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Tuberculous cervical lymphadenitis in a patient with suspected neck recurrence

Yong DJ, Iskandar H, Razif MY

Chin Med J (Engl), 2012 May;125(9):1667-8.
PMID: 22800842

The significance of metastastic disease in the cervical lymph nodes has long been appreciated. The rich lymphatics of the upper aerodigestive tract explained the high incidence of cervical metastasis, occasional bilaterally spread. Even with appropriate treatment, cervical recurrences do occur. Nonetheless, with the resurgence of tuberculosis, the differential of tuberculous cervical lymphadenitis should be excluded. Appropriate modalities should be employed in making the appropriate diagnosis possible.
Ancient schwannoma of cervical sympathetic chain masquerading as carotid body tumour

Lim CC, Chong HS, Yong DJ, Foong SK, Prepageran N

Med J Malaysia, 2018 04;73(2):114-115.
PMID: 29703877 MyJurnal

Schwannoma of cervical sympathetic chain is a rare cause of neck swelling. We report a 73- year-old male presented with anterior neck triangle swelling mimicking a carotid body tumour. Surgical excision was done, and the histopathological examination reported as ancient schwannoma. We would like to discuss the important differential diagnoses and highlight the possibility of an ancient schwannoma of cervical sympathetic chain masquerading as carotid body tumour. Also, to emphasise the importance of imaging for pre-operative planning and counselling.
'Pai Syndrome' with anterior alveolar polyp: A variant of a rare clinical entity

Debnath KK, Kanapaty Y, Yong DJ, Chandran S, Bakri A

Med J Malaysia, 2019 Jun;74(3):229-230.
PMID: 31256179

'Pai syndrome' (PS) is a rare congenital syndrome. Presented here, a new-born baby-girl who exhibited the characteristic features of having a midline nasal (septal) polyp, an anterior alveolar process polyp, and a pericallosal lipoma associated with corpus callosum dysgenesis of the brain. Both polyps were lined with stratified-squamous epithelium. The overall features were largely consistent with those described by Pai et al., in 1987. A midline cleft-lip (with or without cleft-alveolus) is one of the most common features of the syndrome which was however absent in this case. Instead, an anterior alveolar polyp is present, which is relatively rare.
Fulltext Management experience of subglottic stenosis by endoscopic bougie dilatation with mitomycin C and review of literature: case series

Liew YT, Yong DJ, Somasundran M, Lum CL

Indian J Otolaryngol Head Neck Surg, 2015 Mar;67(Suppl 1):129-33.
PMID: 25621268 DOI: 10.1007/s12070-014-0801-8

The aim of the study was to examine and analyze the epidemiology and outcome of treatment for paediatric acquired subglottic stenosis treated with endoscopic bougie dilatation and topical mitomycin C. There were 15 patients identified from 2008 until 2013. All of them had acquired subglottic stenosis due to history of intubation. Majority of the patients had grade III stenosis, with the total of seven. Three patients had grade IV; three were grade II and two were grade I. All of the patients with severe stenosis (grade III and IV) needed tracheostomy while only one in mild stenosis group (grade I and II) required it for prolonged ventilation rather than obstruction due to subglottic stenosis. All of them underwent direct laryngoscopy under general anesthesia followed by endoscopic dilatation with bougie and topical mitomycin C 0.4 mg/ml for 5 min. Aim of success in our study was decannulation of tracheostomy or absence of symptoms at exertion. We achieved 6 (60 %) successful decannulation out of 10 patients with tracheostomy (excluded the patient with tracheostomy in grade I stenosis due to prolonged ventilation). As for those without tracheostomy, 3 (75 %) out of 4 patients were asymptomatic even at exertion. Average number of dilatation was 3.1 times, with mean duration of 28 min. No complications were reported in our series. One patient with grade I stenosis passed away due to severe pneumonia unrelated to the stenosis or dilatation, and she did not have any dilatation before she passed away. Multiple related risk factors were identified such as intubation, prematurity, movement of endotracheal tube, respiratory infection, traumatic intubation and gastroesophageal reflux disease. Experience of open surgical method was very limited in our centre in Sabah in East Malaysia. Endoscopic technique plays an important role in treatment of subglottic stenosis with adjunct like mitomycin C possibly booster the successful rate.
Endoscopic, endonasal decompression of spinal stenosis with myelopathy secondary to cranio-vertebral tuberculosis: two cases

