Exstrophy of the urinary bladder is a rare congenital anomaly which if untreated causes bladder carcinoma and intestinal tumours noted if urinary diversion is performed. It is seen that 50% of all persons afflicted with exstrophy are dead by their tenth year and 66-67% are dead by their twentieth year. It is thus a great rarity to see a case of ectopia vesicae in adulthood. Still more uncommon is to see a case of exstrophy complicated by carcinoma. Here, we report a case of papillary adenocarcinoma of ectopic urinary bladder in a 42-year-old male patient. In view of locally advanced disease, patient was given neoadjuvant chemotherapy. The case is being reported on account of its rarity to sensitise clinicians about rising incidence of carcinoma if mismanaged due to lack of protocol in oncological screening.

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PURPOSE A common definition of a clear margin (≥5 mm) in oral squamous cell carcinoma (OSCC) for all stages is a subject of controversy. Studies have shown that even 1- and 2-mm margins are adequate, and few studies have identified dynamic resection margin as a criterion. We aimed to study the margin to depth of invasion ratio (MDR), margin to tumor thickness ratio (MTR), and margin to tumor size ratio (MSR) as prognostic markers for survival. Notably, to our knowledge, this is the first study to evaluate the role of MDR in OSCC. METHODS A prospectively maintained head and neck cancer database was analyzed from January 2017 to February 2023. The MDR, MTR, and MSR were calculated for each patient. Survival outcomes were analyzed using the Cox proportional model and the Kaplan-Meier method. Akaike's information criterion (AIC) and Bayesian information criterion (BIC) were used to compare different ratio models. X-tiles software was used to identify the optimal cutoff value of MDR. RESULTS Two hundred eighty patients in the database were assessed, of which 123 eligible patients were enrolled in the study. MDR was an independent predictor of disease-free survival (DFS) on multivariate analysis. The MDR model had the lowest values on AIC and BIC analyses. A cutoff value of 0.5 for MDR showed a significant correlation with DFS and overall survival. CONCLUSION MDR was the best predictor of recurrence of all the three ratios studied. The minimum safe surgical margin can be calculated by multiplying the depth of invasion by 0.5. This study signifies the role of dynamic resection margin criteria on the basis of MDR in defining clear margins.

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A-28-year-old male military personnel presented with a four day history of right sided non-colicky abdominal pain radiating to the back, and associated with fever and rigor for two weeks, at Regional Institute of Medical Sciences (RIMS), Imphal, Manipur, India. The fever used to subside only on medication. He had no other gastrointestinal or urinary symptoms. He was not an intravenous drug abuser but consumed alcohol in moderate amounts regularly. There was history of significant weight loss in the recent past.On general examination, he was pyrexic with associated tachycardia. Other than pallor and non tender non matted multiple lymphadenopathy no other significant finding was present.Abdomen was diffusely tender with mild guarding and could be palpated properly only after administering analgesics (Inj. Diclofenac 75 mg i.m.). Multiple lumps were palpated in all the quadrants. The lumps were firm in consistency, tender and mobile. Liver was just palpable.Chest radiograph looked normal. His blood test showed neutrophilia (20×10 9 /l), a raised ESR of 120 and a raised C-reactive protein of 200 mg/l. The rest of the blood tests including serum amylase were in the normal range.An abdominal radiograph was non-contributory and computed tomography of the abdomen multiple enlarged mesentric lymph nodes [Table/ Fig-1]. Patient was treated conservatively and started on broad spectrum intravenous antibiotics (ceftriaxone and ofloxacin) but his condition did not improve. Cultures of blood and lymph node aspirate showed growth on 3 rd day itself which were consistent with culture characteristics of Penicillium marneffei [Table/ Fig-3].Peri oral umbilicated lesions [Table/ Fig-4] appeared in the 4 th day during the course of antifungal treatment which further described the Penicillium dissemination. Treatment was started with Amphotericin B at the dose of 0.6 mg/kg/day intravenously for two weeks followed by Anti Retroviral Therapy and itraconazole as per recommendation. The patient showed marked improvement on follow up after six months and was symptom free with CD4 cell count of 350/mm 3 . DiSCuSSiOnPenicilliosis marneffei (PM) is a disseminated and progressive fungal infection caused by Penicillium marneffei, a facultative intracellular pathogen and the only dimorphic species of the genus Penicillium ABSTRACTOpportunistic infection in HIV disease often present to clinicians in an atypical manner testing clinical acumen. Here, we report a case of Penicilliosis marneffei (PM) infection presenting to surgical emergency as acute abdomen with undiagnosed HIV status in advanced AIDS, chief complaints being prolonged fever and diffuse abdominal pain. Radiologic imaging showed non-specific mesenteric and retroperitoneal lymphadenopathy. Fine needle aspiration cytology (FNAC) of the lymph node was done and subjected to direct microscopy, gram staining and culture on Sabouraud's dextrose agar (SDA) which showed Penicillium marneffei. He was then treated with intravenous amphotericin. This case is reported for its rarity and unusual...