Gastric carcinoid presented as gastric outlet obstruction.

Carcinoids are solid tumors of entero-chromaffin origin classified as neuroendocrine amine precursor uptake and decarboxylation (APUD) cell tumors and are found throughout the gastrointestinal tract from the stomach to the rectum, with a predilection for the ileum. These tumors rarely occur in the stomach, constituting only 2% of gastric tumors and 3.3% of all carcinoid tumors of the gastrointestinal tract. Localization of gastric tumors can be done by ultrasonography, computed tomography, and magnetic resonance imaging, but endoscopic biopsy is required for confirmation; demonstration of neurosecretory granules on microscopy is the most specific feature. Early resection is the treatment of choice. Prognosis of noninvasive tumors <2 cm in size in terms of 5-year survival rate is 100%. The 5-year survival rate declines and prognosis becomes poor with increase in size and with involvement of serosa, perineural infiltration, and lymph node metastasis.

Pseudohermaphrodite presented as an irreducible inguinal hernia.

Absence of antimuellerian hormone or defective functioning of antimullerian hormone type II receptors give rise to a type of male pseudohermaphroditism known as 'persistent muellerian duct syndrome'. Such patients are phenotypically male with 46 XY karyotype and well developed muellerian duct derivatives which may be intra-abdominal or may herniate in inguinal region giving rise to a condition called as 'hernia uterine inguinale'. Cryptorchidism, transverse testicular ectopia and hypospadias are few anomalies associated with this syndrome. Though orchidopexy while leaving the uterus and fallopian tube in situ is an accepted surgical management, compromisation of blood surply to the testes or the vas may occur as vasa efferentia are embedded in the wall of uterus.

Adenoid cystic carcinoma of the male breast.

We present an 82-year-old male patient who presented with complaints of gradually an increasing ulcero-proliferative lesion with persistent mucinous discharge in the left breast. Left side-modified radical mastectomy was done. This was histopathologically diagnosed as an adenoid cystic carcinoma of the left breast. Periodic acid schiff (PAS) staining confirmed the diagnosis. Three of the five axillary lymph nodes excised were positive for malignancy. Although the patient was advised to have postoperative radiotherapy, he did not comply. After 2 years, the patient again presented with local recurrence of the disease. Wide excision of the recurrent malignant nodules over the anterior chest wall was done, and the defect was covered primarily with split thickness skin grafting. Postoperative radiation was given. For the past 9 months, the patient has maintained a regular follow-up on an outpatient basis. He does not have any evidence of recurrence of the tumor--neither locally nor distant metastasis.