A Rare Case of Primary Mesenteric Liposarcoma.

Primary mesenteric liposarcoma is a rare soft tissue malignant neoplasm. The authors present a case of a 42-year-old male with pain in the abdomen and abdominal mass which showed a desmoid tumor on biopsy and CT shows a mesenteric mass present. The patient underwent exploratory laparotomy and a large tumor was excised. The specimen was sent for histopathology and showed dedifferentiated liposarcoma of the mesentery. Immunohistochemistry showed the tumor cells are diffusely positive for mouse double minute 2 (MDM2), p16, and show patchy positivity for the cluster of differentiation (CD) 34. The cells are negative for smooth muscle actin (SMA), desmin, S100, and ckit. After the surgery, the patient recovered well and was given adjuvant chemotherapy with doxorubicin, ifosfamide, and mesna. The patient has no signs or symptoms of recurrence to date. In this case, the combination of surgery and chemotherapy has shown to have a good clinical outcome.

Oh, My Gauze !!!- A rare case report of laparoscopic removal of an incidentally discovered gossypiboma during laparoscopic cholecystectomy.

INTRODUCTION: The work has been reported in line with the SCARE criteria. The most common retained foreign body during surgery is woven cotton surgical sponge, which includes both laparotomy pads and smaller sponges. Sponges are easily retained because of their ubiquitous use, relatively small size and when soaked in blood, sponges conform to and can be difficult to distinguish from surrounding tissues. The problem of retained surgical sponge is known as gossypiboma, and also as 'textiloma', 'gauzoma' or 'muslinoma'. The number of preoperatively diagnosed cases treated by laparoscopic approach is rare in the literature and laparoscopic removal of incidentally detected gossypiboma with concomitant laparoscopic cholecystectomy is not yet reported in the literature. PRESENTATION OF CASE: In 40-year-old female with caesarean section 5 years ago, now during elective laparoscopic cholecystectomy and umbilical hernia repair, an incidentally detected Gossypiboma was encountered. The Gossypiboma was safely excised by laparoscopic technique followed by laparoscopic cholecystectomy and open hernia repair. DISCUSSION: Postoperative complications following surgery are common and mostly unavoidable but some like the gossypiboma are infrequent and avoidable. Most of them are asymptomatic and present in the body for a long period of time. However, once discovered these foreign bodies must be removed for which laparoscopy proves to be a better approach. Most of these cases also are under-reported due to medicolegal implications. CONCLUSION: Gossypiboma is one of the preventable complications of surgery by the compliance of certain measures perioperatively. If detected incidentally, it can be safely managed laparoscopically with a shorter post-operative hospital stay and better cosmetic results.

The Efficacy and Safety of Tetrachlorodecaoxide in Comparison with Super-oxidised Solution in Wound Healing.

BACKGROUND: Some of the relatively newer, more efficacious, and potent topical wound dressing solutions include tetrachlorodecaoxide and super-oxidised solution. This study compares the efficacy and safety of these two drugs. METHODS: This is a block-randomised, double blind, parallel-arm, post-marketing study. One hundred fifty patients with ulcers (75 blocks uniform for sex, ulcer aetiology, diabetes mellitus, and wound area score) were randomised into the two treatment arms. Patients were observed for eight weeks with weekly assessments. One hundred and twenty patients completed the study. Wound healing was objectively assessed by measurement of wound area, scoring of wound exudation and tissue type, and using the pressure ulcer scale of healing Tool (validated for multiple wound aetiologies). Subjective improvement in pain was noted using a visual analogue scale. Both groups were compared using Mann-Whitney U test on all indicators. RESULTS: Difference in change in wound tissue type in the two groups was significant (α=0.05) by intention-to-treat (ITT) and per-protocol (PP) analysis at the end of week two (ITT and PP, P<0.001) and week four (ITT, P=0.010; PP, P=0.009). P-values for other comparisons were not significant (P>0.05). No study-related adverse events were observed. CONCLUSIONS: Both drugs are efficacious. Tetrachlorodecaoxide yields healthy granulation tissue earlier. Both drugs appear to be safe for application.

