We report an adult case of cystic lymphangioma treated with OK-432 (Picibanil®).

A case report and review of the literature concerning the use of OK-432 to treat cystic lymphangioma is presented.

A 31-year-old woman developed a cystic lymphangioma four weeks post-partum. This was treated initially by aspiration, for diagnostic purposes. Investigation suggested that surgery would be challenging. A review of the literature demonstrated success with OK-432 in the treatment of this condition, although primarily in the paediatric population. This patient was successfully treated thus, and at the time of writing remained symptom free. A suggested management plan is outlined.

Treatment with OK-432 is useful in the management of cystic lymphangiomas in adults and should be considered as first line treatment.

We report a case of Masson's pseudotumour or intravascular papillary endothelial hyperplasia presenting in the ethmoid sinus.

We present a diagnostically challenging case of Masson's pseudotumour of the ethmoid sinus presenting with persistent epistaxis and a review of the available literature.

Intravascular papillary endothelial hyperplasia is a benign, reactive lesion first described by the French pathologist Pierre Masson in 1923. It can lead to diagnostic uncertainty due to its close resemblance clinically, radiologically and histopathologically to angiosarcoma.

We report a case of diphtheria in an elderly patient, with a fatal outcome.

Case report and a review of the literature concerning the current recommended guidelines on detection of, and response to, diphtheria.

Although still rare, cases of diphtheria are being reported with increasing frequency in the UK, possibly as a result of immigration and travel. A high index of suspicion, rapid detection of carriers, and instigation of treatment and vaccination are the mainstays of management.

Diphtheria can mimic other forms of acute upper airway obstruction and can lead to a fatal outcome. Otorhinolaryngological surgeons need to consider this re-emergent disease as a potential diagnosis in patients with an unusual presentation of airway obstruction.

Oral involvement is a common manifestation of acquired immunodeficiency syndrome related Kaposi's sarcoma, and it occurs in approximately one-third of afflicted patients.

We report an unusual case of Kaposi's sarcoma of the hard palate which invaded the underlying maxillary bone.

The patient underwent excisional biopsy and was subsequently treated with localised radiation and systemic chemotherapy including liposomal doxorubicin.

The presentation, differential diagnosis, radiographic appearance and management of this serious complication are discussed. Our case highlights the need for a multidisciplinary approach, consisting of ENT, oncology and infectious disease consultation, to ensure appropriate management of maxillofacial, intraosseous, acquired immunodeficiency syndrome related Kaposi's sarcoma.

We report the case of an osteoblastoma of the larynx arising from the vocal fold, which presented with acute airway obstruction and cardiopulmonary arrest.

The histopathological findings, differential diagnoses and a novel method of treating laryngeal osteoblastoma, using transoral laser therapy, are discussed.

Benign osteoblastoma is a rare primary bone tumour usually presenting in young patients in the spine and sacrum. Its occurrence in the larynx is very rare, with only three similar case reports in the literature, none involving tumour arising from the vocal fold. Differential diagnoses must be considered and excluded using both histopathological and clinical features. Once the diagnosis is confirmed, successful treatment is achieved with surgical excision.

Osteoblastoma of the larynx is rare, and the clinical features can vary with the anatomical site of the lesion. The recommended treatment is surgical excision which, if available, may be achieved by transoral laser microsurgery. Due to its potential rapid growth, careful follow up is essential in order to detect recurrence.

We discuss the case of a 73-year-old woman with a six-month history of hoarseness secondary to an aortic arch pseudoaneurysm.

We present the findings of an extensive review of the literature relating to cardiovascular disorders involving the recurrent laryngeal nerve (i.e. Ortner's syndrome).

Ortner's syndrome, also known as cardiovocal syndrome, is a rare condition, with few reports in the literature.

This is only the second documented case of Ortner's syndrome in Great Britain and Ireland, and the first demonstrating an aortic pseudoaneurysm.

To present a significant complication of pharyngolaryngeal reconstruction, which resulted in diagnostic confusion as it mimicked a second primary tumour of the head and neck.

Case report and review of the world literature.

