An Extremely Rare Presentation of Mucinous Adenocarcinoma Originating From Meckel Diverticulum Masquerading in a Young Woman With Crohn's Disease.

Mucinous adenocarcinoma with signet cell features originating from Meckel diverticulum (MD) is an extremely rare primary malignant tumor. A woman in her 30s presented with multiple episodes of vomiting, abdominal pain, and constipation. She had a history of stricturing Crohn's disease and managed well with steroids, azathioprine, and infliximab. This time, a computed tomography scan showed distal ileal small-bowel obstruction. Urgent surgery for a nonsettling small bowel obstruction was performed. MD was incidentally found and was concerning for malignancy. This case report illustrates how this extremely rare malignancy was behaving like Crohn's disease, which delayed the diagnosis and treatment.

Immunophenotypic profile of macrophages in generalized pustular psoriasis and deficiency of the interleukin-36 receptor antagonist.

M2 macrophages are copious in generalized pustular psoriasis (GPP). M2 macrophages seem to acquire new skills and share common characteristics in GPP. HAM56 may play a role in attracting immature neutrophils to the inflammatory environment in GPP.

Case Report of a Distal Phalanx Interosseous Epidermoid Inclusion Cyst Presenting as an Enchondroma.

Introduction: Lesions in the distal phalanx can be attributed to a broad range of pathologies. Benign lesions such as enchondromas are common; however, there are a range of conditions that can mimic tumors on both clinical presentation and imaging. Case Report: Here, we report a case of a 42-year-old man who presented with pain and swelling in the distal phalanx of his right ring finger following trauma. Plain radiographs showed a fracture through a probable enchondroma in the distal phalanx, and this report was corroborated by an MRI. However intraoperatively, the lesion was found to be a caseous lesion encased in a capsule and histological examination revealed the lesion to be an intraosseous epidermoid inclusion cyst. Conclusion: In this report, we discuss how enchondromas can be differentiated from intraosseous epidermoid inclusion cysts on clinical and imaging appearances. Intraosseous epidermoid inclusion cysts are more common in young males, with the previous trauma at the site of the lesion. Radiographically intraosseous epidermoid cysts can be differentiated by enchondromas by the absence of calcification within the lesion, and the location of the lesion in the subungal part of the distal phalanx. Ultimately, however, the definitive diagnosis of both lesions is histological and therefore it is important to maintain a broad differential when approaching the diagnosis of distal phalanx lesions.

A ruptured ovarian cystadenofibroma presenting with life-threatening sepsis and an incidental synchronous endometrial stromal sarcoma.

A woman in her 60s presented with a rare complication of an ovarian cyst which many clinicians may not consider at first presentation. She was admitted with life-threatening staphylococcus aureus sepsis. She presented shocked with a collapse following a 2-day history of diarrhoea, vomiting and pain in the right iliac fossa. She was taken to theatre where a ruptured, widely infarcted left ovarian serous cystadenofibroma was discovered with over 2 litres of purulent fluid exuding from the cyst into the abdomen. She had a left cyst removal, hysterectomy and bilateral salpingo-oophorectomy performed. Histological analysis and molecular gene testing of an incidentally discovered uterine neoplasm revealed an undifferentiated uterine sarcoma. She successfully recovered as an inpatient and was discharged under the care of an oncology team for ongoing management.

Intussusception of a large circumferential caecal adenoma with ileocaecal valve consumption.

We present a case of an unusually large, circumferential tubulovillous adenoma involving the terminal ileum and the caecum with ileocaecal valve consumption, presenting as intussusception in an otherwise healthy 90-year-old woman. The patient presented with several months of chronic symptoms of weight loss and diarrhoea. Clinical examination revealed a right-sided mass. Investigations revealed a large right-sided lesion suspicious of intussusception. The patient underwent a right-sided hemicolectomy where the intussusception was resected. Histology of the resected mass revealed a tubulovillous adenoma with focal invasive adenocarcinoma.

