Large preauricular swelling in a 75-year-old woman

Abstract

A 75-year-old white woman presented to the Oral andMaxillofacial Surgical Clinic at “Evangelismos” General Hos-pital of Athens for evaluation of a mass in the left preauric-ular region. The patient stated that the mass, which hadbeen in that location for 3 months, had been graduallyincreasing in size. Otherwise, it had been entirely asymp-tomatic. The patient decided to seek medical attentionbecause of the large size of the lesion.The past medical history of the patient was remarkablefor diet-controlled type 2 diabetes mellitus and hyperten-sion. The family history was noncontributory. The patientdenied smoking or drinking and she had no allergies. Thepatient’s systemic medications included nifedipine 20 mgorally once a day.Physical examination revealed a frail woman in no acutedistress. The patient denied any recent weight loss. Ex-traorally, a large mass measuring approximately 6 5cmwas observed in the left preauricular region (Fig 1). Themass was firm, nonpulsatile, and fixed to the surroundingtissues. No audible bruit was detected, and there was notenderness to palpation. The overlying skin was normal.Examination of the neck revealed torticollis, with torsion ofthe neck on the right side. There was no lymphadenopathyor thyroid enlargement. The cranial nerves II through XIIwere intact. Intraorally, the patient was noted to be eden-tulous. The remainder of the examination of the oral cavityand oropharynx was normal.The patient was admitted to the hospital for furtherevaluation of the mass in the left preauricular region. Theresults of hematologic and serum chemistry studies on ad-mission were: white blood cell count of 8.3 310 cells/ L;red blood cell count, 4.7 10