Soft Palate Ulcer—Benign or Malignant? | Otolaryngology | JN Learning | AMA Ed Hub [Skip to Content]
[Skip to Content Landing]

Soft Palate Ulcer—Benign or Malignant?

Educational Objective
Based on this clinical scenario and the accompanying image, understand how to arrive at a correct diagnosis.
1 Credit CME

A 71-year-old man with a history of rheumatoid arthritis and type 2 diabetes presented to the otolaryngology team with 6 weeks’ history of pain and ulcers in the pharynx. He also complained of nasal regurgitation. He denied having any systemic symptoms. He took linagliptin, valsartan, and 15 mg of methotrexate weekly. He was a nonsmoker and consumed very little alcohol.

Clinical examination including flexible nasendoscopy revealed multiple shallow ulcers on the posterior wall of the nasopharynx. There was a large defect involving the entire soft palate on the left. There was no obvious mass or any exophytic lesion. The edges of the soft palate defect were smooth and clean (Figure 1). There were no cranial nerve palsies. There was no cervical, axillary, or inguinal lymphadenopathy. Findings of the remaining head and neck examinations were normal.

Please finish quiz first before checking answer.

You answered correctly!

Read the answer below and download your certificate.

You answered incorrectly.

Read the discussion below and retake the quiz.

D. EBV-positive mucocutaneous ulcer

Histologic findings from the biopsy showed stratified squamous mucosa and respiratory-type mucosa with large areas of surface ulceration. There were dense underlying lymphoid infiltrates composed of lymphocytes, transformed lymphoid cells, and plasma cells. The transformed cells resembled atypical immunoblastic or Hodgkin and Reed-Sternberg–like cells (Figure 2A) dispersed between lymphocytes with no evidence of palisaded lymphocytes around those. These cells showed strong positivity for CD20, Pax5, MUM1, CD30, and CD15 on immunohistochemical staining (Figure 2B). More than 90% of the cells’ nuclear expression also showed EBV positivity on EBV-encoded RNA testing, but the results of B-cell clonality analysis using polymerase chain reaction were negative for any monoclonal B-cell population. No lymphoepithelial lesion, dysplasia, or epithelial malignant neoplasm was seen.

Survey Complete!

Sign in to take quiz and track your certificates

Buy This Activity

JN Learning™ is the home for CME and MOC from the JAMA Network. Search by specialty or US state and earn AMA PRA Category 1 CME Credit™ from articles, audio, Clinical Challenges and more. Learn more about CME/MOC

CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.

Article Information

Corresponding Author: Billy L. K. Wong, MBBS, Department of Otolaryngology–Head and Neck Surgery, Broomfield Hospital, CM1 7ET, Essex, United Kingdom (bwonglk@doctors.org.uk).

Published Online: August 12, 2021. doi:10.1001/jamaoto.2021.1927

Conflict of Interest Disclosures: None reported.

Additional Contributions: We thank the patient for granting permission to publish this information.

References
1.
Gaulard  P , Swerdlow  SH , Harris  NL , Sundstrom  C , Jaffe  ES . EBV-positive mucocutaneous ulcer. In: Swerdlow  SH , Campo  E , Harris  NL ,  et al, eds.  WHO Classification of Tumours of Haematopoietic and Lymphoid Tissues. Revised 4th ed. International Agency for Research on Cancer; 2016:307-308.
2.
Ikeda  T , Gion  Y , Nishimura  Y , Nishimura  MF , Yoshino  T , Sato  Y .  Epstein-Barr virus-positive mucocutaneous ulcer: a unique and curious disease entity.   Int J Mol Sci. 2021;22(3):1053. doi:10.3390/ijms22031053PubMedGoogle ScholarCrossref
3.
Ikeda  T , Gion  Y , Yoshino  T , Sato  Y .  A review of EBV-positive mucocutaneous ulcers focusing on clinical and pathological aspects.   J Clin Exp Hematop. 2019;59(2):64-71. doi:10.3960/jslrt.18039PubMedGoogle ScholarCrossref
4.
Dojcinov  SD , Venkataraman  G , Raffeld  M , Pittaluga  S , Jaffe  ES .  EBV positive mucocutaneous ulcer—a study of 26 cases associated with various sources of immunosuppression.   Am J Surg Pathol. 2010;34(3):405-417. doi:10.1097/PAS.0b013e3181cf8622PubMedGoogle ScholarCrossref
5.
Bunn  B , van Heerden  W .  EBV-positive mucocutaneous ulcer of the oral cavity associated with HIV/AIDS.   Oral Surg Oral Med Oral Pathol Oral Radiol. 2015;120(6):725-732. doi:10.1016/j.oooo.2015.06.028PubMedGoogle ScholarCrossref
If you are not a JN Learning subscriber, you can either:
Subscribe to JN Learning for one year
Buy this activity
jn-learning_Modal_Multimedia_LoginSubscribe_Purchase
Close
If you are not a JN Learning subscriber, you can either:
Subscribe to JN Learning for one year
Buy this activity
jn-learning_Modal_Multimedia_LoginSubscribe_Purchase
Close
With a personal account, you can:
  • Access free activities and track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
Education Center Collection Sign In Modal Right
Close

Name Your Search

Save Search
Close
With a personal account, you can:
  • Track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
jn-learning_Modal_SaveSearch_NoAccess_Purchase
Close

Lookup An Activity

or

Close

My Saved Searches

You currently have no searches saved.

Close

My Saved Courses

You currently have no courses saved.

Close
With a personal account, you can:
  • Access free activities and track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
Education Center Collection Sign In Modal Right
Close