A 61-year-old white man presented with a 2-month history of a left parotid tail mass. He denied rapid growth of the mass, involuntary facial twitches, associated pain, or overlying skin changes. He also denied dysphagia, weight loss, otalgia, fevers, night sweats, or chills. He had no remarkable medical or surgical history. He did not smoke and drank alcohol only on occasion. Physical examination revealed a 6 × 5-cm, firm, mobile left parotid tail mass but no other lymphadenopathy. The cranial nerves were grossly intact. The results of the rest of the examination were noncontributory. Fine-needle aspiration of the mass revealed malignant cells with nuclear enlargement, pleomorphism, prominent nucleoli, occasional mitotic figures, and rare cytoplasmic vacuoles (Figure 1[Diff-Quik, original magnification ×200]).