<p class="abstract">Rosai Dorfman disease (RDD) is a rare granulomatous disease that typically presents with massive lymphadenopathy. To our knowledge, there have only been 650 cases reported worldwide. It is more common among adults and has characteristic clinical, radiological and histopathological findings. Here, we present a case of RDD in a 51 year-old man with massive submental lymphadenopathy which was not responding to antibiotics. Computerized Tomographic Scan showed ill-defined non-enhancing soft tissue density while fine needle aspiration for cytology displayed emperipolesis which is seen in patients with RDD. The swelling followed a benign course and reduced in size progressively without further intervention.</p><p class="abstract"> </p>

Neuroendocrine neoplasms (NEN) of the head and neck are a rare and diverse group of tumors. Here, we report a case of a 40-year-old man presenting with symptoms resembling chronic left otitis media, including left ear otorrhea, otalgia, and reduced hearing. Otoscopic examination revealed a whitish mass located behind the tympanic membrane. The patient underwent examination under anesthesia and left cortical mastoidectomy, and a histopathological examination of the middle ear biopsy indicated the presence of an epithelial tumor with neuroendocrine differentiation, suggestive of middle ear adenoma. A staging CT scan performed three months after the mastoidectomy showed a hypodensity in the middle ear cavity, with no significant bony erosion, which could potentially indicate a residual or recurrent tumor. Consequently, a radical mastoidectomy was performed. The histopathological examination confirmed the presence of middle ear adenoma with neuroendocrine differentiation.

Melioidosis is a community-acquired infectious disease that is caused by the Gram-negative bacillus, Burkholderia pseudomallei. It is endemic in Southeast Asia countries, and its clinical spectrum is broad, often mimicking other illnesses, which make diagnosis challenging. The hallmark of its presentation is formation of abscess most commonly in the lungs. The overall mortality rate owing to melioidosis is extremely high especially in the bacteremia form. A 54-year-old woman presented with fever, limited mouth opening, and painful left preauricular swelling for 3 months. Premorbidly, she was well without underlying medical illnesses particularly diabetes or autoimmune disease. Local examination revealed a tender diffuse swelling at the left preauricular region. Her mouth opening was limited to two fingerbreadths. Hematological test showed raised total white cells, erythrocyte sedimentation rate and C-reactive protein. Computed tomography and MRI showed presence of significant left masseteric collection with erosion of left temporomandibular condyle. Other incidental findings from the imaging were multiple liver abscesses and right lower lung abscess. Her indirect immunofluorescence enzyme-linked immunosorbent assay and enzyme-linked immunosorbent assay diagnostic test was positive with significant titre ratio of 1 : 320, which established the diagnosis of melioidosis. Full recovery was attained following surgical drainage of the abscess, together with antibiotics for 6 months (intravenous ceftazidime for a month, followed by oral augmentin for 5 months). Melioidosis involving the TMJ joint is a rare entity. This is the second reported case of melioidosis affecting TMJ joint worldwide, from extensive literature search. This case highlights the importance of suspecting melioidosis in individual presenting with abscess at uncommon and atypical site. Enzymelinked immunosorbent assay is a rapid test as compared to the gold standard blood culture, and it helps in reaching the diagnosis early with its advantages of high sensitivity and specificity.

<p class="abstract">The incidence of lipoma in the laryngeal region is rare. Here we report a case of left false cord lipoma in a 78 years old man who presented with hoarseness for 2 years. Clinically, a bulge with a smooth surface was seen at the left false cord. Intraoperatively, the specimen taken from the left false cord appeared yellowish and was floating on normal saline solution giving a suspect to lipoma. Histologically, the tumors composed of mature adipose tissue. Postoperatively, the patient recovered well with no signs of recurrence.</p>

Kimura disease is an idiopathic chronic inflammatory disorder involving the subcutaneous tissue. It favors the head and neck region, although presentation over atypical sites has been reported. This disease occurs spontaneously, has a characteristic indolent growth pattern but has a high tendency to recur locally after treatment. Due to its benign nature, there is still no clear consensus on the optimal management of this rare disorder. Various treatment options are available which include systemic steroids, antihistamines, immunosuppressant, chemotherapy, radiotherapy, and surgical excision. Presently, the disease remains a therapeutic enigma as the pathogenesis is still a mystery and its tendency to recur following treatment proves to be discouraging. Herein we report a rare case of Kimura disease involving the supra-auricular region who underwent surgical excision.