An endemic of scabies in Kahuta, Azad Kashmir. The study shows a lack of awareness of scabies; mass treatment is needed.

The study was planned to find the awareness of scabies in the Forward Kahuta area of Azad Jammu and Kashmir, Pakistan. For this, a questionnaire related to scabies was distributed among the patients at different walk-in clinics in the region from June 2015 to May 2016. Of the 234 participants, 97(41.5%) were males and 137(58.5%) were females. All of them reported with itching, but 120(51.3%) of the participants didn't even know that itching may be due to scabies which was found in 157(67%) patients, and of them, 106(67.52%) knew that scabies was curable and preventable. Scabies was found in common school students (n=39(24.84%), farmers (n=32(2.38%) and laborers (n=31(19.74%). Due to poor awareness, a multi-dimensional approach is suggested to spread the awareness of skin diseases like scabies in the population under study and mass treatment of scabies in the area is recommended.

Unusual Presentation of Treated Colon Cancer with Extramural Venous Invasion: A Case Report.

Introduction: Colon cancer is one of the leading malignancies globally and continues to be one of the most typical causes of cancer-related mortality. The clinical outcome of the disease depends on the primary tumour stage, regional nodal involvement and distant disease dissemination. It often presents with haematogenous spread to the liver at the time of diagnosis. Another factor for increased mortality is the presence of extramural venous invasion. This is exceedingly important as it has significant prognostic significance and helps predict survival. Case Description: A middle-aged female with a recent history of caesarean delivery presented with abdominal pain and occasional constipation, which led to a series of investigations. Initial computed tomography scan showed proximal to mid-transverse colonic tumoural thickening with locoregional lymphadenopathy and solitary distant metastasis in the left hepatic lobe. This was followed by extended right hemicolectomy and hepatic metastasectomy. The patient remained on follow-up and later presented with thrombus formation in the splenoportal circulation. Initially, this was considered a bland thrombus, and the patient was advised a close follow-up. However, the patient was lost to follow and later presented with extensive thrombosis of the portal and splenic veins. Practical Implications: Confident differentiation of the bland versus malignant thrombosis is crucial to ascertain disease stage and appropriate management. Invasive tissue sampling gives a confident diagnosis of benign versus malignant thrombus. However, using a non-invasive imaging modality, we can still distinguish between the two with reasonable certainty.

Extraskeletal Mesenchymal Chondrosarcoma, a Rare Entity with Unusual Metastases: A Case Report.

Introduction: Extraskeletal mesenchymal chondrosarcoma (ESMC) is rare, aggressive, and high grade malignant tumors originating from soft tissues. It carries a poor prognosis with a tendency for local recurrence and distant metastasis, necessitating long-term follow-up. The most common sites for metastasis are the lungs, bones, and lymph nodes. Meanwhile, pancreatic metastases are extremely rare. Case Description: A 35-year-old female presented with a history of wide local excision for the left upper limb mass; histopathology showed ESMC. She was on surveillance with a computed tomography scan of the thorax and magnetic resonance imaging of the left upper limb at 3-months intervals until she developed vertebral and pancreatic lesions after 6 months post-surgery. No pulmonary metastases were noted. Considering the unusual site for metastasis and to exclude the possibility of any second malignancy, bone biopsy, and endoscopic ultrasound-guided fine-needle aspiration was performed that confirmed metastases. Later she developed osseous metastases in the pelvis and femora. Practical Implication: Pancreatic metastasis from ESMC is extremely rare. In case of new visceral or osseous lesions in a patient with a past medical history of ESMC, the possibility of metastatic disease should be considered. A biopsy can be performed to confirm the diagnosis.