Puraviappan P, Tang IP, Yong DJ, Prepageran N, Carrau RL, Kassam AB

J Laryngol Otol, 2010 Jul;124(7):816-9.
PMID: 20003599 DOI: 10.1017/S0022215109992271

Tuberculosis can cause extensive osseo-ligamentous destruction at the cranio-vertebral junction, leading to atlanto-axial instability and compression of vital cervico-medullary centres. This may manifest as quadriparesis, bulbar dysfunction and respiratory insufficiency.
Fulltext Multicentric Castleman Disease of the Supraglottis: A Surgeons' Dilemma

Jumaat AF, Mohamad Yunus MR, Yong DJ, Md Zin RR, Mat Baki M

Iran J Otorhinolaryngol, 2023 Mar;35(127):101-108.
PMID: 37223400 DOI: 10.22038/IJORL.2023.57806.2995

INTRODUCTION: An abnormal mass in the head and neck involving the supraglottic and cervical region offers a wide range of differential diagnoses. The pathology is either benign or malignant in nature. Castleman disease (CD) is an uncommon lymphoproliferative disorder characterised by hypervascular lymphoid hyperplasia and is classified into unicentric or multicentric disease. Histopathologically it is divided into hyaline vascular (HV), plasma cell (PC), and mixed cellularity variants. The multicentric disease is linked with PC and has the propensity to progress to lymphoma or Kaposi Sarcoma.
CASE REPORT: We report a case of a 45-year-old gentleman who presented with a painless anterior neck swelling and left supraglottic mass for six months. Computed tomography (CT) contrast imaging demonstrated a homogenous enhancing lesion at the left supraglottic and the midline of the anterior neck with erosive changes of the thyroid cartilage. A surgical resection of the anterior neck mass was performed. The diagnosis of Castleman disease plasma cell variant was made by histopathologic evaluation. The patient remained well post-resection.
CONCLUSION: Supraglottic multicentric Castleman disease is the least expected diagnosis in this case. Unicentric disease is treated with surgery. However, limited studies are available in determining the effectiveness of surgery in multicentric diseases. The plasma cell variant requires a multidisciplinary and multimodal approach due to an inclination towards malignancy. Research is needed to determine the role of surgery in multicentric disease and to develop optimum guidelines for managing cases. To date, there is unsubstantial literature describing supraglottic multicentric disease.
Findings from a Malaysian multicentre study on oropharyngeal squamous cell carcinoma

Sathasivam HP, Davan SP, Chua SM, Rohaizat RF, Japar R, Zakaria Z, et al.

Infect Agent Cancer, 2023 Nov 28;18(1):74.
PMID: 38017493 DOI: 10.1186/s13027-023-00557-0

BACKGROUND: In addition to the conventional aetiologic agents of oropharyngeal squamous cell carcinoma (OPSCC) such as tobacco usage, alcohol consumption and betel quid usage, it has been established that a proportion of OPSCC are driven by persistent oncogenic human papillomavirus (HPV) infections. Currently, there is a lack of data on the burden of HPV- associated OPSCC in Asian countries including Malaysia.
METHODS: A cross-sectional multicentre study with tissue analysis of Malaysian patients diagnosed with primary OPSCC within a five-year period, from 2015 to 2019 between 01/01/2015 to 31/12/2019 was undertaken. Determination of HPV status was carried out using p16INK4a immunohistochemistry on tissue microarrays constructed from archived formalin-fixed paraffin-embedded tissue.
RESULTS: From the cases identified, 184 cases had sufficient tissue material for analysis. Overall, median age at diagnosis was 63.0 years (IQR = 15) and 76.1% of patients were males. In our cohort, 35.3% of patients were Indian, 34.2% were Chinese, 21.2% were Malay and 9.2% were from other ethnicities. The estimated prevalence of HPV-associated OPSCC in our cohort was 31.0% (CI 24.4-38.2%). The median age for the HPV-associated OPSCC sub-group of patients was not significantly lower than the median age of patients with HPV-independent OPSCC. More than half of HPV-associated OPSCC was seen in patients of Chinese ethnicity (54.4%). Patients with HPV-associated OPSCC had a much better overall survival than patients with HPV-independent OPSCC (Log rank test; p