Solitary scalp metastasis - a rare presentation of hepatocellular carcinoma.

INTRODUCTION: Hepatocellular carcinoma (HCC) is among the commonest cancers in the world. Metastasis is one of the most significant factors affecting prognosis. Common sites of extrahepatic metastases include lungs, regional lymph nodes and less commonly bone. CASE PRESENTATION: A 56-year-old male presented with a painless occipital scalp lump of three months duration, with recent rapid enlargement. His skull x-ray showed a lytic lesion over occipital bone and the contrast CT scan of the brain showed a scalp mass with destruction of the adjacent skull. Core biopsy of the lesion revealed a metastatic deposit from a hepatocellular carcinoma. CONCLUSION: Primary presentation with skeletal metastases are rare in HCC with only a few reported cases. Here we report a case of HCC presenting as a solitary scalp lump.

Jejunal obstruction due to a variant of transmesocolic hernia: a rare presentation of an acute abdomen.

BACKGROUND: Internal hernias include paraduodenal, pericecal, through foramen of Winslow, intersigmoid and retroanastomotic hernias. These hernias could be either congenital or acquired after abdominal surgery. They account for approximately 0.5-5 % of all cases of intestinal obstruction. CASE PRESENTATION: A 48-year-old female was admitted to casualty with a history of abdominal distension and vomiting of 3 days duration. An abdominal X-ray supine film showed multiple small bowel loops with air fluid levels. On surgery she was found to have a transmesocolic hernia. The defect in the transverse mesocolon was repaired. CONCLUSION: The clinical signs and symptoms of lesser sac hernia are non-specific. These rare lesser sac hernias can be lethal. Therefore, immediate diagnosis and surgery is essential. Although a rare entity, they account for significant mortality form intestinal obstruction. We report an extremely rare case of an internal abdominal hernia through the transverse mesocolon, in a young woman.

Pancreatic desmoplastic small round cell tumour--a rare presentation of painful obstructive jaundice.

CONTEXT: Pancreatic desmoplastic small round cell tumour (DSRCT) is an extremely rare malignancy of which very few reports exist. It follows an aggressive course and has a dismal prognosis. CASE REPORT: A twenty-four-year-old male presented with a one-month history of rapidly progressive obstructive jaundice associated with abdominal pain suggestive of a biliary colic. Contrast-enhanced CT (CECT) of the abdomen revealed a pancreatic head mass. He underwent a pancreaticoduodenectomy and adjuvant chemotherapy and is disease free one year after surgery. CONCLUSION: This is the first reported case of a pancreatic head DSRCT, discovered in a young male investigated for a short history of painful obstructive jaundice.

Minithoracotomy oesophagectomy for oesophageal carcinoma with aberrant right subclavian artery: a rare case of dysphagia.

BACKGROUND: Aberrant R/subclavian artery is a rare congenital anomaly involving aortic arch. Oesophageal carcinoma with associated aberrant R/subclavian artery is very rare and only few cases has been reported in literature. If unrecognized and injured during oesophageal surgery, it can lead to disastrous complications. When associated with oesophageal carcinoma, it can cause diagnostic confusion as the symptoms are similar. CASE PRESENTATION: A 60 year old previously healthy female presented with intermittent dysphagia, odynophagia and loss of weight of 3 months duration. She was found to have a oesophageal carcinoma with incidentally co-existing aberrant R/subclavian artery. CONCLUSION: Although rare this entity should be considered as a differential diagnosis in a patient with dysphagia. In addition, pre-operative identification is important to prevent intra operative vascular complications. The diagnosis and treatment of this rare condition is discussed in this article.

Neurofibroma invading into urinary bladder presenting with symptoms of obstructed defecation and a large perineal hernia.

BACKGROUND: Pelvic floor hernias pose a diagnostic and a treatment challange. Neurofibromatosis is a rare systemic disease, and urinary tract involvement is rare. CASE PRESENTATION: Here we report a case of a 54-year-old female with multiple neurofibromatosis who presented with features of obstructed defecation and was found to have a large perineal hernia. At surgery, we found an unusual herniation of a large neuropathic bladder and rectum through a perineal defect. She underwent reduction cystoplasty and repair of the pelvic floor using a prolene mesh. Subsequent histopathological examination confirmed a large neurofibroma infiltrating the urinary bladder. CONCLUSION: Neurofibromatosis of the bladder is rare it should be considered as a differential diagnosis in patients presenting with symptoms of obstructed defecation.