Lymphoma Masquerading as an Ear Mass

Due to the infrequently reported location, malignancies of the ear are usually misdiagnosed at the time of first presentation. To the best of our knowledge, there have been no reports in literature regarding diffuse large B-cell lymphoma (DLBCL) presenting as an ear mass, as was seen in our patient. We describe a case of a 38-year-old gentleman who presented with four months of worsening dyspnea on exertion and nonproductive cough. On exam there was a 4 cm x 5 cm erythematous, non-tender, and immobile mass on the right lower ear in the intertragic notch, sparing the lobe. CT of the neck and chest revealed prominent cervical lymph nodes and a diffusely spread circumferential soft tissue mediastinal mass involving the lungs, pleura, and pericardium. Malignancy was suspected, so the right ear mass was biopsied. Findings were consistent with DLBCL, germinal center B-type. This case provides a rare example of DLBCL presenting as an ear mass in a 38-year-old male with a chronic cough. We believe that prompt radiological evaluation of the chronic nonresolving cough may have helped in timely diagnosis of the malignancy, possibly halting the extensive infiltrative spread of disease, and thereby reducing the morbidity that the patient eventually suffered.