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.

Papillary thyroid carcinoma is a common thyroid malignancy reported world wide. It affects females more commonly in the 4th to 6th decades of life. The patients usually present with a painless anterior neck mass and occasionally with lymph node involvement. We report a case of an elderly male who presented with hoarseness and hemoptysis, which warranted bronchoscopy. Biopsy of the intraluminal tracheal mass revealed the diagnosis of papillary thyroid carcinoma. Computed tomography scan of the neck confirmed the presence of the primary lesion in the right thyroid lobe with invasion into the adjacent trachea and esophagus.

The unilateral nasal symptom should trigger a treating physician to a certain diagnosis. The differential diagnosis includes foreign body, rhinolith and tumour. The chronicity of symptom helps a lot with the diagnosis. Foreign body for example, tends to present with positive history of insertion, mainly by children or the acute symptom of local infection. In the presence of prolonged symptom, rhinolith should be suspected especially when the patient presents with pathognomonic nasal obstruction with foul smelly discharge. A referral should be made for a nasoendoscopy evaluation whenever a rhinitis-like symptoms remain after a period of medical treatment for allergy. We share a case of a missed diagnosis of a rhinolith after six years of symptoms. Keywords: nose; obstruction; rhinolith; unilateral

Foreign bodies or objects in the ear are one of the most common problems encountered by otorhinolaryngologist (ORL) with attendant complications, removal of which requires expertise. Patients with this problem who sought treatment in the otorhinolaryngology clinic of Hospital Universiti Sains Malaysia (HUSM) were studied for duration of one year from January 2010 to December 2010. Specifically, the clinical presentation, type of foreign body and management outcome were analysed. 72 patients were reviewed - 44 (61.1%) males and 28 (38.9%) females. The age range was one year to 75 years with 59.8% being children below 10 years old. Ear pain (56.9%) was recorded as the most common and persistent symptom and insects (54%) were the commonest foreign body encountered. 95% (69) of the foreign bodies were removed under clinic setting with only three (4.2%) cases requiring general anaesthesia. Post-removal complications were noted in only one patient (1.4%). Repeated attempts by untrained personnel should be avoided and timely referral is vital to avoid undesirable complications.

Jugular phlebectasia has been increasingly recognised with the advent of non-invasive diagnostic methods. Phlebectasia differs from varix, as it is an abnormal outward dilatation of a vein without tortuosity. It presents as a soft, compressible mass, apparent upon straining or execution of the Valsalva maneuver. The differentials for neck masses are broad, but if the swelling appears on the Valsalva maneuver, the type of mass narrows down to a laryngocele, superior mediastinal mass or phlebectasia. A simple non-invasive investigation, such as ultrasonography, is used as a diagnostic tool. We report a case of jugular phlebectasia that was suspected clinically and confirmed via ultrasound to be a vascular lesion which changed its size upon straining.

This study is aimed to examine the predominant inflammatory cells in nasal polyps (NP) in the local community and its correlation to the clinical presentations. Materials and Methods: The study was done retrospectively looking at patients who had undergone functional endoscopic sinus surgery (FESS) in Hospital Universiti Sains Malaysia (HUSM), Kelantan, Malaysia with a histopathological diagnosis of nasal polyposis (NP), between the years 2004 to 2008. Sixty two patients between the ages of 18 years to 60 years old were selected and data relevant to the study were collected from the patient’s folders using a specially created form prepared for the study. The NP histopathology report from each patient underwent FESS were analysed and the patients were divided into eosinophilic and non eosinophilic dominant group. Clinical presentations from each patient were also gathered and analysed according to the NP group. Results: In HUSM, there were a higher number of eosinophilic types NP as compared to the neutrophilic type NP which is contrary to other study conducted on Asian populations. The clinical symptom correlations between either eosinophilic or non-eosinophilic type of NP have not shown any significant associations. Conclusion: The study showed that the incidence of histological subtypes of nasal polyp in HUSM is almost the same as that found in other parts of the world (Europe and North America) which will reduce the possibility of racial or geographical influence on the pathogenesis of the nasal polyp. Clinical symptoms and presentation alone are not enough to differentiate the type of the nasal polyp without the histological study.

Hypopharyngeal cancer (HPC) is generally a rare head and neck malignancy. There are differing clinical presentations depending on the subsite location of primary tumour. Advanced HPC will have neck node metastasis particularly upper jugulodigastric nodes. We report a patient with postcricoid tumour who presented with anterior huge neck swelling mimic thyroid mass. The patient first presented to the General Surgical Unit for management of presumed thyroid lesion. She was diagnosed post-cricoid squamous cell carcinoma when further assessed by otorhinolaryngologist.