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Case report
A 56-year-old white man from north-west England presented to his general practitioner complaining of bilateral ear lobule swellings, which had developed over the previous 12 months (Figure 1 ). The swellings were painless and were not associated with any other ear symptoms. The patient did not have any symptoms of B-cell lymphoma at the time of presentation. The past history was insignificant.
Fig. 1
Front profile of the patient, showing the bilateral ear lobule swellings.
On examination, both ear lobules had solitary, firm swellings approximately 2 cm in diameter. There were no signs of inflammation. The skin of the left ear lobule was irregular over the swelling and was not freely mobile, but there was no ulceration (Figure 2 ). The ear examination was normal. A differential diagnosis of fibroma or lipoma of the ear lobule was considered and excision biopsy of the nodules was planned.
Fig. 2
Left ear, showing rounded, lobulated swelling of the ear lobule (note the similarity to otophyma).
In February 1999 (14 months after onset of the condition), excision biopsies were carried out on both ear lobules, and the specimens were sent for histological examination.
Histologically, both specimens shared morphological changes, demonstrating overlying skin with an underlying diffuse dermal infiltrate (Figure 3 ). This infiltrate consisted of small B-lymphocytes. These demonstrated strong positivity with the B-cell markers CD20 and CD79a, while staining negatively with markers for epithelial and Hodgkin's cells. The features...