Mediastinal germ cell tumours are a rare group of extragonadal germ cell tumours with less than 5% prevalence of all germ cell tumours. Primary mediastinal germ cell tumours themselves account for 16-36% of the extragonadal germ cell tumours. Along the spectrum of osteosarcoma, parosteal osteosarcoma is a welldifferentiated surface osteosarcoma with a prevalence of 4% of all osteosarcoma. As such synchronous primary parosteal osteosarcoma and primary mediastinal germ cell tumour are exceedingly rare. This leads to complexity in determining the most appropriate chemotherapy for two different types of tumours and its potential side effects of reduced immunity leading to potential secondary infection. Here we report a case of a 16-year-old boy who presented with synchronous primary osteosarcoma and primary mediastinal germ cell tumour, complicated with atypical mycobacterial infection post-operatively. Additionally, we discuss our choice of chemotherapy and the management of the atypical mycobacterial infection.

Relapsing Polychondritis with Laryngotracheal Involvement: A Case Report Relapsing polychondritis is a progressive multisystemic disease affecting primarily cartilaginous tissue of otorhinolaryngologic structures. Because of its rarity and progressive involvement of multisystem, diagnosing and managing a relapsing polychondritis is a clinical challenge, especially when it involves laryngotracheal cartilages, which can be critical and potentially life threatening. We reported a case of a 56-year-old man who presented with progressive shortness of breath and noisy breathing due to thickening of laryngotracheal cartilages. A diagnosis of relapsing polychondritis was made after considering his clinical, histological and radiological findings. Eventhough relapsing polychondritis with laryngotracheal cartilages involvement was rare and the nature of this disease was progressive, it was still advisable to consider a diagnosis of relapsing polychondritis whenever encountered cases of airway obstruction with evidence of thickened trachea, despite the other systemic manifestations did not reveal yet. Generally, systemic corticosteroid and other immunosuppressive agents are the treatments of choice in most cases however, when laryngotracheal cartilages are involved, emergency tracheostomy will be indicated.

This is a retrospective study examining the outcome of paediatric patients with subglottic stenosis who underwent partial cricotracheal resection (PCTR) as a primary open procedure from 2004 to 2012. There were 5 patients identified aged from 3 to 18 years old. All the subglottic stenosis were acquired type. All of them were secondary to prolonged intubation. Three patients were classified as Myer-Cotton grade III and the other two were Myer-Cotton grade IV. Two of the patients had concomitant bilateral vocal cord immobility. All patients underwent two staged PCTR . All patients underwent two staged PCTR, and one patient underwent posterior cordectomy apart from partial CTR at different setting. All patients were successfully decannulated at various durations postoperatively. Although this is an early experience in our institution, PCTR has shown to be effective and safe procedure in patients with subglottic stenosis especially those with Myer-Cotton grade III and IV.