Severe obscure gastrointestinal bleeding from Meckel's diverticulum with predominant ectopic pancreatic tissue.

Obscure gastrointestinal bleeding represents about 5% of all gastrointestinal haemorrhages which is characterized by continuous or recurrent bleeding from an undetermined source after an initial bidirectional endoscopy. Meckel's diverticulum is a rare but recognized cause of obscure gastrointestinal bleeding. A carefully selected line of investigations is paramount to localize the causative lesion in obscure gastrointestinal bleeding which is a challenge in subacute cases. We present a case of 35-year-old female with thalassemia minor and mild anaemia presented with acute gastrointestinal bleeding from the ectopic pancreatic mucosa of an Meckel's diverticulum where only a small focus of gastric tissue was identified histologically during the follow-up. This case discusses the rarity of this histological presentation of Meckel's diverticulum as obscure gastrointestinal bleeding and the importance of intraoperative decision-making and intraoperative enteroscopy in cases of obscure gastrointestinal bleeding when other tests are negative.

Spontaneous omental infarction: A rare case of acute abdomen.

Omental infarction is a rare but a sinister cause of acute abdomen. Preoperative diagnosis is challenging due to its rare nature. It poses nonspecific abdominal signs that can be easily mistaken with other more common intra-abdominal pathologies. We report a case of a 37-year-old male patient presented with right lower quadrant abdominal pain with an elevation of inflammatory markers. His cross-sectional imaging did not a reveal specific diagnosis; therefore, a diagnostic laparoscopy was performed which revealed a non-inflamed appendix and an inflammatory mass formed by the ischemic omentum attached to the ascending colon. Diagnostic laparoscopy and subsequent laparotomy revealed spontaneous omental infarction. The histology of the resected specimen was in keeping with the omental necrosis. This case reflects the importance of considering omental infarction in patients presenting with abdominal pain and raised inflammatory markers. He made an uneventful recovery following surgery.

Postmenopausal hyperandrogenism due to an ovarian sex cord-stromal tumour causing elevated dehydroepiandrosterone sulphate: a case report.

BACKGROUND: The source of excess androgen can be obscure in postmenopausal women with new-onset hyperandrogenism. If serum dehydroepiandrosterone sulphate (DHEAS) is raised, it is presumed to be of adrenal origin because DHEAS is exclusively produced from adrenal cortical cells. This reports an elderly female presenting with new-onset hyperandrogenism due to an ovarian sex cord-stromal tumour, associated with increased serum DHEAS levels. CASE DESCRIPTION: A 76-year-old female with long-standing diabetes and hypertension presented with hirsutism and male type alopecia for six months. She had menopause at 55 years of age. There was a pelvic mass on examination. Total testosterone was 6.106 ng/ml (0.124-0.357) and DHEAS was > 1000 µg/dL (35-430). Contrast-enhanced computed tomography of the abdomen and pelvis showed a heterogeneously enhancing complex mass measuring 11 × 8 cm in the left adnexal region. Adrenal glands were normal. She underwent total abdominal hysterectomy, bilateral salphingo-oophorectomy, and omentectomy. Both testosterone and DHEAS normalised following surgery. Histology revealed a sex cord-stromal tumour, likely a steroid cell tumour with malignant potential. Fluorodeoxyglucose-Positron emission tomography did not show any additional lesions. CONCLUSIONS: Due to the lack of sulfotransferase in ovarian tissue, markedly elevated DHEAS originating from an ovarian neoplasm is unusual. This phenomenon has not been described except in a patient with a steroid cell tumour causing Cushing syndrome and hyperandrogenism. The mechanism of this rare occurrence remains elusive. Knowledge of this unusual presentation would enable the clinicians to be cautious in localising the androgen source in women with hyperandrogenism.

Profile of breast cancer in a group of women in a developing country in South Asia: is there a difference?

BACKGROUND: Breast cancer is the commonest cancer among Sri Lankan women. The aim of this study was to document the breast cancer profile of a group of Sri Lankan women and compare it with regional data. Patient-tumor characteristics and predicted prognosis are compared with the immune profile. METHODS: A total of 814 Sri Lankan women with breast cancer were studied, with their information retrieved from patient records. Tumor type and grade were reassessed on routine tissue sections. The Nottingham Prognostic Index (NPI) was calculated. Estrogen receptors (ER) and human epidermal receptor 2 (HER2) were assessed using Dako antibodies. Strong nuclear staining for ER in >10% of tumor cells and strong, complete cell membrane staining (3+) for HER2 were regarded as positive. An SPSS-16 software program and the chi-squared test were used for statistical analysis. RESULTS: The highest prevalence (32%) was in the 50- to 59-year age cohort (mean +/- SD 51.88 +/- 11.939 years). In all, 58% of the tumors measured between 2 and 5 cm. Most (52%) were moderately differentiated and were invasive ductal carcinomas (86.3%). Regional lymph node metastasis was present in 41% of the patients. ER was expressed in 31.7% and was more frequent in women >35 years (p < 0.024). HER2 was found in 14.5% of tumors. Its expression was lower in ER-positive tumors (p < 0.000). Well-differentiated tumors were frequently ER-positive (p < 0.000) and HER2-negative (p < 0.001). The NPI was better for ER-positive (p < 0.000) and HER2-negative tumors (p < 0.028). CONCLUSIONS: The overall profile of breast cancer and immune characteristics of Sri Lankan women in this study was largely comparable to profiles documented elsewhere in the region despite the lower prevalence of ER.