Malignant peripheral nerve sheath tumor (MPNST) is an extremely rare sarcoma of soft tissue. It is locally invasive, frequently recurred and metastasizes distantly, therefore has a very poor prognosis. the most involved sites are human body and extremities, and MPNST occurs and involved very rarely in the parapharynx of neck. MPNST does not react to radiotherapy and chemotherapy, therefore complete surgical resection is the most important treatment. Since immunohistochemical staining is essential for the final diagnosis, it is common to be confirmed after surgery. We report a case of giant MPNST without symptom in the head and neck involving the right parapharynx with multiple distant metastases in a 74-year-old patient on a review of the literature.

Intraosseous lipoma is an extremely rare benign primary bone tumor, most commonly found in the long bones of lower extremities and calcaneus. Very few cases have been reported in the skull base, and mostly noninvasive follow-up is proposed due to its indolent growth and the low possibility of malignant transforming. Surgical biopsy or treatment is needed only when the patient’s symptom is correlated with the location of the lesion. We report a rare case of symptomatic intraosseous sphenoid lipoma which presented ipsilateral retroorbital pain accompanied by watering eye and runny nose on the same side. Surgical excision led to immediate resolution of the symptoms and the tumor was pathologically confirmed. This case highlights the radiographic differential diagnosis based on the review of literature.