Case report: A rare case of eccrine carcinoma.

INTRODUCTIONS: Sweat gland carcinoma is very rare with a reported incidence of less than 0.005% of all tumour specimens resected surgically (Tulenko and Conway, 1965) [1]. CASE REPORT: A sixty year old male patient presented to us with a solitary swelling over the left chest wall since two months. DISCUSSION: Cutaneous apocrine gland carcinoma, a subtype of sweat gland carcinoma, is a very rare malignant neoplasm arising in areas of high apocrine sweat gland density. The variability of the histological features even in the same tumour, and its rarity, have contributed to some confusion regarding the classification of sweat gland carcinoma. CONCLUSIONS: Sweat gland carcinomas are a rare group of tumours with potential for local destruction as well as distant metastasis. Wide surgical excision along with regional lymph node dissection in the presence of clinically positive nodes is the recommended treatment. However, a frequent follow up is essential to detect early recurrence as well as distant metastasis.

Primary adenosquamous carcinoma of ampulla of Vater-A rare case report.

INTRODUCTION: Primary adenosquamous carcinoma (ASC) of the ampulla of Vater (AmV) is extremely rare. Carcinoma of the ampulla of Vater tends to manifest early due to biliary outflow obstruction, as opposed to pancreatic neoplasms that often are advanced at the time of diagnosis. Periampullary carcinomas are treated by pancreaticoduodenectomy (PD). Adenosquamous carcinoma carries very dismal prognosis. PRESENTATION OF CASE: Here we present a case of 58-year-old male who was presented with abdominal pain, jaundice and anorexia with no history of (h/o) pruritus and clay colored stool. All blood investigations were normal except liver function tests (LFTs). Ultrasonography (USG) of abdomen suggestive of periampullary mass with dilated pancreatico-biliary tree. Endoscopic retrograde cholangiopancreatography (E.R.C.P.) demonstrated large deformed and bulky papilla with ulcerated lesion with infiltration in to duodenum. Exploratory laprotomy proceeds Whipple's pancreaticoduodenectomy done. Histopathology revealed adenocarcinoma of the ampulla of Vater. Immunohistochemistry was confirmatory of adenosquamous carcinoma. DISCUSSION: Adenosquamous carcinoma (ASC) is defined as a tumor in which both glandular and squamous elements are histologically malignant. Compared to adenocarcinoma, ASC of the AmV is a rare malignancy. Preoperative diagnosis is difficult because of the lack of defining characteristics in imaging studies and the difficulty in acquiring both malignant components by limited biopsy. Periampullary carcinomas are treated by pancreaticoduodenectomy. CONCLUSION: Adenosquamous carcinoma is a very rare form of cancer of the AmV. Pancreaticoduodenectomy is the treatment of choice though early recurrence and distal metastasis may be encountered after surgery. Follow-up should be more frequent to detect possible early recurrence and distal metastasis.

Multiple giant intra abdominal lipomas: A rare presentation.

INTRODUCTION: Solitary or multiple lipomas, composed of mature fat, represents by far the most common benign mesenchymal neoplasm occurring throughout the whole body, but they rarely originate in the intestinal mesentery. PRESENTATION OF CASE: A 60-year-old male presented with left sided abdominal distension and pain since 4 months, ultrasonography and computerized tomography abdomen was suggestive of multiple well-defined fat density lesions in the lower abdomen and pelvis. USG guided fine needle aspiration cytology was conclusive of a spindle cell lesion. Exploratory laparotomy was performed and multiple major fat tissue swellings were excised. Histopathology confirmed it to be spindle cell type of lipoma. DISCUSSION: Because of the silent nature the exact prevalence of lipomas is unknown. It can arise in any location in which fat is normally present, reported intra abdominal lipomas have been very rare. Clinical manifestations depend on the size and location of the growth. In most patients, symptoms are few or absent. USG and CT scan abdomen are used for the diagnosis. Complete surgical excision being the only treatment. CONCLUSION: Intra abdominal lipoma is a very rare entity, and many cases might be ignored due to their silent nature. They might or might not present with any symptoms. Complete surgical excision being the only treatment, with a very good prognosis.

Bilateral giant juvenile fibroadenomas of breasts:a case report.

Juvenile fibroadenoma constitutes only 4% of the total fibroadenomas. The incidence of giant juvenile fibroadenomas is found to be only 0.5% of all the fibroadenomas. Bilateral giant juvenile fibroadenomas are extremely rare, and only four cases have been reported in the literature. To the best of our knowledge, we are presenting the fifth case of bilateral giant juvenile fibroadenomas in a 12-year-old prepubertal girl. The diagnosis was made on fine-needle aspiration cytology which was confirmed on histopathology. In this paper, we present this rare case to illustrate the diagnosis and management of this tumour and to emphasize that these tumours are almost always benign and should be treated with breast-conserving surgery to provide a healthy physical and social life to the patient.

Pseudomyxoma peritonei presenting as sub-acute large bowel obstruction.

A case of pseudomyxoma peritonei, a rare mucin-secreting tumour in the peritoneum, in a 30-year-old male and presenting as sub-acute large bowel obstruction, is reported here with review of the literature.

Meckel Gruber Syndrome--a case report.

Meckel Gruber Syndrome is a rare syndrome inherited as Mendelian autosomal recessive condition. The affected infant usually has a large occipital encephalocoele associated with renal cysts and sometimes polydactyly. The prognosis is poor. The affected child is still born or dies early in infancy. If diagnosis is done by prenatal ultrasound examination termination of pregnancy can be done.

Nodular and diffuse fibrous proliferation of tunica vaginalis--a case report.

A case of nodular and diffuse fibrous proliferation (NDFP) of the tunica vaginalis testis occurring in a 40 year male is described. Immunohistochemistry confirmed fibroblastic origin. Histogenesis & differential diagnosis of this lesion is considered. Simple excision of this lesion is curative. The lesion is very rare but it is important that both surgeons & pathologists become aware of this entity to avoid radical orchiectomy in young patients.