Correlation of Preoperative Anemia Subtypes with Tumor Characteristics, Systemic Inflammation and Immediate Postoperative Outcomes in Gastrointestinal Cancer Patients - A Prospective Observational Study.

PURPOSE: Patients with gastrointestinal (GI) malignancies more frequently present with anemia. A large proportion of them exhibit a systemic inflammatory response causing anemia of chronic disease. Although tumor factors play an essential role in determining the prognosis, studies have also reported the role of host factors in the outcome. This study was done to determine the association between systemic inflammation, tumor characteristics, and immediate postoperative outcome among various anemia subgroups. METHODS: This was a single-center, prospective observational study of patients undergoing treatment for GI cancers. The modified Glasgow Prognostic Score (mGPS) was calculated, and patients were followed up until discharge regarding postoperative complications, length of the hospital, ICU stay, and mortality. The patient demographics, tumor characteristics, systemic inflammation, and postoperative complications were studied among different subtypes of anemia. RESULTS: A total of 209 patients were analyzed, and a higher prevalence of normocytic anemia (52.63%) and systemic inflammatory response (62.21%) was observed among the study population. Systemic inflammation was significantly associated with a higher nodal stage (p = 0.02) and margin positivity (p = 0.006). Patients with higher mGPS had significantly higher requirements for blood transfusion (p = 0.003), superficial SSI (p = 0.03), and sepsis (p = 0.02); however, other postoperative complications were comparable among patients without an inflammatory response. CONCLUSION: Higher prevalence of normocytic anemia is observed among patients with gastrointestinal cancer. Normocytic anemia is significantly associated with systemic inflammation with no significant difference in tumor characters and immediate postoperative outcomes.

Pulmonary cryptosporidiosis in a case of adenocarcinoma of stomach: A rare case report.

Cryptosporidium species are commonly known to cause chronic intractable diarrhea in patients suffering from human immunodeficiency virus (HIV)-acquired immunodeficiency syndrome, however extra-intestinal presentations have been rarely reported. Hereby, we report a rare case of isolated pulmonary cryptosporidiosis in a 75-year-old HIV-negative patient with metastatic carcinoma of the stomach who was managed conservatively with hemostatic radiotherapy for palliative care. The patient had presented with cough with expectoration for 2 months. Sputum microscopic examination was suggestive of pulmonary cryptosporidiosis. There was no evidence of intestinal cryptosporidiosis. Therapy for pulmonary cryptosporidiosis was started with tablet nitazoxanide. The patient succumbed to the disease few days later following discharge. Although rare, patients with disseminated gastrointestinal malignancy can potentially have isolated pulmonary cryptosporidiosis.

The Association Between Helicobacter Pylori and Perforated Gastroduodenal Ulcer.

Background Although the role of Helicobacter pylori (H. pylori) is well known in peptic ulcer disease (PUD) etiology, its role in perforated peptic ulcer (PPU) is not well established. This study aimed to assess the role of H. pylori infection in patients with PPU and to compare it with its prevalence in patients with PUD. Methodology This prospective analytical study was conducted for two years. The study patients were classified into two groups: group I consisted of patients (n = 48) operated for PPU and group II were patients (n = 48) with PUD diagnosed by endoscopy. The study excluded patients with any previous anti-H. pylori treatment, gastric malignancy, conservative management of sealed PPU, and those with a diameter of perforation less than the diameter of endoscopic biopsy forceps. Blood samples were taken for H. pylori serology IgG (ELISA) test. The mucosal biopsy samples from both the groups were tested with a rapid urease test and modified Giemsa stain examination to detect H. pylori. Results The prevalence of H. pylori infection were significantly less in patients with PPU than with PUD: by rapid urease: 12.5% vs. 31.2%, p: 0.002; modified Giemsa stain: 10.4% vs. 31.2%, p: 0.012; and IgG serology: 50 % vs. 68.7%, p: 0.012, respectively. Alcohol and tobacco were significant risk factors (p: 0.002 vs. p: 0.002 respectively). However, nonsteroidal anti-inflammatory drugs (NSAIDs) use was not a significant risk factor for PPU (p: 0.083). Conclusion H. pylori infection was not significantly associated with PPU. Some other factors like alcohol intake and tobacco were also involved in perforation. We can conclude that H. pylori infection is not a risk factor for PPU.

Pigtail catheter drainage and surgery in severe acute pancreatitis.

