draining. The patient had intermittent bleeding from the mass and the laboratory examination showed severe anemia, for which she receive d2Uo fblood. There was a red hemorrhagic vegetative mass in the left external auditory canal. The facial nerve and other lower cranial nerves were normal. A computed tomographic scan of the temporal bone showed a large solid mass in the postauricular soft tissue with extension to the mastoid and middle ear and erosion of the bony septets (Fig 2). The mass had also extended into the infratemporal space and occupied most of this space. There were several enlarged lymph nodes in the II, III, and V levels of the right side of the neck. Magnetic resonance imaging examination showed a mass with extension to the mastoid and middle ear (Fig 3). An incisional biopsy of the mass disclosed a malignant germ cell tumor. The serum -fetoprotein (AFP) level was elevated. Surgical resection of the tumor was performed to remove the necrotic tissue. Lateral temporal bone resection, total parotidectomy with dissection of facial nerve, comprehensive resection of the soft tissue of the postauricular and infratemporal regions, and posterolateral neck dissection were performed. After complete gross ablation of the tumor, a plastic surgeon (M.H.) used a temporalis muscle flap, which was rotated over its pedicle, to cover the exposed bone, elements, and vessels. The result of the pathologic evaluation using immunohistochemical studies indicated a YST. The pathologic examination of the mass showed reticular and microscopic areas formed by a loose meshwork lined by flat and cuboidal cells with pleomorphic nuclei, prominent nucleoli, frequent mitotic figures and vacuolated cytoplasm, and a perivascular organoid arrangement of tumoral cells (Schiller-Duval bodies) and solid undifferentiated areas. Intracytoplasmic and extracellular hyaline globules that stained positively with periodic acid-Schiff and multiple hemorrhagic areas were also seen. Immunohistochemistry was strongly positive for AFP and periodic acid-Schiff, focally positive for chromogranin, and positive for keratin (Fig 4). The surgical margin was free of tumor and 0 of 17 lymph nodes was involved. The patient was advised to undergo chemotherapy, but the parents refused. After 9 months of follow-up, there has been no sign of recurrence, the patient is asymptomatic, and the serum AFP level is within the normal range.