Tuberculous osteomyelitis of sternum secondary to primary tuberculous mastitis.

Sternal tuberculosis secondary to tuberculous mastitis is uncommon. The invasion of the sternum following a primary focus in the breast has not been reported. This may be due to the resistance offered by pectoral fascia and periosteum to the spread of infection into the bone. We present a case of tubercular sternal osteomtyelitis following tubercular mastitis in a 40-year old female. A brief case report and a review of literature are presented.

Retention of an endoscopic capsule.

Capsule endoscopy is a highly advanced, newer technology to look for small bowel diseases. But it has certain contraindications such as bowel narrowing, strictures that have to be ruled out on Barium studies or with computed tomography. We present a rare case of retention of endoscopic capsule even after ruling out stricture or bowel thickening on radiological imaging.

Special Relevance of FDG-PET as an Upfront Diagnostic Modality at Initial Diagnosis and in Suspected Recurrence in Patients of Breast Carcinoma Hailing From Lower Socioeconomic Status Owing to Relative Late Presentation: A Pilot Study in a Medical College Hospital Setting in India.

FDG-PET has found relatively limited use in routine management of breast carcinoma due to its limited utility in assessing the primary and axillary lymph node status. The aim of the study was to assess its role in a medical school and municipal hospital setting of Mumbai, where majority belongs to the lower socioeconomic status and presents relatively late and hence whole body FDG-PET could find important place for assessing whole body disease status that would justify being used upfront in this group of patients. Thus, the premise of this study was that FDG-PET will have special relevance in this particular setting for evaluation of patients of breast carcinoma with respect to initial staging, detection of locoregional recurrence and metastasis and assessing response to systemic treatment. A total of 52 patients proven to have breast carcinoma, who had undergone (18)F FDG-PET for disease staging at initial diagnosis and in in recurrent disease staging with a few cases as a baseline study for early treatment monitoring purposes over a study period of 3 years, were included in this analysis. 33.3 % of patients with pretreatment baseline FDG-PET were upstaged with diagnosis of additional lesions in the adrenal gland, liver, internal mammary, cervical lymph nodes and the mediastinum. On a lesion specific analysis, the percentage of increased lesion detection (including both lymph node with distant metastasis) by FDG-PET was 42.7 %. FDG-PET was found to be 100 % sensitive and specific for confirming recurrent breast cancer. Four out of 18 patients on chemotherapy underwent second FDG-PET after first cycle of chemotherapy, showed responsiveness to chemotherapy by decreased maximum standardized uptake value (SUVmax). FDG-PET showed 9 liver lesions in 6 patients, only 3 of them was reported in USG. In one patient USG abdomen was inconclusive between hemangioma and metastasis, FDG-PET ruled out liver metastasis in this patient. In the examined patient population belonging to lower socioeconomic status, where usual presentation is relatively late, upfront whole body survey with FDG-PET or PET/CT is of considerable value in view of higher probability of existence of metastatic disease, thus can be an important one-stop shop tool in assessing whole body disease status in a single examination. It also proved efficacious in diagnosing loco regional and distant recurrence, metabolic characterization of lump and early response to treatment in the examined few cases following one cycle of chemotherapy in locally advanced breast cancer.

Pelvic neurofibroma.

A 58-year old male presented with a hard lump in lower abdomen extending into pelvis. Clinical examination and computed tomography scan revealed pelvic retroperitoneal mass. Patient underwent exploratory laparotomy - revealing a well encapsulated retroperitoneal mass extending up to coccyx, posterior to the urinary bladder. It had displaced the recto-sigmoid colon and urinary bladder to the right. Histopathological findings revealed a neurofibroma. Pelvic neurofibromas are known to arise from certain pelvic organ. However, present case ruled out any organ involvement both on imaging and intraoperatively. This shows that these tumors can arise de novo also. A brief case report and review of literature is presented.

