Enterobius Vermicularis: A Parasitic Cause of Appendicular Colic.

Enterobius vermicularis is the most commonly identified parasite incidentally found within the appendix of a clinically diagnosed appendicitis. This parasitic cause of appendicular colic, primarily affecting children, is an important cause of negative appendicectomy. We report an unusual and interesting case of a young female who presented with clinical features of acute appendicitis. Laparoscopic appendicectomy revealed the presence of an Enterobius vermicularis infestation originating from the lumen of her vermiform appendix. Our case report is supplemented with a review of the literature, an overview of the parasitology, and discussion of pertinent symptomatology and peri-operative management strategies.

Ectopic breast carcinoma presenting as sebaceous cyst left axilla.

A 43-year-old woman with a positive family history of breast cancer presented with a painless lump in her left axilla for 2 years. Clinical diagnosis was a left axillary sebaceous cyst as the lump was inseparable from the skin. The lesion was excised under local anaesthesia and reported as breast tissue widely infiltrated by an invasive ductal carcinoma (grade 2). The malignancy was not involving the epidermis but <1 mm away from deeper margins. Re-excision of the deeper tissue with an axillary sentinel lymph nodes biopsy was performed and deep margins were reported to be tumour-free with no nodal involvement.

Appendiceal mucocele: a missed diagnosis.

A 38-year-old man presented to clinic with recurrent right iliac fossa pain from a young age; three episodes of which required hospital admission. He was otherwise well with no associated symptoms. In view of persistent pain and recurrent admissions a CT scan was arranged which showed a dilated retrocaecal appendix suggesting recurrent appendicitis. Further to CT findings the patient underwent an urgent appendicectomy for a presumed diagnosis of chronic appendicitis but histology in fact revealed a cystoadenoma of appendix. Postoperatively the patient's symptoms resolved and he was discharged from surgical care. It is important to note that in this case the diagnosis of appendiceal mucocele was not considered therefore not particularly accounted for during surgery. Has this been a malignant cystadenocarcinoma any spillage of malignant cells into the abdominal cavity during the operation could have a grave impact on long-term recovery and prognosis.

Intracystic papillary carcinoma of breast: report of three cases and review of the literature.

Intracystic papillary carcinoma (IPC) of the breast is a rare malignant tumour, found mainly but not exclusively in elderly women. IPC may be asymptomatic or presents with a palpable mass or blood-stained nipple discharge. The tumour is encysted within a dilated duct with arborisation of the fibrovascular stroma and contains nodules of papillary carcinoma surrounded by a thick fibrous capsule. Frequently excisional biopsy is required for diagnosis. The mainstay of treatment is breast-conserving surgery or mastectomy. Sentinel node biopsy could be considered in invasive cases. Adjuvant radiotherapy (XRT) and/or endocrine therapy is considered in appropriate cases. Prognosis is excellent. We report three such cases of IPC, in elderly women, which were successfully treated.

Skin lesion in axilla: an unusual presentation of invasive lobular carcinoma of breast.

Invasive lobular carcinoma (ILC) of breast is known to present with atypical clinical findings in the breast, making it difficult to diagnose. It is also known to have unusual sites of metastases arising de novo or in patients treated for known ILC. Skin lesion in axilla could be a cutaneous metastasis from ILC or ILC in ectopic breast tissue (EBT). We present two cases with skin lesion in axillas which after excision were surprisingly reported as ILC. On further investigations these were found to be primary in EBT. Though such cases are reported, carcinoma arising from EBT is a very rare presentation and one should be aware of this, when dealing with a skin lesion.

Sebaceous carcinoma of the skin of the breast: a case report.

INTRODUCTION: Sebaceous gland tumours are rare and their presence should be considered as a marker for Muir-Torre Syndrome, alerting to search for an occult malignancy. CASE PRESENTATION: A 43-year-old Caucasian female patient underwent excision of a sebaceous cyst. Histopathology confirmed a sebaceous carcinoma. Further investigations revealed multiple intra-abdominal malignancies. She has been under regular follow-up in the relevant clinics. CONCLUSION: Sebaceous carcinoma should be excised completely and followed-up for the detection of possible metastases. Surgical removal of primary or metastatic cancers may be curative and should be attempted wherever possible. It is very important for clinicians not to miss such skin lesions as they may precede the presentation of internal malignancies.

Nonsurgical management of pancreaticopleural fistula.

CONTEXT: Pancreaticopleural fistula is seen in acute and chronic pancreatitis or after traumatic or surgical disruption of the pancreatic duct. Surgery leads to healing in 80-90% of cases but carries a mortality of up to 10%. AIM: Our aim was to assess the management of pancreaticopleural fistula on a specialist pancreatic Unit. METHODS: Patients presenting with pancreaticopleural fistulae were identified from acute and chronic pancreatitis databases. Management and outcome were compared with previous studies identified in MEDLINE and EMBASE. RESULTS: Four patients presented with dyspnoea from large unilateral pleural effusions. Three had a history of alcohol abuse and one of asymptomatic gallstones. All were treated with chest drainage, octreotide and endoscopic retrograde cholangiopancreatography plus/minus pancreatic stent. Two had a pancreatic stent in situ for 5 and 8.5 months respectively. In the third sphincterotomy was performed; in the fourth the pancreatic duct could not be cannulated. The fistula healed in all cases, with no recurrence after 12-30 months, and no deaths. There are 14 reports including 16 cases treated with endoscopic retrograde cholangiopancreatography plus/minus pancreatic stent in the literature, with no recurrence after follow up ranging 4-30 months and no deaths in these 16 cases. CONCLUSIONS: A high index of suspicion is necessary to be aware of its presence. These data suggest that endoscopic management is preferable alternative to surgery for pancreaticopleural fistula.