JAMA Clinical Challenge

A Pain in the Neck

Bulge on the patient's neck, behind her right ear

Javier Munoz, MD
Haythem Ali, MD
A 68-year-old female smoker recently diagnosed with small cell lung cancer presents with a bulging area on her neck, behind her right ear (figure). The patient denies headache or vomiting. Physical examination is remarkable for ataxia with chorea, particularly of her right upper extremity, which has remained relatively unchanged for the last few years. The patient has a history of hemangioblastoma resected 12 years earlier, which recurred after 3 years, at which time she had a second resection and radiation therapy, with poor follow-up since then.

See the full article for an explanation and discussion.

Author Affiliations: Drs Munoz (javier.munoz@me.com) and Ali are affiliated with the Department of Hematology-Oncology, Henry Ford Hospital, Detroit, Michigan.