Report of Cases Demonstrated at the F.R.C.S. Class.

Case I. Swelling in the Neck. Mrs. W. aged 28 complained of a lump at the right angle of the jaw, the size of a hen egg. She had had the swelling for several years, during which it had varied in size and had been subject to attacks of inflammation. The diagnosis of a suppurating tubercular gland had been formed. Six months ago she was admitted to hospital during an acute attack when she was considered to have an abscess. By splinting the head, the inflammation subsided and her large unhealthy tonsils were removed by dissection as these were considered to be an exciting focus. During the removal of the right tonsil, a quantity of thick, clear fluid was observed to escape as the tonsil was separated from its bed in its postero-inferior area, i.e. from the junction of the posterior pillar of the fauces and the tongue. This fluid aroused comment at the time but no cause for it was found. During the following week the tumour steadily became smaller, but then it began to enlarge to its present dimensions. The swelling extends from slightly underneath the anterior border of sterno-mastoid into the sub-maxillary triangle and also is in contact with the angle of the jaw. It is quite painless and what is important in the diagnosis, it is translucent. Here therefore, is a patient with a swelling containing clear fluid. What is the diagnosis? The following are possibilities given in order of probability: (I) A branchial cyst; (2) A cystic hygroma; Other suggestions made by members of the class were: a dermoid cyst, a sebaceous cyst, and a lipoma. The tumour is probably a branchial cyst because of the following points. Its position and the history of seven or eight years with the occasional attacks of inflammation is in keeping with the known habits of these swellings. The clear fluid which escaped when the tonsil was removed, followed by its reduction in size suggests that it may have had a connection with the pharynx. Finally its translu-cency shows that the fluid is clear and not pus. This factor is important in excluding a tubercular abscess which also would be unlikely to persist for so many years without development one way or another, and also had it been an infection in a gland it would probably have subsided after removal of the tonsils, instead of which the tumour has …