A 61-year-old man developed a granulomatous foreign body reaction, mimicking a second primary tumour, at the distal end of a salivary bypass tube, following pharyngolaryngectomy and reconstruction using a tubed anterolateral thigh flap. Clinically and radiologically, this was felt to represent a second primary tumour of the oesophagus, but biopsies revealed full thickness inflammation of the mucosa and granulation tissue. Repeat oesophagoscopy two weeks after removal of the tube showed complete resolution.

No record of an oesophageal foreign body reaction to a Montgomery salivary bypass tube has previously been reported in the world literature. This report highlights the potential for such a lesion to cause diagnostic confusion with a second primary tumour.

Extraskeletal Ewing's sarcoma is a rare tumour of mesenchymal origin, which is histologically similar to primary osseous Ewing's sarcoma. The majority of cases have been reported in the lower limb and paravertebral region, with a few cases reported in the neck.

We report a patient with extraskeletal Ewing's sarcoma presenting with a right-sided neck mass, vocal fold palsy and T1 nerve root involvement. The detection of characteristic features on computed tomography and magnetic resonance imaging scans, in conjunction with histological analysis, was required to make the diagnosis.

Radiological imaging demonstrated that the tumour was infiltrating through the neural exit foramina of the lower cervical nerve roots, with encasement of the vertebral artery. The patient was managed with combination chemotherapy for systemic control and irradiation for local control.

Extraskeletal Ewing's sarcoma has a propensity to occur in a paravertebral location, being found rarely in the cervical region, and has a predilection to infiltrate through neural exit formina. Computed tomography and magnetic resonance imaging are helpful in the diagnosis of this rare tumour.

We report a rare case of chronic facial pain following sclerotherapy for intraparotid haemolymphangioma, thereby highlighting an important clinical consideration when advising this treatment option as an alternative to surgery in the head and neck.

Case report, with a review of relevant literature.

Sclerotherapy of lymphangiomata is well reported in the literature. Unusually, our young patient with an intraparotid haemolymphangioma experienced severe, chronic pain following intralesional injection of sodium tetradecyl sulphate, which required management by a specialist pain service. We discuss the technique of sclerotherapy for such lesions, and also discuss the potential side effects of two agents commonly used in our centre: OK 432 and sodium tetradecyl sulphate.

Non-surgical treatments of lymphangiomata and venous vascular malformations are not without complication. Both patient and clinician should be aware of this, and of the other potential side effects of sclerotherapy, prior to its use in the head and neck.

A case of solitary extracranial cysticercosis of the parotid gland is reported. A discussion concerning the clinical features, imaging modalities, diagnostic methods and management of cysticercosis, along with a review of relevant literature is also presented.

A young female patient presented with features resembling acute parotitis. Solitary cysticercosis of the parotid gland was diagnosed, based on fine needle aspiration cytology and radiological investigations. Medical therapy was effective, consequently surgery was deferred.

This is the first report of solitary extracranial cysticercosis of the parotid gland. A high index of suspicion for such parasitic infestations is essential even in non-endemic areas due to the ease of worldwide travel.

We present a rare case of laryngeal mucosal neuroma, and its management, in a patient with multiple endocrine neoplasia type 2 B.

We present a case report and a review of the world literature concerning laryngeal mucosal neuroma and its association with multiple endocrine neoplasia type 2 B.

An 11-year-old girl was diagnosed with multiple endocrine neoplasia type 2 B on the basis of clinical presentation and genetic testing. Several years later, whilst undergoing general anaesthesia for routine dental treatment, the anaesthetic team were concerned by masses on the patient's vocal folds, which they felt could compromise her airway. The ENT team were informed of the situation and an urgent microlaryngoscopy was performed. Biopsies taken at the time were reported as showing benign mucosal neuromas. A few months later, the patient presented with acute stridor, and flexible nasal endoscopy revealed recurrence. This episode settled without surgery.

Multiple endocrine neoplasia syndromes are inherited autosomal cancer syndromes. Laryngeal mucosal neuroma can manifest as potentially airway compromising lesions in patients with multiple endocrine neoplasia type 2 B. Although apparently rare, we feel this case highlights the need for vigilance and prompt recognition of this treatable condition.