A 60-year-old man presented with abdominal pain for 3 months. Clinical examination revealed a well-defined intra-abdominal mass lesion measuring about 5 ¥ 6 cm, which was located in the left of umbilical region and extending into the left lumbar quadrant. The mass was mobile, non-tender and had firm consistency. The rest of the clinical examination and routine investigations were normal. The patient was evaluated with ultrasound of the abdomen, which showed 7 ¥ 8 ¥ 7 cm 3 hypo-echoic and solid nature mass underneath the parietal wall, with no intervening bowel coils. Contrastenhanced computed tomography scan confirmed ultrasound findings; in addition, it showed mass in close proximity to loop of small bowel and its mesentery (Fig. 1a). The patient underwent exploratory laparotomy, and intraoperative mass was seen arising from anti-mesenteric border of the ileum about 50 cm proximal to ileocaecal junction (Fig. 1b). The mass was resected en-bloc with adjacent ileum and end-to-end anastomosis was performed. Resected specimen showed (Fig. 2) that the mass is arising from diverticulum of small bowel, that is, Meckel's diverticulum. Post-operative period was uneventful. Histopathology revealed both spindle and epitheloid-shaped tumour cells with marked nuclear atypia, suggestive of malignant gastrointestinal stromal tumour (GIST). Immunohistochemistry revealed tumour cells positive for CD 117(C-KIT). The patient was followed up after two years and showed no recurrence/metastasis.Meckel's diverticulum is the most commonly encountered congenital anomaly of the small intestine, occurring in approximately 2% of the population. 1 It is located on the anti-mesenteric border of the ileum, approximately 4560 cm proximal to ileo-caecal valve and results from incomplete closure of omphalo-mesenteric duct. An equal incidence is found among men and women. Meckel's diverticulum has lining mucosa similar to that of the adjacent bowel but may contain heterotopic mucosa, the most common of which is gastric mucosa in 50%, pancreatic mucosa in 5% and may also harbour colonic mucosa. The majority of Meckel's diverticula are incidentally discovered during autopsy, laparotomy or barium studies. The most common clinical presentations of Meckel's diverticulum are gastrointestinal bleeding (from chronic ulcer in ileum adjacent to Meckel's diverticulum containing gastric mucosa), intestinal obstruction and diverticulitis. Incidence of tumours within Meckel's diverticulum is 0.53.2%, most of them are benign tumours like leiomyomata, angiomas, lipomas and villous adenomas. Malignant neoplasms include adenocarcinoma, sarcoma, carcinoid tumour, melanoma, lymphoma and GIST. 2,3 GISTs are rare neoplasms that account for 0.1-1% of gastrointestinal malignancies. Described in 1983 by Mazur and Clark, 4 GISTs arise from interstitial cells of Cajal, the pacemaker cells of the gastrointestinal tract. 5 GIST occurs in adults at a median age of 58 years and most commonly arise from stomach (60%), small intestine (30%) and less than 10% in the oesophagus, c...
Testicular tumors are very common among man under the age of 45 years. The case of bilateral synchronous testicular seminoma is very rare. We present a case of bilateral synchronous testicular seminoma stage-I in a 42-year old Indian male who came to our hospital with chief complaints of dull ache in the abdomen and groin, bilateral scrotal swelling and heaviness, left-sided scrotal swelling since last four years, and right-sided since last two years. He underwent bilateral orchidectomy followed by radiotherapy. In this case we throw light on this rare condition and discuss the management.
Introduction: Benign prostatic obstruction/enlargement (BPO/BPE) is one of the important aetiology for Bladder outlet obstruction (BOO) in men. Study has been planned to measure various parameters of bladder dysfunction by using Cystometry in patients of Prostatism and to find out correlation between various parameters like age, prostate size, IPSS, management of patients with Prostatism, choice of operative procedure performed and various histopathological findings. Methods: This was observational study. Total 75 patients with age> 50 year and IPSS > 19 having symptoms of Prostatism were included in the study. Patient detailed history was taken and demographic parameters with IPSS, histopathological findings, management plan, Ultrasonography findings were recorded in structured proforma. Results: It is seen that the maximum i.e. 39 (52%) cases of prostatism are observed in the age group of 60 to 70 years. The average age was 67.29 years. Maximum i.e. 31 (41.33%) cases of prostatism had prostate size in 50-70 gms.36 patients were managed by catheterisation while surgery was performed in remaining 39 patients. Transurethral resection of prostate (TURP) was performed in 36 of 39 patients. IPSS was decreased significantly from average of 26 to average of 22 after 2 weeks of operation/catheterisation. Conclusion: Prevalence of BPE increases with age as there found to be positive correlation between age and Prostate size. TURP was preferred procedure in our tertiary centre for the treatment of BPE. Significant decrease in IPPS suggests improvement in symptoms of BPE after operation/catheterisation. Keywords: Bladder outlet obstruction; Prostatism; International Prostate Symptom Score; Transurethral resection.
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