BACKGROUND AND AIM: Severe acute pancreatitis is initially managed with conservative treatment. Patients who failed conservative management were effectively treated with pigtail drainage. Factors predicting surgery remain uncertain. METHODS: A total of 58 patients with severe acute pancreatitis presenting to JIPMER Hospital were studied and managed with a step-up approach. In this prospective observational study, patients were divided into three groups based on the final mode of treatment received: conservative, pigtail alone, and surgery groups. RESULTS: Of 58 patients, 30 patients were managed with conservative treatment, 20 patients with pigtail alone, and 8 patients underwent surgical treatment after pigtail failure. Overall sepsis reversal was achieved in 22 of 28 (78.5%) patients: 18 were in the pigtail alone group, and 4 were in surgery group, which was statistically significant (P = 0.03). Respiratory failure was the most common organ failure, 68.9%, and overall mortality was 8.62 in this study. On univariate analysis, absence of sepsis reversal within 2 weeks of pigtail insertion is a predictor of need of surgery. Other significant findings were higher catheter-related complications in the surgery group (P = 0.01) and a 100% unimicrobial infection in the surgery group (P = 0.02). Overall mortality was 8.6%, which did not differ significantly between the groups. CONCLUSION: The step-up approach avoided unnecessary intervention, and 52% patients recovered by conservative treatment alone. Sepsis reversal within 2 weeks of pigtail insertion can be used as a predictor of surgery in the early course of severe acute pancreatitis managed by the step-up approach.

Appropriateness of American Society for Gastrointestinal Endoscopy Guidelines for Upper Gastrointestinal Endoscopy: A Prospective Analytical Study.

Introduction Extensive use of upper gastrointestinal endoscopy (UGE) with the advent of open access centers has resulted in inappropriate endoscopies. Our study aimed to evaluate the appropriateness of American Society for Gastrointestinal Endoscopy (ASGE) guidelines for UGE and to assess the diagnostic yield of endoscopy in a tertiary care center in South India. Methods The study was conducted as a prospective analytical study. Indications for endoscopy were classified as "ASGE appropriate" and "ASGE inappropriate". The significance of association of ASGE guidelines and other categorical variables with endoscopic findings were assessed. Results ASGE appropriate indications and inappropriate indications accounted for 85.9% and 14.1% of endoscopies, respectively. The most common appropriate indication was persistent dyspepsia despite adequate proton-pump inhibitor (PPI) therapy (28.1%) and the only inappropriate indication for endoscopy was isolated dyspepsia without adequate PPI therapy (14.1%). The diagnostic yield of endoscopy for appropriate indications was 69.5% and for inappropriate indications was 55.1%, the difference was statistically significant (P= 0.003; OR-1.857). The sensitivity and specificity of ASGE guidelines was 88.5% and 19.5%, respectively. Conclusion According to our study, ASGE guidelines may be considered as appropriate guidelines for UGE in our population and these guidelines were followed 85.9% of the times in referring patients for the same. However, the high diagnostic yield even in inappropriate endoscopies indicates the necessity of further studies that might identify other relevant indications for endoscopy, thus avoiding misutilization of resources without missing out on relevant cases.

Comparison of Endoscopic Variceal Ligation with Endoscopic Sclerotherapy for Secondary Prophylaxis of Variceal Hemorrhage: A Randomized Trial.

Background Though endoscopic variceal ligation (EVL) is commonly being used and has overcome the disadvantages of sclerotherapy (ST), still sclerotherapy is used as a therapeutic procedure for bleeding esophageal varices in the present institute. Hence, the study was done to see the advantages of EVL over ST. Methods Patients with portal hypertension and bleeding esophageal varices underwent banding if found to have grade 3 or 4 varices. They were randomized to EVL group, where they were reviewed after two weeks for any residual varices for which repeat banding was done and endoscopic sclerotherapy (EST) group, where ST was done until the varices were obliterated or reduced to grade 1. The efficacy, complications, recurrent bleeding rate and recurrence of varices were compared. Results A total of 60 patients were included, 30 in each group. In EVL group, four sessions were needed to eradicate the varices in 73% of patients while it was five sessions in EST group (46% patients) (p-value = 0.0001). The mean number of sessions needed in EVL and EST group was 3.73 and 5.36, respectively. The average time taken for eradication of varices was 78.6 and 134.6 days in EVL and EST group, respectively (p-value = 0.004). Complications were higher in EST group (p-value < 0.05). Conclusion EVL alone was effective than ST in terms of the number of sessions needed for eradication of varices and total duration required to completely obliterate them. The complications were less in EVL group with no significant difference in recurrent bleeding rate and recurrence of varices between the groups.

