thyroid cancer and has an excellent prognosis.