Isolated pancreatic tail injury: A rare presentation.

INTRODUCTION: Pancreatic injuries occur in up to 10% of all major blunt abdominal trauma events. Due to the retroperitoneal location of the pancreas, isolated pancreatic injury occurs in less than 5% of cases. PRESENTATION OF CASE: A 12 year old male child was brought to the emergency department with epigastric pain 12 days after alleged history of fall from bicycle. On admission, he had tenderness in the epigastrium. CT scan revealed a transection through the tail of the pancreas with no injury to any other organ. As there was no evidence of duct injury, he was treated conservatively. DISCUSSION: Morbidity and mortality rates for isolated pancreatic trauma are directly related to the presence of damage to the pancreatic duct. Helical multislice CT scan represents the best noninvasive diagnostic method for the detection of pancreatic injury. Hyperamylasemia should at least be considered as a sign of probable pancreatic injury in the setting of blunt abdominal trauma. CONCLUSION: Trauma to the pancreas is not common, and isolated pancreatic trauma is even less common. An isolated pancreatic injury may be missed or the diagnosis may be delayed because the initial symptoms and signs of pancreatic injury are subtle.

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.

A comparative study of colostrum dressing versus conventional dressing in deep wounds.

INTRODUCTION: Deep wounds are extending deeper, across deep fascia into muscles or deeper structures. Understanding of nutrition, immunology, psychological issues, the physiology and the metabolic interactions require for optimal treatment of deep wounds. Wound dressing plays one of the important roles in wound healing. Newer type of wound dressings - Biological dressings like colostrum powder, collagen granules create the physiological interface between the wound surface and environment which is impermeable to bacteria. AIM: To compare the efficacy and safety of colostrum dressing and conventional dressing in deep wounds. MATERIALS AND METHODS: Data was collected from all patients with deep wounds (stage II-IV), admitted during the period of April 2013 to March 2014, considering the inclusion and exclusion criteria. RESULTS: Less number of dressings, short healing time, rapid healing and decrease pain seen in colostrum dressing group compared to conventional dressing group. CONCLUSION: Colostrum powder dressings are safe, promoter of wound healing, more patient compliance in terms of less pain, less number of dressing required. This treatment though found to be more expensive than conventional dressings; results indicate that colostrum powder dressings may be used as an adjunct in management of deep wound.

High-grade myxofibrosarcoma-presented as a large mass of right upper arm.

Myxofibrosarcoma is one of the rare soft tissue sarcomas. We present a case of a 65-year-old male having large soft tissue mass over right upper arm associated with surface ulceration. On histopathological study tumor was diagnosed as myxofibrosarcoma - high grade according to modified FNCLCC grading system. Like many other tumors of connective tissue, soft tissue sarcoma exhibits high recurrence. In our case, tumor showed features of high grade with local recurrence, large size; however, no evidence of metastasis was noted. For this unpredictable clinical behavior, we are presenting this case.

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.

Matrix-producing metaplastic breast carcinoma - a rare malignancy.

Patient: Female, 33 Final Diagnosis: Matrix-producing metaplastic breast carcinoma Symptoms: - Medication: - Clinical Procedure: Operative Specialty: Oncology Objective: Rare disease. BACKGROUND: Metaplastic breast carcinomas are ductal carcinomas that undergo metaplasia into non-glandular growth patterns. They are very rare, accounting for less than 1% of all invasive breast carcinomas. CASE REPORT: A 33-year-old female patient presented with a lump in her left breast. Axillary lymph nodes were not palpable. FNAC of the lump was positive for malignant cells. The patient underwent modified radical mastectomy with axillary clearance. The histopathological report was matrix-producing carcinoma with infiltrating duct carcinoma. The tumor was positive for immunohistochemical markers keratin, EMA (Epithelial Membrane Antigen), and S100, thus confirming it to be matrix-producing carcinoma breast. After surgery, the patient recovered uneventfully. CONCLUSIONS: Matrix-producing breast carcinoma is a rare type of metaplastic carcinoma characterized by a ductal carcinomatous element with direct extension to areas showing cartilaginous or osseous differentiation, lacking an interspersed spindle cell component. It has better prognosis than metaplastic carcinoma. Immunohistochemically, they are positive for keratin, EMA (Epithelial Membrane Antigen), and S100. The tumor, which is matrix-producing, is S100 reactive and nonreactive for cytokeratin. They are usually ER- and PR-negative. The average age of these patients is approximately 58 years. Surgery remains the mainstay of therapy, using either mastectomy or local excision.

Rhabdomyosarcoma of the breast - a rare malignancy.

PATIENT: Female, 60 FINAL DIAGNOSIS: Rhabdomyosarcoma of the breast Symptoms: Lump in axilla Medication: - Clinical Procedure: Mastectomy Specialty: Oncology. OBJECTIVE: Rare disease. BACKGROUND: Primary nonepithelial malignancies of the breast include primary breast sarcomas, therapy-related breast sarcomas, the phyllodes tumors, and primary breast lymphomas. They account for less than 5% of all breast neoplasms. CASE REPORT: We report the case of a 60-year-old postmenopausal female diagnosed with rhabdomyosarcoma with infiltrating duct carcinoma. She was treated with modified radical mastectomy with axillary clearance and postoperative chemotherapy. CONCLUSIONS: Primary rhabdomyosarcoma of the breast in adults is extremely rare. Rhabdomyosarcomas in adults account for less than 3% of all adult primary soft-tissue sarcomas. Primary breast sarcomas usually present as large painless breast lumps with no associated skin and nipple changes or axillary lymphadenopathy; they are more aggressive and have more rapid growth than epithelial malignancies or benign breast lesions. The tumor can grow to large size, around 5.8 cm. Affected patients are typically women in their 50 s (ranging from 17 to 89 years), but it is also seen in men. The treatment of primary breast sarcomas requires a multidisciplinary approach. Surgery remains the mainstay of therapy. Chemotherapy has no clearly defined role in primary breast or soft-tissue sarcomas. The prognosis of primary breast sarcomas depends on the histologic grade and size of the tumor. They spread locally and hematogenously, but they are not usually associated with axillary lymphadenopathy.

