Giant epithelioid hemangioma of the external auditory canal: Role of imaging in clinical management

Being uncommon neoplasms of elusive origin, epithelioid hemangiomas are benign vascular tumors found in young adults. 1 These epithelioid hemangiomas are mostly found in the head and neck region, presenting as solitary or multiple lesions, and they vary between 2 and 3 cm in diameter, and morphologically manifest as intradermal papules or subcutaneous nodules. 2 More eloquently termed as angiolymphoid hyperplasia with eosinophilia on pathological basis, these tumors are amenable to surgical excision, though rare instances exist where they might regress on their own. 3 A 23-year-old male, who we report, had a bizarre unusual presentation with an extremely large mushroom shaped mass occluding the left external auditory canal. He had considerable facial disfigurement, pulsatile tinnitus and unilateral deafness. Even though it was clinically thought to be a malignant mass, cross sectional imaging gave clue to its highly vascular yet benign nature. Despite its large size, the tumor did not cause osseous destruction and had simply traveled into adjacent anatomical structures and overlying subcutaneous tissues and skin. The characteristic histologic picture was pathognomonic. This case report highlights the unusually large size and atypical clinical presentation of the tumor.