Effect of Comprehensive Surgical Safety System on Patients' Outcome: A Prospective Clinical Study.

Background Patient safety has become an integral part of hospital management to prevent catastrophic events which adversely affects the patients, care providers and the hospital. Surgical Checklists are an easy and simple way to prevent surgical errors and complications. Objective This prospective study is to evaluate the effect of SURPASS (Surgical Patient Safety System) checklist on the outcome of the patients who underwent surgery in our hospital. Methods All the patients who underwent surgery in the sixth unit of Department of Surgery from April 2014 to May 2015 were included in the study excluding those aged above 13 years and day care surgery cases. For the control group (initial six months) no checklist was implemented whereas for the study group (next six months) SURPASS checklist was implemented. Data collected on age, sex, diagnosis, surgical procedure, type of anaesthesia, number and type of postoperative complications, need of second surgery because of complications, length of hospital stay and outcome (discharge, disability or death). Mann-Whitney U test and Fisher's exact test were used for analysis. Results Of the total 372 patients operated, 200 were before and 172 were after implementation of SURPASS checklist. Before implementation of the checklist, complications were noticed in 66.66% of elective and 77.23% of emergency cases. Whereas after implementation of checklist the complications in elective cases were found to be 51.09% (p-value = 0.008) and 67.50% (p-value = 0.024) in emergency cases. Conclusion Implementation of SURPASS checklist is effective in reducing the rate of postoperative complications in both elective and emergency surgeries.

Concurrent Chemoradiation Affects the Clinical Outcome of Small Bowel Complications Following Pelvic Irradiation: Prospective Observational Study from a Regional Cancer Center.

Background To appraise the spectrum of small bowel complications following pelvic irradiation and to assess the clinical outcome and factors associated with adverse clinical outcome in these patients. Methods This descriptive clinical study was done for three years in a tertiary care center in South India. Patients managed for post-irradiation small bowel complications, irrespective of the indication for radiotherapy, were studied. Patients with associated non-gastrointestinal radiation toxicity, radiation proctitis, and radiation colitis were excluded. The parameters assessed were the range of small bowel complications, a comparison of operative and non-operative management, morbidity and mortality, the severity of complications in relation to the dose of radiotherapy, and various factors influencing the clinical outcome. Results A total of 50 patients were studied. Stricture and perforation peritonitis were the most common presentation (n=25; 50%). A majority of the patients (n=37; 74%) presented after six months following radiotherapy. Post-operative mortality was 16% (n=5). Age, body mass index (BMI), previous surgery, operative intervention, primary or adjuvant radiotherapy, concurrent chemoradiotherapy (CCRT), and various radiation protocols were not associated with adverse clinical outcomes with respect to overall mortality, the requirement of surgery, and operative mortality. However patients who were operated and those who received CCRT had a significantly longer mean intensive care unit (ICU) stay (3.51 days vs. 0.68 days; p = 0.0001) as well as overall mean hospital stay (14.87 days vs. 5.58 days; p = 0.001) and an insignificant mortality rate (16% vs. 15%; p = 0.4085). Conclusion The present study observed that the patients who were operated and those who received CCRT had significantly longer hospitalization and relatively higher mortality. Considering the fact that many of the patients who develop post-irradiation complications may not report back to the same center, the incidence of small bowel complications could be higher in reality, which ascertains the necessity for more precision in the radiation technique and operative care in developing countries.

A Surgical Conundrum in Feeding Jejunostomy-Jejunojejunal Intussusception: A Case Series.

Intussusception is a common cause of intestinal obstruction in the pediatric population. Usually, it is primary and benign and can be managed by nonoperative interventions in 80% of the cases. Adult intussusception accounts for only 5% of all cases of intussusception and 1%-5% of all cases of intestinal obstruction. Unlike in the pediatric population, intussusception in adults is usually caused by a pathologic lead point. The initial investigation to diagnose it is an ultrasound abdomen followed by contrast-enhanced computed tomography (CECT) of the abdomen. The placement of an intestinal tube for feeding purposes has been rarely reported as a cause of intussusception. Here, we present a case series of four patients who had jejunojejunal intussusception following the placement of feeding tubes into the jejunum. Three patients were operatively managed and one was managed conservatively.