Laparoscopic excision of mesenteric cyst of sigmoid mesocolon.

Mesenteric cysts are rare abdominal tumours. They are found in the mesentery of small bowel (66%) and mesentery of large intestine (33%), usually in the right colon. Very few cases have been reported of tumours found in mesentery of descending colon, sigmoid or rectum. Mesenteric cysts do not show classical clinical findings and are detected incidentally during imaging due to absent or non-specific clinical presentation or during management of one of their complications. Ultrasonography (USG)/computed tomography (CT)/ magnetic resonance imaging (MRI) are used in diagnosing mesenteric cyst but they cannot determine the origin of cyst. Laparoscopy not only helps in diagnosing the site and origin of the mesenteric cyst but also has a therapeutic role. Laparoscopic treatment of mesenteric cyst is a safe, preferred method of treatment and is a less-invasive surgical technique. Here, we present an unusual case of mesenteric cyst arising from the sigmoid mesocolon treated by laparoscopic excision.

Retropancreatic Teratoma with Intra-thoracic Extension.

Primary retroperitoneal teratoma is a rare entity in adults. We present a case of 23-yearsold female who presented with complaint of abdominal pain in left upper quadrant. Computed tomography scan revealed a retroperitoneal retropancreatic teratoma near celiac axis with intra thoracic extension. Laparotomy with tumor resection was done. The case report is interesting for intra thoracic extension of retropancreatic teratoma.

Retroperitoneal approach for recurrent benign multicystic peritoneal mesothelioma.

Benign multicystic peritoneal mesothelioma (BMPM) is an uncommon lesion. It presents as a lump in abdomen or a finding seen on imaging modalities. Surgery is the primary modality of treatment. However, it has a high recurrence rate; this results in adhesions and subsequent surgeries difficult. We present a case of recurrent BMPM in a female operated twice earlier in a rural centre. Imaging modalities showed majority of the lesion in paracolic and retroperitoneal region. Hence, retroperitoneal approach for surgery was taken. This avoided previous surgical adhesions. A brief case report on this novel approach and review of literature is presented.

Adenocarcinoma of an Ileostomy in a Case of Hirschprung's Disease with Retroviral Disease.

The number of ileostomies created for benign diseases such as familial adenomatous polyposis and ulcerative colitis is increasing. Long-term ileostomies are prone to develop various complications over time. Ileostomy site carcinoma is a well-established complication in ulcerative colitis and familial adenomatous polyposis that have undergone total colectomy. However, no case of ileostomy site carcinoma has been described in a patient with Hirschprung's disease. We present the first case of adenocarcinoma at an ileostomy site in a patient with Hirschprung's disease with retroviral disease.

Mortality pattern of the 26/11 Mumbai terror attacks.

BACKGROUND: Mumbai, one of the industrial capitals cities of the world, has witnessed a series of terror attacks over the last two decades. The 2008 Mumbai terror attacks referred as "26/11" drew widespread global condemnation and killed 166 people, in addition to wounding more than 300 people. The mortality pattern and the pathophysiology of organ injuries are presented. The objective of this study was to determine the different patterns of injury in a terrorist attack of such magnitude and clinical implications in reducing mortality. METHODS: Data were collected from hospital records of 114 victims whose postmortems were conducted at the Sir JJ Group of Hospitals. The records were studied with respect to pattern and nature of injury. RESULTS: A total of 175 people were killed, 9 were terrorist with 166 victims. Of the 166 mortalities, postmortems were conducted on 114 predominately male victims ages 5 to 70 years old; 108 of these were dead on arrival. Sixty-eight people died from bullet injuries, 30 from blast injuries, and 10 had both bullet and blast injuries. Six were postoperative deaths (all bullet injuries), of which two were early postoperative deaths and four late postoperative deaths due to septicemia. CONCLUSION: There was multimodal pattern of injuries with predominance of bullet injuries sustained to vital organs. The hostage crisis resulted in varied and delayed evacuation times, which led to the death of nine victims with non-severe organ injuries. Delayed implementation of Prehospital Trauma Life Support due to the unsecured site and the hostage crisis can also be one of the causes. LEVEL OF EVIDENCE: V, epidemiological study.

