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An intriguing ‘cyst’ of the ear
  1. Gideon Ze Lin Tan1,
  2. Fredrik Petersson1,
  3. Xinni Xu2,
  4. Thomas P Thamboo1
  1. 1 Pathology, National University Hospital, Singapore
  2. 2 Department of Otolaryngology–Head and Neck Surgery, National University Hospital, Singapore
  1. Correspondence to Dr Gideon Ze Lin Tan, Pathology, National University Hospital, Singapore 119074, Singapore; Gideon_tan{at}

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Clinical question

A 35-year-old woman presented with a 2 cm left ear concha fluctuant swelling that had gradually increased in size over 2 months (figure 1). There were no lesions nor lymphadenopathy elsewhere. The initial clinical impression was an ear pseudocyst. The lesion was subsequently excised. Intraoperative findings were those of a cystic lesion with a thickened anterior wall. Fragments of the ‘cyst’ wall were sent for histological review. Review the high quality, interactive digital Aperio slide at and consider your diagnosis.

Figure 1

Clinical image of the ear swelling.

Five differential diagnoses

  1. Lymphoproliferative disorder.

  2. Lymphohistiocytic infiltrate, possibly infectious.

  3. Metastatic melanoma.

  4. Rosai-Dorfman disease (RDD).

  5. Soft tissue neoplasm.

The correct answer is after the discussion.


RDD, also …

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  • Handling editor Iskander Chaudhry.

  • Contributors GZLT and TPT conceived of the presented idea. GZLT, FP, XX and TPT all contributed towards the the writing of the manuscript. TPT supervised the project.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.