A Masquerading and Unconventional Cause of Dynamic Intestinal Obstruction: Strangulated Obturator Hernia.

Obturator hernia is an extremely rare type of abdominal wall hernia occurring mostly in elderly, thin females. It is characterized by the herniation of intra-abdominal contents through the obturator foramen. Symptoms are often nonspecific, and the patient usually presents with an acute or subacute intestinal obstruction. A high index of suspicion is needed in such females presenting with abdominal distention and positive Howship-Romberg signs. Computed tomography of the abdomen and pelvis are often necessary to arrive at a diagnosis, and immediate surgical intervention is recommended. The high postoperative morbidity and mortality are often attributed to a delay in the diagnosis and in initiating treatment. We present a case of a 65-year-old lady with strangulated obturator hernia who underwent emergent, lower midline laparotomy with resection and anastomosis of the small bowel and purse-string repair of the hernial defect.

Comparing Surgical Site Infection and Scar Cosmesis Between Conventional Linear Skin Closure Versus Purse-string Skin Closure in Stoma Reversal - A Randomized Controlled Trial.

Introduction Stoma closure is one of the most frequently performed surgeries. The common complications are surgical site infection (SSI) and poor scar cosmesis. Purse-string sutures are expected to have less incidence of SSI due to the free drainage of secretions from the wound and possibly the early detection of a wound infection. Compared to the conventional linear closure, the purse-string closure technique is expected to have less wound infection, improved scar cosmesis, and good patient satisfaction because of a smaller size scar. Hence, a well-structured study is required to substantiate the advantage of this technique. Methodology This randomized control trial was carried out for two years in a tertiary care centre in Southern India. Patients with various stoma reversals, including colostomy, as well as ileostomy reversal, were included in the study. Patients were divided into Group I - conventional linear skin suturing (n = 40) and Group II - purse-string closure (n = 40). After the closure of rectus muscle, the skin is closed using the purse-string method (subcuticular) in the experimental group. Results Both the groups were comparable with respect to age, gender, body mass index (BMI), the presence of co-morbidities, and indication for surgery. Stomal procedures were done (26.3%) for malignant cases. The difference in mean hospital days for both groups were statistically insignificant (11.95 vs. 9.9; p = 0.927). The incidence of SSI between the groups were statistically significant (17 vs. 3; p = 0.003). The mean Patient and Observer Scar Assessment Scoring (POSAS) scores between the groups (65.30 vs. 83.40; p = 0.012) were statistically significant. This proved significant improvement in scar cosmesis in purse-string skin closure. At one month postoperative, the purse-string group had better patient satisfaction (3.08 vs. 4.48; p = 0.001), which was evidenced by a mean Likert 3 scale score. The mean visual analogue scale (VAS) score did not show any significant difference in pain between the groups. Conclusion Purse-string skin closure for stoma reversal had significantly less incidence of SSI. The duration of antibiotic therapy was also less in purse-string skin closure patients as compared to linear skin closure patients. Purse-string skin closures significantly improved the scar outcome and patient satisfaction.

Medical students' perception of the educational environment in a tertiary care teaching hospital in India.

Background: The educational environment perceived by students has an impact on satisfaction with the course of study and academic achievement. We aimed to analyse the perceptions of medical students about their learning environment and to provide feedback to stakeholders involved in curriculum planning and execution. Methods: We did a cross-sectional descriptive study at Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry using the Dundee Ready Educational Environment Measure (DREEM) questionnaire. The DREEM inventory was administered to the undergraduate students of all semesters (n = 452). Students' perceptions of learning, perception about teachers, academic self-perceptions, perceptions of atmosphere and their social self-perceptions were measured. The scores obtained were expressed as mean (standard deviation) and analysed using t-test and 1-way ANOVA (with post-hoc comparison using Tukey test). The difference between semesters and gender was also analysed. Results: The mean (SD) global score was 122.06 (22.27), out of a maximum possible score of 200. Our students opined that teachers were knowledgeable, with this component scoring the maximum of 3.32 and, at the same time, they felt that teaching overemphasizes factual learning (1.41). Only 6 items scored <2. 'Students' perception of atmosphere' scored high among other domains (30 of 48, 62.5%). The mean global score of preclinical students (125.35 [20.43]) was better than clinical students (119.13 [23.44]; p = 0.003). Conclusion: Although the global score is more positive, we identified a few areas of concern such as overemphasis on factual learning, authoritarian teachers, the not-so-helpful existing learning strategies, vast curriculum (inability to memorize all), lack of supporting system for stressed out students and the boredom they felt in the course. These vital areas should be addressed by the stakeholders for the betterment of learning in the institute.

