Review Question - QID 108513

A 65-year-old woman is brought to the clinic by her son for a month-long history of intermittently reporting strange, putrid smells that she cannot describe well. The patient denies fever, recent infections, and recent procedures, but does report an episode of vomiting last week after waking up. She has a history of mild hypertension controlled by diet as well as migraines in young adulthood, and she takes no medications. The patient does not drink alcohol and has a 10-pack-year history of smoking that was discontinued 30 years ago.

On exam, the patient is alert and oriented and is currently asymptomatic. Temperature is 97.5°F (36.4°C), pulse is 76/min, blood pressure is 136/90 mmHg, and respirations are 10/min. Nasal exam reveals moist mucous membranes and clear turbinates. No foreign body is identified. Pupils are 4cm bilaterally and reactive to light and accommodation. The rest of her neurological exam is grossly normal. The patient’s head MRI is shown in Figure A. Which of the following is the best description for this lesion on a histopathologic level?