A 42-Year-Old Man With a Right Ear Mass

Kristin K. Egan, MD; Douglas K. Hanks, MD; David W. Kim, MD; Andrew H. Murr, MD


July 30, 2015

Editor's Note:
The Case Challenge series includes difficult-to-diagnose conditions, some of which are not frequently encountered by most clinicians but are nonetheless important to accurately recognize. Test your diagnostic and treatment skills using the following patient scenario and corresponding questions. If you have a case you would like to suggest for a future Case Challenge, please contact us.


A 42-year-old man presents to the otolaryngology clinic with a right ear mass situated in the conchal bowl. The mass has been present for a few months, without any notable changes in size. The patient's primary concern is his cosmetic appearance. He denies experiencing any pain, warmth, or tenderness associated with the mass.

The patient's medical history is significant for a 4-month history of a left-sided cervical neck mass and ipsilateral Horner syndrome, for which he received treatment about 2 years ago. Fine-needle aspiration at that time revealed numerous sinus histiocytes, but further tissue was needed for a definitive diagnosis. MRI done at that time demonstrated that the mass was encasing the carotid artery and showed prominence of nasopharyngeal tissue, which was also seen on clinical examination. The patient was taken to the operating room and underwent biopsies of the nasopharynx and tonsils, which were negative for malignancy.

The patient was then treated by the oncology service with dexamethasone 4 mg twice daily for 14 days. He had noted resolution of his ptosis and a decrease in the size of his neck mass. The patient returned 2 months later with improved, but still notable, miosis, as well as a neck mass. He was once again given dexamethasone 4 mg twice daily for 1 month, but he was subsequently lost to follow-up until his current presentation to the otolaryngology clinic. The patient states that he experienced complete resolution of his Horner syndrome from the previous presentation 2 years ago. No other positive pertinent symptoms are noted.

The patient is not currently on any medications and has no active medical conditions. He does not chew tobacco, smoke, or use any illicit substances. The family history is unremarkable.


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