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Clinical Challenge
October 31, 2019

A Painless Retroauricular Mass

Author Affiliations
  • 1Caruso Department of Otolaryngology–Head and Neck Surgery, Keck School of Medicine, University of Southern California, Los Angeles
JAMA Otolaryngol Head Neck Surg. 2020;146(1):75-76. doi:10.1001/jamaoto.2019.3246

A 31-year-old Hispanic woman had a 3-year history of a steadily growing, increasingly pruritic, painless mass behind the right ear. The patient denied bleeding from the mass, ear pain, trauma, fever, fatigue, night sweats, or recent illnesses. Her medical history included eczema treated with triamcinolone acetonide cream. Otherwise, the patient had no family history or exposure to tobacco or alcohol.

On physical examination, a 2-cm, nontender, mobile retroauricular mass with superficial excoriations was palpable over the right mastoid cortex. The patient had no hearing deficits and no fistula into the external auditory canal. There was no palpable head and neck lymphadenopathy. Serologic studies revealed an elevated absolute eosinophil count of 790/μL (reference range, <700/μL; to convert to ×109 per liter, multiply by 0.001) and an eosinophilia percentage of 9.7% (reference range, <6.0%). The T1-weighted postcontrast magnetic resonance imaging of the head and neck showed a heterogeneously enhancing mass with irregular borders in the right retroauricular space, with a tract coursing anteriorly toward the parotid gland (Figure, A).

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