Foreign body aspiration in the adult airway is very rare. A neglected foreign body can occur when the patient is mentally challenged or is in an unconscious condition such as following trauma. The diagnosis can be delayed because there is no typical history of choking or breathing difficulty.

Lingual tonsil is a part of Waldeyer’s ring. It consists of lymphoid follicles and subject to proliferation and hypertrophy. Palatine tonsillitis, by far is the commonest cause of odynophagia originating from oropharyngeal region. Lingual tonsillitis is a rare occurrence. We reported a patient who presented with severe odynophagia after two months of palatine tonsillectomy. Examination revealed the lingual tonsils were inflamed and covered with exudates.

A 63-year-old gentleman presented with a two-day history of sudden, painless blurring of vision in the left eye, immediately after waking up in the morning. He is known to have had diabetes mellitus and hypertension for seven years, and a recent attack of angina pectoris. There was no history of trauma and no associated neurological abnormalities. Visual acuity was 6/6 in the right eye and ‘Counting Fingers' in the left eye. Ocular examination was normal in the right eye (Panel A). Pupil examination of the left eye (Panel B) showed the presence of a relative afferent pupillary defect (RAPD), in addition to the above shown abnormality in the fundus. What is the diagnosis? Answer: refer to page 153

(Refer to page 131) Answer: Left Non-arteritic Anterior Ischaemic Optic Neuropathy (AION) Panel A shows a normal right fundus with a normal optic disc and retina, and the left fundus (Panel B) showing sectoral optic disc swelling with corresponding flame-shape haemorrhage.

A 59-year-old woman presented with a two-week history of spontaneous gum bleeding and easy bruising. Her full blood count on admission showed pancytopenia with haemoglobin of 96 gm/L, total white cell count of 1.6 x 109/L (absolute neutrophil count of 0.26 x 109/L) and platelet count of 17.0 x 109/L. Peripheral blood film showed a few abnormal hypergranular promyelocytes present. Five days later she developed the above signs. What is the diagnosis? Answer: refer to page 72

(Refer to page 51) Answer: Spontaneous bilateral periorbital haematoma associated with acute promyelocytic leukemia In this patient, the spontaneous bilateral periorbital haematoma could be due to severe thrombocytopenia. However the presence of abnormal promyelocytes in the peripheral blood smear (Panel, darkly stained cells are promyelocytes) is suggestive of acute promyelocytic leukemia (APL) which should be confirmed with a bone marrow biopsy, cytogenetic study for t(15;17) and molecular study for PML-RARa oncogene fusion.

Transmigration of a foreign body across the neck following accidental ingestion is a rare complication. We report a case of a 52-year-old female who presented with a right-sided sharp neck lump a few days following ingestion of fish bone. An anterior posterior view of neck radiography revealed a horizontal radio-opaque object consistent with a migrated fish bone. She underwent an emergency neck exploration and foreign body removal which was later identified as the fish bone. Awareness of all possible complications due to foreign body migration is essential to avoid misdiagnosis.

Multiple primary malignancies of the upper aerodigestive tract occurring in the same patient are not commonly reported. The incidence varies from 1% to 20%. Second primary malignancy occurring at the same anatomical location is more common than those that arise from a distant location. We report a case of a 52-year-old Malay man who was previously treated for nasopharyngeal carcinoma with chemoradiotherapy and subsequently developed a basal cell carcinoma complicated by multiple recurrences and squamous cell carcinomas of the temporal region and the nose. Such an occurrence has not been previously reported in the literature.