No abstract

BACKGROUNDPerforation remains a surgical disease and management means emergency surgical intervention. Primary closure with omental buttress, Graham's live/dead omental patch repair, Jejunal serosal (Thal) patch repair and antrectomy with Billroth II reconstruction have been the traditionally followed procedures depending on the site/size of the perforation. This study reports a series of cases of perforated duodenal ulcer closed by Gastric seromuscular advancement flap. This article compares the advantages and disadvantages of either methods and details the indications and method of this alternative repair.

Study conducted in Government Villupuram medical college about morphological features of nodular hidradenoma by reviewing the hispathology slides of five cases in one year period. Analytical study done regarding the gender, age, and sites distribution of tumour and also variation in gross and histopatholgy features. OBJECTIVE: To describe and study the morphological features of Nodular Hidradenoma along with data on gender and age. Study on Sites and morphological features also included. MATERIALS AND METHOD: Retrospective evaluation of histopathological records during the previous year 2013-2014. The study was conducted in Tertiary care Teaching hospital, Government Villupuram Medical College, Villupuram. 5 cases of nodular hidradenoma were identified. Data on gender, age, Clinical presentation, gross and microscopic findings with hematoxylin and eosin stains were collected. Histological slides were reviewed. KEYWORDS: Giant Nodular hidradenoma, Cyst with papillary excrescencess, Squamous horn pearls, solid and cystic areas. INTRODUCTION:Nodular hidradenoma is a benign adnexal neoplasm arising from the distal excretory ducts of eccrine sweat glands. Though it is a benign neoplasm very rarely malignant transformation can occur. (1) It frequently occurs from fourth to eighth decade of life and it is rare in children. (1) This tumor has gender predilection with female preponderance in ratio of 1.7:1. (2) It most commonly occurs in head, trunk and extremities and can occur in any cutaneous skin surface. (3) Our case series includes one case in breast. These tumours usually presents as a solitary, slowly enlarging, intradermal nodule, ranging in size from 0.5-2.0cm or more. Nodular hidradenoma breast is still a rare tumour. (4) Rapid enlargement of the tumor raises the possibility of malignant transformation or haemorrhage. (5) Grossly these tumors are often solid and cystic. (6) Microscopically, they are well circumscribed , sharply demarcated from the epidermis by Grenz zone and tumor is composed of solid and cystic spaces. Solid areas reveal the presence of epithelial lobules. Within the lobules two types of cells are seen. Predominant cell type is the polyhedral cells with more basophilic cytoplasm and the other cell type is round with a clear cytoplasm due to the presence of glycogen. (7) Cystic spaces often contain eosinophilic fluid material, these cysts occur due to tumor cell degeneration. Lumen of cysts usually contain homogenous eosinophilic material and in few cases contain haemorrhagic foci probably due to rapid growth of lesion or after minor trauma. (8) There are also tubular lumina of varying sizes seen, sometimes lined by cuboidal ductal cells. In some tumors squamoid differentiation (9) can occur. There even may be keratinizing cells with formation of squamous horn pearls particularly in clear cell hidradenoma. (10)