A prospective analysis of 69 patients who had been treated for nasopharyngeal carcinoma (NPC) by external radiotherapy was carried out. Biopsies from the posterior nasopharynx were performed and analyzed by in situ hybridization using an antisense Epstein-Barr Early RNA (EBER) radio-labelled riboprobe. None of the patients had evidence of disease in the nasopharynx. One patient was found to have nasopharyngeal carcinoma detected only by in situ hybridization. In the subsequent 18-month follow-up of these clinically- and biopsynegative patients, only one patient developed relapse in the nasopharynx. In situ hybridization is a valuable tool for the detection of NPC and should be routinely available in histopathology laboratories where NPC is regularly diagnosed.

Formerly a fatal condition, Wegener's granulomatosis is now treated with good results. Clinical morbidity is often due to failure by clinicians to make the diagnosis. Many patients (including our cases reported here) present with atypical symptoms, and only a high index of suspicion will ensure early diagnosis. Classical chest and renal symptoms often indicate late stage disease. We present two cases that underline the limitations of current ‘diagnostic’ immunological tests whilst emphasising the importance of clinical features in diagnosis.

Standard treatment with Cytotoxic agents and corticosteroids are effective but carry considerable morbidity. We have followed the current trend of incorporating a less toxic antibiotic agent in the management of this enigmatic condition.

Clinically evident metastases to the thyroid gland are rarely found antemortem. A case of a 59-year-old woman with a history of rectal carcinoma, who presented with low back pain and a mass in the right lobe of her thyroid gland, is presented. The tumour of the thyroid was found to be metastatic adenocarcinoma from her previous rectal cancer. Other synchronous metastases were noted in her lumbar spine and kidneys.

The clinical finding of metastases to the thyroid gland is rare, particularly from a colorectal primary. One must consider, however, the possibility of a tumour of the thyroid gland representing a secondary malignancy in any patient with a prior history of cancer.

Six cases of papillary thyroid carcinoma showing clinically highly aggressive behaviour by invading the upper airway and digestive tract structures were retrospectively reviewed to evaluate the morphological variants of the tumours. Four of them were found to be pure papillary and one was a mixed-papillary and follicular-variants regarded as non-aggressive. Only one case was found to be tall cell variant – regarded as an aggressive variant of papillary thyroid carcinoma. The findings suggest that the prognosis of papillary thyroid carcinoma cannot be predicted from its morphological variant and attention should be given to other clinical parameters.

A 36-year-old patient with a primary leiomyosarcoma of the left parotid gland is presented. To our knowledge this is only the second case of a parotid leiomyosarcoma in the world according to the literature review.

Metastatic carcinoma of the tonsil is rare with only some 100 cases having been reported in the literature, of which nine have resulted from stomach carcinoma. Tonsillar metastases rarely become apparent before the diagnosis of the primary neoplasm. We describe here the clinical and histopathological findings of a case of unilateral palatine tonsil metastasis as the first sign of a signet-ring cell carcinoma of the stomach. This has not been reported previously.

Sebaceous carcinoma arising from the buccal mucosa is very rare. Only one such case has been reported in the English literature. We report a second case arising in an 11-year-old girl.

The histopathological finding of heterotopias or choristoma is rare. This paper describes two patients who presented with chronic recurrent tonsillitis and underwent tonsillectomy. Histological examination revealed heterotopic cartilage in the tonsil of one patient and bone in that otthe other.

Facial palsy in the presence of ipsilateral parotid tumour is considered to be pathognomonic of malignancy. However, benign neoplasms and inflammatory lesions of the parotid gland have been reported to present with facial palsy. A case of lipoma of the parotid gland associated with partial facial paralysis is reported. Lipomas are very rarely seen in this site. To our knowledge, a lipoma of the parotid producing facial paralysis has not been described previously. This report highlights the difficulties in pre-operative diagnosis and management of such a lesion.

A sporadic case of the intestinal-type sinonasal adenocarcinoma is described. The patient was a comparatively young 33-year-old woman employed as a senior biochemical scientific technologist for several years. The light microscopical pattern was that of a papillary-tubular adenocarcinoma with areas of more solid mucinous elements in the deeper parts of the neoplasm. The neoplasm had invaded the nasal septum and reached the left orbit invading the left ethmoidal sinus. The glands were lined by columnar cells with elongated spindle-shaped nuclei and the cells expressed cytokeratin, carcinoembryonic antigen (CEA), Chromogranin A, gastrin and serotonin but not neurone-specific enolase (NSE) nor synaptophysin. Neurosecretory granules were present. There was no history of wood dust inhalation and her exposure to chemicals is of some interest but had probably little or no role in the causation of this neoplasm.

A case of paraganglioma arising within a parathyroid gland is reported. The lesion was an incidental finding in a block dissection of neck performed for squamous carcinoma of the pharynx. A well-circumscribed lesion, exhibiting the characteristic pathological features of a paraganglioma, was embedded within the right inferior parathyroid gland. Due to its location, the chief histological differential diagnosis was an unusual variant of parathyroid adenoma. Immunohistochemistry and electron microscopy assisted in reaching a diagnosis. This, as far as we are aware, is the first reported case of a paraganglioma of the parathyroid gland.

A case of schwannoma of the larynx is presented. Clinical findings are presented together with magnetic resonance images. The literature is reviewed. The surgical technique is discussed and the histology is described.