Carcino-sarcoma in a case of syringocystadenoma papilliferum: a rare entity.

Syringocystadenocarcinoma papilliferum is a rare form of adenocarcinoma of the skin. It is the malignant counterpart of syringocystadenoma papilliferum (SCAP). It usually develops on the scalp in a long-standing lesion identified clinically as SCAP. Twelve cases of syringocystadenocarcinoma papilliferum have been reported in literature, with limited information regarding its clinical and histological characteristics. Sarcomatous change in a case of SCAP has not been reported in literature till date to the best of our knowledge. We present the first case of syringocystadenocarcino-sarcoma papilliferum in a middle-aged female with a satellite lesion over the scalp.

Primary hepatic choriocarcinoma: a rare cause of spontaneous haemoperitoneum in an adult.

Choricarcinoma is a beta human chorionic gonadotrophin secreting neoplasm pertinent to uterus and pregnancy mostly. It occurs primarily in gonads but rarely in extragonadal sites. Primary hepatic choriocarcinoma is an extremely rare tumor. Most of the reported cases are seen in infants representing metastasis from an occult placental choriocarcinoma. Till date, only 7 cases of primary hepatic choriocarcinoma in adults have been reported in literature. We present a case of a 40-yearold male presenting as haemoperitoneum due to ruptured hepatic tumor. He underwent emergency left lateral segmentectomy. He died on 10(th) postoperative day. The surgical specimen and autopsy findings confirmed it to be primary hepatic choriocarcinoma. This is the first case report from Indian Subcontinent. A brief case report and review of literature is presented.

E-Cadherin as a diagnostic biomarker in breast cancer.

BACKGROUND: E-cadherin is expressed in most normal epithelial tissues. Selective loss of E-cadherin can cause dedifferentiation and invasiveness in human carcinomas, leading E-cadherin to be classified as a tumor suppressor. Loss of E-cadherin has been demonstrated in invasive lobular carcinoma of the breast, but the relationship between E-cadherin expression and breast cancer histopathology and prognosis is less clear. AIM: Our objective was to assess loss of E-cadherin as a diagnostic breast cancer biomarker and as an aid to the sub-classification of invasive breast cancer. We also correlated the loss of expression of E-cadherin with various clinical and pathologic prognostic factors. MATERIAL AND METHODS: Breast cancer specimens after modified radical mastectomy were obtained from women who underwent surgery at Grant Medical College and Sir J.J Group of Hospitals, Mumbai, India between May 2007 and October 2010. We stained 276 breast cancers specimens with monoclonal antibodies to E-cadherin. The breast cancers were classified by histopathological type. RESULTS: A statistical correlation of E-cadherin loss with a positive diagnosis of invasive lobular carcinoma was found, but there was no correlation with any prognostic tumor variables. A negative E-cadherin stain was a sensitive and specific biomarker to confirm the diagnosis of invasive lobular carcinoma (specificity 97.7%; negative predictive value 96.8%; sensitivity 88.1%; and positive predictive value 91.2%). Positive E-cadherin expression was also associated with tubulolobular carcinomas. CONCLUSIONS: E-cadherin immunohistochemistry is helpful in classifying breast cancer cases with indeterminate histopathologic features. E-cadherin loss is uncommon in non-lobular carcinomas but shows no correlation to currently established prognostic variables.

Waist cancer: report of two cases.

