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A 51-year-old female of East Asian descent presents with a 1month history of a painless lump behind the left ear discovered incidentally after a brief febrile episode. Physical examination reveals a left post-auricular lump that is hard and fixed to the underlying bone, with no other similar lesion or systemic abnormality detected (Figs. 1, 2 and 3). Fig. 1 a-b Coronal Computed Tomography (CT) of the cervical spine The diagnosis can be found at https://doi.