Huge dedifferentiated liposarcoma of the left thigh with a high grade fibrosarcomatous differentiation and a local recurrence.

Dedifferentiated liposarcoma is one of the variants of liposarcoma which has a more aggressive course. It constitutes less than 10% of all the liposarcomas and is often found in the retroperitoneum and the mediastinum. We are reporting a rare case of a 60 years old female who presented with a huge, soft tissue mass in the left thigh with a past history of an operation which was done15 years back. The histopathological examination showed a well differentiated liposarcoma with a high grade fibrosarcomatous differentiation. Immunohistochemical studies confirmed the dedifferentiated liposarcoma with the high grade fibrosarcomatous differentiation. To the best of our knowledge, this is the 11th case in the literature with rare findings.

Unusual presentation of eosinophilic enteritis as multiple strictures of small intestine.

Eosinophilic enteritis is a rare disease of unknown etiology. It is characterized by eosinophilic infiltration of the bowel wall to a variable depth and symptoms associated with gastrointestinal tract depending upon the predominant layer involved. Diagnosis of eosinophilic enteritis requires a high index of suspicion and exclusion of various disorders that are associated with peripheral eosinophilia. We report a case of unusual presentation of eosinophilic enteritis clinically presenting as intestinal obstruction due to multiple strictures of the small bowel in an adult male.

Malignant change in an epidermal cyst over gluteal region.

A 72-year-old male presented with a large ulceroproliferative lesion over left gluteal region. After histopathological confirmation of squamous cell carcinoma, the lesion was excised with wide margins. Further histopathological study of the excised specimen revealed the growth arising from an epidermal cyst. Malignant change is a rare, but wellknown complication occurring in an epidermal cyst. The mainstay of treatment consists of wide excision of cancerous lesion with primary reconstruction of the defect.

Acute spontaneous gastric perforation in neonates: a report of three cases.

Gastric perforation in neonates is a rare, serious and life-threatening problem. The precise aetiology is obscure in most cases. By virtue of its high mortality rate, it requires prompt recognition and surgical intervention. We report three cases of neonatal gastric perforation managed by early resuscitation and primary repair.

Fine needle aspiration diagnosis of carotid body tumor in a case of multiple paragangliomas presenting with facial palsy: a case report.

BACKGROUND: Carotid body tumors (CBTs) constitute the most common extraadrenal paragangliomas. Many lesions diagnosed as CBTs by fine needle aspiration (FNA) cytology are clinically unsuspected. The main differential diagnosis is a thyroid neoplasm. The location of the mass in the lateral neck with prolonged history, hemorrhagic FNA and cytologic features resembling the endocrine neoplasm help in arriving at a suggestive diagnosis of paraganglioma. CASE: A 32-year-old male presented with left-sided facial palsy and swelling in the left side of the neck of 8 months' duration. The FNA sample was hemorrhagic and showed loosely arranged groups and acini formed by round to oval cells. A diagnosis of CBT was suggested. It was supplemented by additional noninvasive methods, such as ultrasonography of the neck region with color Doppler, computed tomography and magnetic resonance imaging of the brain, which also revealed a neoplasm suggestive of carotid body tumor in the right side of the neck and neoplastic lesion in the left cerebellopontine angle, suggestive of paraganglioma. CONCLUSION: FNA, with the other noninvasive radiologic investigations, plays an important role in the diagnosis of CBT. We present this case of multiple paragangliomas for its unusual presentation and FNA diagnosis.

Recurrent dermatofibrosarcoma protuberans over anterior abdominal wall.

A 45-year-old female complained of a painless swelling, which had developed in the epigastric region, and was slowly growing in size over the last one year. The patient had undergone excision of a similar swelling at the same site seven years ago and was now facing recurrence. Histopathology and immunohistochemical (IHC) examination confirmed the diagnosis of Dermatofibrosarcoma Protuberans.

Duodenal stenosis secondary to tuberculosis.

An 18-year-old man presented with complaints of epigastric pain, vomiting after meals, loss of appetite and weight, evening rise of temperature, and irregular bowel movements. Barium meal follow-through revealed a dilated stomach and first and second parts of the duodenum and stenotic lesion in the second part of the duodenum. Endoscopic biopsy of the stenotic lesion revealed acute on chronic nonspecific duodenitis with fibrosis. Isoperistaltic antecolic gastrojejunostomy was done to bypass the obstruction, and enlarged lymph nodes were biopsied. The biopsy of the enlarged lymph nodes revealed changes consistent with tuberculosis; therefore, the patient was started on antituberculous drugs in the postoperative period.

Congenital paraesophageal hiatus hernia with gastric volvulus.

Paraesophageal hiatus hernia is rarely seen in the neonatal period. An intrathoracic gastric volvulus complicating such a hernia is rarer. The upper gastrointestinal tract contrast study is diagnostic. Rapid diagnosis and treatment is essential. It avoids lethal complications as gastric dilatation, gangrene and perforation, which in turn may lead to cardiopulmonary arrest.