History:

This 36 year old black male was referred to the surgical oncology clinic because of a left-sided parotid mass that had been present for 2 years and was increasing in size.

The patient used tobacco (20 pack-year) alcohol (12 pack of beer/day). He also states that he had a history of unprotected sex and felt he was at risk for HIV infection.

Review of systems revealed severe rheumatoid arthritis with a 10 lbs. weight loss.

Physical Exam:

Inspection of the patient's neck revealed a 3 cm left parotid mass which was tender to palpation. The mass was firm, well circumscribed, and lay in the mid-portion of the parotid gland. Examination of his oral cavity and oropharynx revealed no abnormalities. By indirect examination, the larynx and hypopharynx were without abnormality. The rest of the physical examination was negative except for evidence of severe rheumatoid arthritis affecting several joints. There was no lymphadenopathy.

Labs:

WBC: 15,5000/cmm

RBC: 100mi/cmm

PMNs: 89%

Lymphs: 6%

Monos: 5%

NA+: 137MEQ/L

K+: 4.5MEQ/L

CL-: 101MEQ/L

HCO3: 21MEQ/L

AGAP: 15.0MEQ/L

Glu: 108MG/DL

BUN: 9MG/DL

Cr: 1.0MG/DL

Urinalysis = within normal limits

HIV Status: Negative

Question #1:
Given the above presentation what diagnostic studies would you find helpful in establishing your course of treatment?

a. CT sialogram of the parotid gland

b. CT scan of the head and neck

c. MRI scan of the parotid gland

d. No studies are needed.

e. Fine Needle Aspiration