Laparoscopic versus Open Repair of Para-Umbilical Hernia- A Prospective Comparative Study of Short Term Outcomes.

INTRODUCTION: Para-Umbilical Hernia (PUH) is one of the most common surgical problems. Since the prosthetic repair has become the standard of practice for inguinal hernia management, the same has been adapted for para-umbilical hernia management with better outcome. There is still debate going on regarding the optimal surgical approach. There are very few prospective studies comparing the laparoscopic and open method of para-umbilical hernia mesh repair. This study compared the short term outcomes following laparoscopic versus open mesh repair of PUH. AIM: To compare the early complications of open repair with laparoscopic repair of PUH. To compare the post-operative hospital stay of open repair with laparoscopic repair of PUH. MATERIALS AND METHODS: This was a prospective comparative clinical study done from August 2014 to August 2016. All the patients above the age of 13 who attended our surgical outpatient department with PUH were taken into our study. Exclusion criteria included 1) Patients with obstructed or strangulated PUH 2) Patients with abdominal malignancies 3) Patients with coagulopathy, severe cardiopulmonary disease, ascites and renal failure 4) Patients who had PUH repair in combination with another major surgical operation such as laparoscopic cholecystectomy and inguinal hernia repair 5) Patients with recurrent PUH. Institute Ethical Committee clearance was obtained for this study. RESULTS: Out of 40 patients with PUH, 20 received open meshplasty and 20 patients received laparoscopic meshplasty. Postoperative pain and length of hospital stay is significantly less in laparoscopic PUH repair. Postoperative complications like wound infection, seroma, and haematoma are relatively less in laparoscopic group though statistically not significant. CONCLUSION: Laparoscopic PUH repair has significantly better outcome in terms of postoperative pain and postoperative hospital stay.

Clostridium perfringens - A bacterial pathogen gaining recognition in necrotizing pancreatitis.

We report an interesting case of necrotizing pancreatitis due to Clostridium perfringens in an elderly man who came to the hospital with complaints of severe abdominal pain. The infection further worsened with the dissemination to other internal organs. The patient did not show any improvement despite intensive care and treatment. This emphasizies the fact that early diagnosis and appropriate treatment would reduce the morbidity associated with necrotizing pancreatitis.

Retroperitoneal Necrotizing Fasciitis Masquerading as Perianal Abscess - Rare and Perilous.

Necrotizing fasciitis is one of the uncommon presentations of a rapidly spreading subcutaneous tissue infection. Although the actual cause is unclear in many cases, most of them are due to the rapid proliferation of microorganisms. Retroperitoneal necrotizing fasciitis is extremely rare. It is a potentially lethal infection that requires immediate and aggressive surgical care. Early diagnosis is the key to a better prognosis. The possibility of retroperitoneal necrotizing fasciitis should be suspected in patients with symptoms of sepsis that are disproportionate to clinical findings. The rapid deterioration of the patient also gives a clue towards the diagnosis. We report a 35-year-old male with perianal abscess who had been progressed to retroperitoneal necrotizing fasciitis. The patient was managed successfully with aggressive debridement and drainage after laparotomy. Appropriate antibiotics were used to combat the sepsis. The patient recovered well at follow up, three months after discharge. Another patient, a 45-year-old male with a retroperitoneal abscess, progressed to retroperitoneal necrotizing fasciitis, and extra peritoneal drainage and debridement was done. Antibiotics depending upon the culture and sensitivity were used to control sepsis. But the patient succumbed to death 45 days after surgery due to uncontrolled sepsis. Necrotizing fasciitis of any anatomical site needs aggressive surgical care with early intervention. But retroperitoneal necrotizing fasciitis needs an extra effort for diagnosis. After diagnosis, it needs timely surgical intervention and appropriate antibiotic therapy for the recovery of the patients.

Giant Intramuscular Nodular Fasciitis Masquerading as Soft Tissue Sarcoma with Neural Involvement - A Case Report.

