an intracranial
space-occupying, heterogeneously contrast-enhancing lesion at the level
of the left cerebello-medullary junction, and contrast enhancement of the
ipsilateral meninges. Cerebrospinal fluid analysis revealed a marked mixed
cell pleocytosis (nucleated cell count 655 cells/lL). The mass was visualized
within the horizontal ear canal by otoscopic examination and a biopsy
was taken. Impression smears of the biopsy contained many anucleate keratinized
squamous epithelial cells, mild mixed inflammation, and few presumptive
fibroblasts. With the provided clinical history and MRI findings, a
cytologic diagnosis of cholesteatoma was made. A ventral bulla osteotomy
was performed,