Primary anorectal melanoma: an update.

The anorectum is a rare anatomic location for primary melanoma. Mucosal melanoma is a distinct biological and clinical entity from the more common cutaneous melanoma. It portrays worse prognosis than cutaneous melanoma, with distant metastases being the overwhelming cause of morbidity and mortality. Surgery is the treatment of choice, but significant controversy exists over the extent of surgical resection. We present an update on the state of the art of anorectal mucosal melanoma. To illustrate the multimodality approach to anorectal melanoma, we present a typical patient.

Infiltrating lobular carcinoma of the breast presenting as gastrointestinal obstruction: a mini review.

One in twelve American women will develop breast cancer, with infiltrating lobular carcinoma (ILC) comprising approximately 15% of these cases. The incidence of ILC has been increasing over the last several decades. It has been hypothesized that this increase is associated with combined replacement hormonal therapy. Although pathologically distinct from infiltrating ductal carcinoma (IDC), ILC is treated in the same manner as IDC. However, ILC demonstrates significantly different patterns of late local recurrence and distant metastasis. The incidence of extra-hepatic gastrointestinal metastases is reported to be 6% to 18%, with stomach being most common. Herein, we present a brief review of the literature and a typical case involving ILC initially presenting as a small bowel obstruction. Evidence suggests that the late clinical patterns of ILC are distinctly separate from IDC and physicians need be cognizant of its late local recurrence and unique late metastatic pattern. Different follow up strategy should be entertained in patients with ILC.

Strangulated hernia through a defect in the broad ligament: a sheep in wolf's clothing.

Small bowel obstruction due to an internal hernia is an uncommon finding and, when caused by a defect in the broad ligament, it is exceptionally rare. This condition should be considered when evaluating all female patients presenting with de novo small bowel obstruction. We report an unusual case of intestinal obstruction from an internal hernia through the left broad ligament in a middle-aged patient with no prior surgical history and discuss the relevant literature and treatment. Although an oncologic diagnosis should be entertained, a small bowel obstruction arising in the pelvis may involve the broad ligament in parous patients. An internal hernia through the broad ligament should be considered in the differential diagnoses of female patients presenting with intestinal obstruction.