Nodular Fasciitis (NF) is described as a benign reactive proliferation of myofibroblasts that occurs predominantly in the subcutaneous location. Most commonly presents as rapidly growing swelling in the young adults, with usual size of less than 4cm and located commonly in the extremities. We hereby report a case of giant nodular fasciitis of 10cm diameter which presented in an unusual location (gluteal region) and rare plane of origin (intramuscular) with unusual symptom of sciatic nerve involvement. Because of the size, location and neural involvement a clinical diagnosis of soft tissue sarcoma was made. After investigating with trucut biopsy and magnetic resonance imaging, benign nature of the lesion confirmed and treated with complete excision, carefully preserving the sciatic nerve. This case is presented for its rarity in size, location, plane of origin and neural compression. To the best of our knowledge this is the first case of nodular fasciitis of 10cm size and in the gluteal muscles.

Rectal adenocarcinoma infiltrating the bulbar urethra and metastasising to the penis.

Secondary penile tumours from rectal carcinoma is a known clinical entity but can be missed unless carefully evaluated. We report a case of rectal adenocarcinoma with synchronous painless penile nodules. A patient presented with constipation and rectal bleeding. He had an anorectal growth as well as palpable nodules on his penis. Rectal biopsy yielded adenocarcinoma. Imaging revealed direct infiltration of tumour into the bulb of the penis as well as distal shaft lesions. Fine-needle aspiration cytology of the penile nodule showed metastatic adenocarcinoma. Diversion colostomy was performed and the patient referred for chemoradiation. Since he did not have any urinary symptoms, the penile lesions were left unaltered. Repeat imaging after concurrent chemoradiotherapy showed no response. The prognosis was explained and the patient was given palliative clinic care.

Pilomatrixoma - Presented as Hypopigmented Tender Nodule: Diagnosed by FNAC: A Case Report with Review of Literature.

Pilomatrixoma (PMX) is a skin appendage tumor of hair matrix origin, which usually occurs on the face or upper extremities. Although the lesion can appear at any age, it is commonly seen in children and is more common in females. Despite being better defined, pilomatricomas continue to be frequently misdiagnosed and are not usually considered in differential diagnoses, either in clinical set-up or during cytological reporting. They typically present as a superficial, firm, solitary, slow-growing, painless mass in the dermis. The overlying skin may be normal or exhibit a bluish-red discoloration or ulceration. We report an 18-year-old girl presented with tender, subcutaneous nodule with overlying skin showing atrophy and hypopigmentation. Clinically, it was diagnosed as neurofibroma and sent for FNAC. We offered precise diagnosis of pilomatrixoma on cytological examination, (where chances of wrong diagnosis are very high) and it was subsequently confirmed by histopathology. We discuss the varied clinical presentations, diagnostic difficulties, and differential diagnoses of PMX.

Median raphe cysts of the prepucial skin, with triple histological linings: a case report and review of the literature.

A median raphe cyst is an uncommon entity. An extensive literature search has revealed only less than 200 reported cases. Among these, only less than 10 have been reported from the Indian subcontinent. Usually, it is located in the midline, anywhere between the urethral meatus and the anus. We are presenting a case of a prepucial median raphe cyst, which occurred at a very uncommon location, which presented with symptoms, which is also a rare scenario. This case has been presented for its rare location, uncommon clinical presentation and an interesting triple lining presentation in histology.

An ectopic breast tissue presenting with fibroadenoma in axilla.

Introduction. The congenital anomalies of breast, especially the polymastia (supernumerary breast) and polythelia (supernumerary nipple), always do not fail to amuse the clinicians because of their varied presentations, associated renal anomalies, and pathologies arising from them. The axillary polymastia is a variant of ectopic breast tissue (EBT). Ectopic breast tissue can undergo the same physiological and pathological processes as the normally located breast. The incidence of fibroadenoma developing in ectopic breast is reported as a rare entity, the most common being the carcinoma. Case Presentation. A 31-year-old Dravidian female presented with a lump of 4 cm in the right axilla for the past year which gradually increased in size, giving discomfort. Our initial differential diagnosis was fibroadenoma, lipoma, and lymphadenopathy. Further investigation and histopathological report of excision biopsy confirmed it as a fibroadenoma on ectopic breast tissue in the axilla. Patient has no associated urological or cardiac anomaly. Conclusion. This case has been reported for its rarity and to reemphasise the importance of screening of EBT for any pathology during routine screening of breast.