W. J. S. Nettle’s research while affiliated with Flinders Medical Centre and other places

A man of 63 developed unilateral gustatory rhinorrhea shortly after radical parotidectomy for infiltrating squamous cell carcinoma that had metastasised to the parotid lymph nodes. There is a similarity between this condition and the gustatory vasodilatation and sweating of Frey's syndrome, but despite circumstantial evidence that misdirected nerve regeneration causes these symptoms, their exact aetiology is still unknown.

A case of closed rupture of the musculotendinous junction of the extensor hallucis longus is reported. This unusual injury was sustained by rapid, powerful forced flexion of the great toe against resistance. This type of injury has not previously been reported in the literature. The injury is postulated to be a late complication of fracture of the distal tibial shaft, with damage sustained to the segmental muscle and tendon blood supply at the time of fracture. This case demonstrates successful outcome of surgical management of this condition

Fine needle aspiration biopsy (fnab) of salivary glands was performed in 187 patients. In 106 patients with satisfactory fnab smears who proceeded to surgery, the original cytologic diagnosis was compared with subsequent histopathology. There were 74 benign tumours and 25 malignant tumours. Nineteen of the latter were primary malignant neoplasms of the salivary glands and 6 were metastatic. The cytologic diagnosis by fnab correlated exactly with the histologic diagnosis in 95% of benign neoplasms and in 68% of malignant neoplasms with an overall accuracy of 88%. A false negative diagnosis for malignancy was male in five cases and a false positive diagnosis in one case. Hence the sensitivity for malignancy was 80% and the specificity was 99%. The most frequently misdiagnosed lesions were pleomorphic adenoma and mucoepidermoid carcinoma. Fnab of salivary gland lesions is easy to perform and free of complications, but the cytologic patterns may be difficult to interpret, and considerable experience is necessary in order to achieve a high diagnostic accuracy.

A review of all fine needle aspiration biopsies of salivary gland lesions performed at the Flinders Medical Centre during a 9-year period revealed a number of cases in which there was a discrepancy between the initial cytology report and the definitive diagnosis by histology examination. The most common problem was that of atypical features in pleomorphic adenoma, raising a suspicion of a low-grade malignant tumour in 4 cases. One mucoepidermoid carcinoma and one acinic cell carcinoma had been wrongly diagnosed as Warthin's tumours on the basis of the presence of sheets of bland epithelial cells with oncocyte-like cytoplasm. One trabecular monomorphic adenoma was misdiagnosed as adenoid cystic carcinoma, and one adenoid cystic carcinoma as pleomorphic adenoma. The cytologic patterns of these cases are presented and discussed.