Mantle Cell Lymphona Masquerading as Obstructive Sleep Apnoea

@#Tonsillar malignancy typically presents with asymmetrical tonsillar enlargement, lesion on the tonsils, sore throat or a neck mass. We report a case of unsuspected tonsillar malignancy in a 56-year-old gentleman who presented with symptoms of obstructive sleep apnoea. His tonsils were grade III bilaterally with normal mucosa. Tonsillectomy was performed to improve patient’s compliance with Continuous Positive Airway Pressure (CPAP) therapy. These tonsillar specimens were reported to be Mantle Cell Lymphoma (MCL) based on the histology and ancillary studies. This case highlights that benign-looking symmetrical tonsillar enlargement can harbour occult malignancy. It is important to note that OSA symptoms may be the presentation for haematological malignancies. Tonsillar specimens should be sent for histopathological examination regardless of the indication to avoid misdiagnosis and delay in treatment.

Isolated sphenoid sinusitis: A big headache

@#Isolated sphenoid sinusitis is a rare clinical entity with potentially devastating complications such as cranial neuropathies, cavernous sinus thrombosis, meningitis and intracranial abscess. It accounts for only 2.7- 3.0% of all paranasal sinus diseases.1A patient may present with myriad symptoms, ranging from occipital or vertex headache, retro-orbital pain, otalgia, drowsiness to meningitis-like symptoms. With these non-specific and varied symptoms, patients are usually not referred to an otorhinolaryngologist, which contributes to further delay in diagnosis and proper management. Prompt and accurate diagnosis is necessary in order to avoid catastrophic complications due to the proximity of the sphenoid sinus to vital neurovascular structures.

Solitary Fibrous Tumour of the Submandibular Region: A Rare Entity

Solitary fibrous tumours of the head and neck region are extremely rare. The clinical diagnosis is often difficult to establish, and this lesion may be indistinguishable from other soft tissue neoplasms. An 18-year old Chinese gentleman presented with a painless right submandibular swelling which was increasing in size for eight months. A computed tomography scan showed a well-defined solid mass measuring about 2.0 x 2.96 cm in the submandibular region. The tumour was resected and was confined within its capsule. Immunohistochemical staining was strongly positive for CD34, CD 99, and vimentin and negative for desmin, smooth muscle actin (SMA), cytokeratin, S100 and CD68. The microscopic and immunohistochemical profile were compatible with solitary fibrous tumour. Distinguishing solitary fibrous tumours from various spindle neoplasms can be difficult. In view of the resemblance, immunohistochemical staining can help differentiate solitary fibrous tumour from spindle neoplasm.