A 67-year old man had a large irreducible right inguino-scrotal hernia which had been enlarging for 8 years. During the last two weeks he had felt a 'dragging' pain in the right groin. He had no fever, anorexia or evidence of intestinal obstruction. The scrotum was neither tender nor tense. Surgery revealed an indirect inguinal hernial sac containing the caecum, ileum and appendix. The appendix was inflamed but not perforated. Histopathological confirmation was obtained. The appendix was covered by adjacent inflamed mesentery. The ileum was normal and devoid of a Meckel's diverticulum. After performing an a appendicectomy, the bowel was returned to the peritoneal cavity. The hernial sac was divided close to the neck and a Shouldice repair done.

ObjectiveTo investigate whether magnetic resonance imaging (MRI) changes the management of patients with screen-detected invasive lobular carcinoma (ILC). MethodsA retrospective, controlled, single-centre analysis of 138 cases of screen-detected ILC was performed. All patients were assessed by a single multidisciplinary team as to whether preoperative MRI altered the initial management decision or reduced re-operation rates. ResultsForty-three percent of patients had preoperative MRI. MRI guided surgical management in 40.7% patients. Primary mastectomy rates were not significantly different between the MRI and non-MRI groups (32% and 30% respectively, p=0.71). The MRI group had a lower secondary surgery rate (6.8% versus 15.2%); however, the results did not reach statistical significance, and there were no unnecessary mastectomies. Conclusions

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PURPOSE There is a significant disparity in global cancer care and outcome between countries. Progress in the treatment of symptomatic plasma cell myeloma (PCM) in high-income countries is not seen in low- and middle-income countries. MATERIALS AND METHODS This is was a retrospective cohort study of all patients diagnosed with PCM between May 1, 2013, and September 30, 2021, at the first hemato-oncology center in Sri Lanka. We aimed to provide data on clinicopathologic characteristics, response, and survival estimates. RESULTS A total of 79 patients with PCM received first-line therapy during the study period. The median age was 64 years, and approximately one third (33%) of patients were older than 70 years. There were 42 (53%) males and 37 females. Hypercalcemia, renal impairment, anemia, and bone disease were detected in 36.7%, 38%, 72.1%, and 81%, respectively. Thirty-nine, 34, and six patients received a combination of cyclophosphamide, thalidomide, and dexamethasone; bortezomib, thalidomide, and dexamethasone; and other treatments, respectively. The overall response rate (≥ partial response) was approximately 97% for both cyclophosphamide, thalidomide, and dexamethasone and bortezomib, thalidomide, and dexamethasone. Twenty-three (29%) of these patients died during the study period, but only 14 (18%) died due to PCM or associated sepsis. After a median follow-up of 40.6 months (range, 35.2-59.07 months), the median overall survival was 84.2 months (95% CI, 60.87 to not available). The 5-year estimated overall survival was 65%. CONCLUSION To our knowledge, this is the only well-characterized study on long-term survival of patients with PCM in Sri Lanka. We have shown that it is possible to successfully apply Western treatment and supportive care protocols to the local population. These published data will help to benchmark and improve the treatment and develop blood cancer care in the local setting.

Ÿ Primary branchiogenic carcinoma, which is a squamous cell carcinoma arising in a branchial cyst, is extremely rare and a highly contentious clinicopathological entity. Ÿ The case report highlights the controversy surrounding this entity and establishes the diagnosis based on a set of histopathologic criteria proposed by Martin et al, and later modified by Khafif et al. Ÿ In this case the identification of the normal cyst lining, zone of transition and the frankly invasive component, within the same lesion supported a diagnosis of primary branchiogenic carcinoma over a metastasis.

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