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Clinical Challenge
March 2017

Protruding Glistening Mass on the Posterior Surface of the Auricle

Author Affiliations
  • 1Department of Otorhinolaryngology–Head and Neck Surgery, Jeju National University School of Medicine, Jeju, Republic of Korea
JAMA Otolaryngol Head Neck Surg. 2017;143(3):305-306. doi:10.1001/jamaoto.2016.2349

A man in his 50s presented with a 5-year history of a slow-growing mass on the posterior surface of the left auricle. He denied any history of trauma or surgery around the ear, and reported only a cosmetic problem without pain or discharge. His medical history was positive for hypertension, impaired glucose tolerance, dyslipidemia, and hyperthyroidism, and negative for unusual skin pigmentation or cardiac problems. A laboratory examination revealed only slightly elevated thyroid-stimulating hormone levels (4.80 µU/mL). A physical examination showed a solitary, 1-cm, dome-shaped, glistening, flesh-colored mass adherent to the posterior groove of the concha ridge (Figure, A and B). There were no abnormal pigmented skin lesions on the rest of his body, including the face, trunk, and extremities. Neither a palpable thyroid nodule nor enlargement of hands and feet was identified. Surgical excision was performed. Gross total extirpation of the mass from the surrounding tissues was enabled by meticulous dissection. Intraoperatively, the 1-cm mass was noted to be gelatinous and glossy with well-demarcated and smooth border. It was attached to the posterior surface of the concha cartilage but easily separated using blunt dissection. Unexpectedly, low-viscosity mucoid fluid had smeared on the surface. The histopathological examination revealed the tumor to be overall hypocellular and composed of bland spindle cells with no mitotic activity in a slightly basophilic myxoid matrix (Figure, C). The surgical wound uneventfully healed, and no recurrence was noted during the 6-month follow-up period.