Saree is a type of female costume unique to Indian subcontinent. This includes a superficial cloth and a skirt underneath which is fastened securely to the waist by a cord. Persistent and long-term wearing of this costume has resulted in waist dermatoses. This waist dermatoses giving rise to malignancy is being reported here and 'saree cancer' is the term used to this entity of waist cancer. Here two cases of waist cancer are reported.

Primary schwannoma of adrenal gland: a case report.

Primary schwannoma of the adrenal gland is a rare tumour and only one case is described in Indian literature. We report the clinical, pathological and radiological features of adrenal schwannoma discovered accidentally in a 34 years old female as part of gynaecology work-up.

Estrogen receptor (ER) and progesterone receptor (PgR) in breast cancer of Indian women.

OBJECTIVE: To determine the expressions and relationship between estrogen receptors (ERs) and progesterone receptors (PgRs) in breast cancer in Indian women. PARTICIPANTS: Surgically removed breast cancer tissues were collected from Grant Medical College and Sir JJ Group of Hospitals, Mumbai, India, taking (n = 300) cases of infiltrating duct cancer of Indian women after radical mastectomy and lumpectomy; the age- and menopausal-related subgroups satisfied this requirement. MEASUREMENTS: Statistical significance was calculated by the likelihood ratio test; relative risk served to check for significant differences. Relapse-free interval probabilities were calculated according to Kaplan and Meier, with Cox-Mantel test comparing survival functions and P values. RESULTS: We observed that only in middle-aged postmenopausal patients bearing pT2 tumors were ER and PgR receptors shown to have a prognostic significance with the lowest tested cutoff value being 5 fmol/mg. CONCLUSION: Immunohistochemistry analysis has been shown to be a prognostic factor for patients with breast cancer; the major aim of determining the ER receptor status is to assess predictive response to hormonal therapy.

The p53 breast cancer tissue biomarker in Indian women.

BACKGROUND: Combination chemotherapy is highly effective in locally advanced breast cancer. A negative expression of biomarker p53 indicates a higher chance of responding to this regimen. Patients' p53 status may be used as a biological cancer marker to identify those who would benefit from more aggressive treatments. AIMS: The role of p53 in modulating apoptosis has suggested that it may affect the efficacy of anticancer agents. p53 alterations in 80 patients with locally advanced breast cancer IIIB undergoing neoadjuvant chemotherapy were prospectively evaluated. MATERIALS AND METHODS: Patients received three cycles of paclitaxel (175 mg/m(2)) and doxorubicin (60 mg/m(2)) every 21 days. Tumor sections were analyzed before treatment for altered patterns of p53 expression, using immunohistochemistry and DNA sequencing. RESULTS: An overall response rate of 83.5% was obtained, including 15.1% complete pathological responses. The regimen was well tolerated with 17.7% grade 2/3 nausea and 12.8% grade 3/4 leukopenia. There was a statistically significant correlation between response and expression of p53. Of 25 patients who obtained a complete clinical response, only two were classified as p53-positive (P = 0.004, χ(2)). Of 11 patients who obtained a complete pathological remission, one was positive (P = 0.099, χ(2)). CONCLUSION: Immunohistochemical (IHC) analysis has been shown to be a prognostic factor for patients with breast cancer in India. Paclitaxel is one of the most promising anticancer agents for the therapy of breast cancer, where it has also shown activity in tumors resistant to doxorubicin.

High grade leiomyosarcoma of the testes.

Testicular leiomyosarcoma is a rare tumor. It may arise secondarily following exposure to radiotherapy, chronic inflammation, or usage of high dose anabolic steroids. However, in absence of risk factors, it is rarely seen. Only 15 cases of Primary Intra testicular leiomyosarcoma have been reported in world literature. We present a case of testicular tumor in an elderly male. Preoperative work up showed raised Lactate Dehydrogenase (LDH) levels. He underwent high orchidectomy. Histopathology and immunohistochemistry confirmed it to be a primary intra testicular leiomyosarcoma. A brief case report with review of literature is presented.