We report a case of primary temporal bone diffuse B-cell non-Hodgkin lymphoma, which is a rare entity. A 71-year-old male with a history of dementia and hemicraniectomy presented due to 1 month of a pronounced left ulcerative mastoid lesion. Strikingly, there were no cranial nerve deficits which was unexpected due to the degree of the lesion. Initially, infectious mastoiditis was suspected based on physical examination alone. Due to the patient being a poor historian, it was difficult to determine whether this was an acute or chronic issue. Temporal bone squamous cell carcinoma, infectious mastoiditis, and actinomycosis were on the differential, but biopsies revealed non-Hodgkin lymphoma.

Lipomas, tumors of adipose tissue, are common and make up 16% of tumors of mesenchymal origin. Approximately 25% of lipomas occur in the head and neck region and are commonly found subcutaneously in places, such as the posterior neck. 1 The prevalence is higher among men than women, and often arise in the fifth or sixth decade of life. 2 Lipomas can further be categorized based on their histopathology into variants such as angiolipoma, chondrolipoma, spindle cell lipoma, or, in our case, osteolipoma. 1 An 81-year-old Caucasian male complaining of dysphagia associated with weight loss of 2 years duration was referred to the otolaryngology office after magnetic resonance imaging (MRI) of the brain demonstrated a hyperintense retropharyngeal mass with smooth margins measuring 4.46 cm  2.35 cm in sagittal view (see Figure 1). The MRI was originally ordered for cognitive complaints. Nasopharyngeal fiber-optic examination revealed a large mass in the left posterior pharyngeal wall partially obstructing the airway. No mucosal ulceration was noted, and the true vocal folds demonstrated full range of motion. A computed tomography (CT) scan of the neck with contrast