Filariasis an Unusual Cause of Retroperitoneal Fibrosis, Hydronephrosis, and Infertility in a Young Adult Male.

Background: Filariasis is a tropical disease caused by infection with nematode parasites of the Filarioidea family. Filariasis is an endemic disease in parts of India, Sub-Saharan Africa, and Southeast Asia. Filariasis is a progressive disease predominantly affecting the lymphoreticular system, which can result in genitourinary complications (hydrocele, scrotal pain, and infertility), lymphedema, and elephantitis. Retroperitoneal fibrosis has a broad etiology, including secondary to chronic infection. Currently an estimated 25 million men are suffering from lymphatic filariasis with urogenital involvement worldwide. Case Presentation: We present a rare case of a 40-year-old man presenting with fever, groin lymphadenopathy, and a history of infertility. Imaging confirmed significant hydronephrosis and retroperitoneal fibrosis. Filariasis serology was positive. Prior bilateral testicular biopsy demonstrated chronic inflammation and atrophy. Disease course was not improved by empirical eradication and supportive retrograde ureteral stenting. The patient developed elephantitis and progressive retroperitoneal fibrosis leading to a solitary functioning right kidney with nephrostomy. Conclusion: Urologists should be aware of index presentations of filariasis and its associated urological complications, particularly in the travelling adult population in whom the etiology of renal impairment and infertility remains unclear.

Unusual presentation for a tailgut cyst.

A 67-year-old man with a slow-growing, asymptomatic perianal lesion was presented to the colorectal clinic. Physical examination and radiological investigation were suggestive of an externally prolapsing colonic polyp. However, intraoperative findings of a cystic lesion containing a thick brown substance questioned the initial diagnosis. After complete surgical resection of the encapsulated lesion, histological examination revealed a tailgut cyst (cystic hamartoma). These uncommon lesions originate from an embryological remnant of the hindgut. They are generally benign but may have extremely rare malignant potential which warrants complete surgical resection. Throughout the literature, they are described to present with various symptoms and may be found in several anatomical locations, most commonly within the retrorectal space. In very rare instances, with only two other documented cases, they can be found externally at the anorectal junction. Although very rare, an anal tailgut cyst should be taken into account in differential diagnosis.

Human papilloma virus and squamous cell carcinoma of the anus.

The incidence of anal cancer is increasing. In the UK, the incidence is estimated at approximately 1.5 per 100,000. Most of this increase is attributed to certain at-risk populations. Persons who are human immunodeficiency virus (HIV)-positive and men who have sex with men (MSM), Organ transplant recipients, women with a history of cervical cancer, human papilloma virus (HPV), or cervical intraepithelial neoplasia (CIN) are known to have a greater risk for anal cancer. This paper will focus on HPV as a risk factor for anal intraepithelial neoplasia (AIN) and discusses the etiology, anatomy, pathogenesis, management of squamous cell carcinoma (SCC) of the anus.

Acute small bowel obstruction secondary to intestinal endometriosis, an elusive condition: a case report.

BACKGROUND: Endometriosis is a benign condition affecting females of reproductive age. Although intestinal endometriosis is common it is rare for the condition to manifest as an acute bowel obstruction secondary to ileocaecal and appendicular endometriosis. This case is important to report as it highlights the diagnostic difficulty this particular condition presents to an emergency surgeon. CASE PRESENTATION: We present the case of a 33 year old female of Asian origin who presented with symptoms and signs of an acute small bowel obstruction. A right hemicolectomy for suspected malignancy was performed with an ileocolic anastomosis. Histological examination demonstrated extensive endometriosis of the appendix and ileocaecal junction. CONCLUSION: Enteric endometriosis should be considered as a differential diagnosis when assessing females of reproductive age with acute small bowel obstruction. A high index of suspicion is required to arrive at a diagnosis of this elusive condition.