A large vagal neurilemmoma in a 33-year-old man is reported. He complained of slowly progressive palsy of the tongue on the left side. Weakness of soft palate movement was also noted. Magnetic resonance imaging (MRI) revealed a tumour in the left parapharyngeal space with partial extension to the posterior cranial fossa through the jugular foramen. Carotid angiography revealed avascularity of the tumour and anterior shift of the left internal carotid artery. The venous phase showed no blood flow in the internal jugular vein. The tumour was successfully extirpated via a transmandibular transpterygoid approach. Although vagus nerve dysfunction was not observed pre-operatively, the tumour was identified as a neurilemmoma arising from the vagus nerve. The surgical approach should be selected according to the lesion in individual patients. Since neurilemmoma is benign in nature, minimal post-operative sequelae should be expected.

Two cases of papillary thyroid carcinoma presenting as a cystic lateral neck mass are reported. This tumour characteristically presents in patients under 40-years-old and in the presence of an occult primary tumour may mimic a branchial cyst. In such cases simple aspiration of the cyst will produce a chocolate-brown serous fluid which excludes the diagnosis of a branchial cyst and is characteristic of papillary thyroid carcinoma. Cytological examination of the fluid has a high degree of sensitivity and specificity in the diagnosis of thyroid malignancy and should avoid delay in diagnosis and unneccessary surgical exploration prior to definitive treatment.

Epithelial-myoepithelial carcinoma (EMC) accounts for approximately one per cent of salivary gland tumours. This tumour is gaining wider recognition following inclusion into the WHO histological classification of salivary gland tumours in 1990. Salivary gland tumours characteristically present with an enlarging mass. We describe an unusual presentation of a salivary gland tumour with stenosis of the external ear canal in the absence of a palpable mass. EMC usually arises from the salivary glands but isolated cases have been described arising primarily from the paranasal sinuses, trachea and lacrimal gland. The management of this tumour is still evolving with surgical excision being the main-stay of treatment. The efficacy of radiotherapy has not yet been established but high local recurrence rates despite apparently adequate excision and the possibility of a multicentric origin of the tumour may herald an increasing role for radiotherapy in the future. We stress the importance of awareness of adjacent structures when considering the cause of cartilaginous canal stenosis.

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.

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.

Adenoid cystic carcinoma is the commonest tumour of minor salivary glands. In the case described here a pulmonary mass was found. This was likely to be a distant metastasis, particularly as the primary tumour was of cribriform subtype with perineural invasion and resection was microscopically incomplete. However, surgical excision of the pulmonary mass enabled histopathological studies to be carried out which found it to be an unrelated bronchioloalveolar carcinoma.