Background:In the modern era, the major cause of gastric outlet obstruction (GOO) is known to be a malignancy, especially in the developed world. Many books and articles do suggest that the benign causes continue to be the major cause of GOO in the developing world however, there is growing evidence proving the contrary. Males were (more commonly) affected females and individuals in their fifth and sixth decade have been the predominant age group in the majority of studies. There is a minimal data of GOO from South India.Aims:A retrospective analysis of the endoscopic findings of patients presenting with features of GOO to determine the demographic and etiological patterns.Materials and Methods:A retrospective study of the endoscopic findings of patients with GOO from January 2005 to January 2014 was done. The diagnosis of GOO was based on clinical presentation, and an inability during the upper endoscopy to enter the second portion of the duodenum as documented in the endoscopy registers. Patients who have already been diagnosed with malignancy prior to the endoscopy were excluded from the study; so were the patients with gastroparesis.Results:A total of 342 patients with GOO underwent the endoscopy during the study period. The causes for benign obstruction were predominantly peptic ulcer disease. The major cause for malignant obstruction was carcinoma of stomach involving the distal stomach. The male to female ratio was 3.2:1. The patients with malignancy were older than patients with benign disorders. Most of the patients were in the sixth and seventh decade. The risk of malignancy was higher with increasing age, especially in women. A fourth of all carcinoma stomach presented with GOO.Conclusion:The study demonstrates that the cause for GOO in Kerala, South India is predominantly malignancy. The etiological and demographic patterns were similar to the studies conducted in the developed nations.
Sarcomas of the genitourinary tract are extremely uncommon and accounts for only 1-2% of genito urinary malignancies. Sarcomas of the para testicular region, comprising tissues such as the epididymis, spermatic cord, inguinal canal and testicular tunica are also extremely rare. epidydimal leiomyosarcoma accounted only for 4 percentage of all para testicular tumours and only 16 cases are reported so far in literature and they account 4% of all Para testicular sarcomas. We are presenting a 61-year-old patient presented with a hard welling of 1 year duration, with no other associated symptoms. On ultrasound evaluation, it was reported as extra testicular lesion, possibly from epididymal tail. We performed a high inguinal orchidectomy. Histopathological examination revealed a para testicular leiomyosarcoma arising from epididymis. This case has discussed because of the rarity of the disease and possible cure if diagnosed early and treated aggressively.
Groove pancreatitis is a chronic type of segmental or focal pancreatitis seen to affect the groove, which is the region between the head of the pancreas, the duodenum, and the common bile duct. Despite its incidence remaining unknown, it accounts for 2.7% to 24.5% of pancreaticoduodenectomies performed for chronic pancreatitis. A diverse etiology has been implicated but the exact cause is yet to be identified. As it closely mimics pancreatic malignancy and remains mostly undiagnosed preoperatively, many patients often end up undergoing a pancreaticoduodenectomy. Awareness of this entity and early diagnosis will help us address this issue with more conservative measures than by resorting to a morbid procedure such as a pancreaticoduodenectomy.We report a case of a 50-year-old male, a chronic alcoholic, with a two-year history of upper abdominal pain, postprandial vomiting, and weight loss. An abdominal contrast-enhanced computed tomography (CECT) scan was suggestive of either a pancreatic malignancy or a possibility of groove pancreatitis. However, postoperative histopathological examination confirmed the lesser known groove pancreatitis. Here, we review the clinical, radiological, and pathological characteristics of groove pancreatitis, as its diagnosis and management still pose a challenge.
Background Overdiagnosis is a phenomenon where an indolent cancer is diagnosed that otherwise would not have caused harm to the patient during their lifetime. The rising incidence of papillary thyroid cancer (PTC) in various regions of the world is attributed to overdiagnosis. In such regions, the rates of papillary thyroid microcarcinoma (PTMC) are also rising. We aimed to study whether a similar pattern of rising PTMC is found in Kerala, a state in India, where there has been a doubling of thyroid cancer incidence over a decade. Methods We conducted a retrospective cohort study in two large government medical colleges, which are tertiary referral facilities in the state of Kerala. We collected data on the PTC diagnosis in Kozhikode and Thrissur Government Medical colleges from 2010 to 2020. We analysed our data by age, gender and tumor size. Results The incidence of PTC at Kozhikode and Thrissur Government Medical colleges nearly doubled from 2010 to 2020. The overall proportion of PTMC in these specimens was 18.9%. The proportion of PTMC only marginally increased from 14.7 to 17.9 during the period. Of the total incidence of microcarcinomas, 64% were reported in individuals less than 45 years of age. Conclusion The rise in the number of PTCs diagnosed in the government-run public healthcare centres in Kerala state in India is unlikely to be due to overdiagnosis since there was no disproportionate rise in rates of PTMCs. The patients that these hospitals cater to may be less likely to show healthcare-seeking behavior or ease of healthcare access which is closely associated with the problem of overdiagnosis.
Squamous cell carcinoma (SCC) of the scalp is the second most common non-melanoma cancer of the skin. The incidence of squamous cell carcinoma on the scalp is on the rise, but the intracranial extension is rare. Cranial invasion is rare in SCC of the scalp, but when present, it is associated with a poor prognosis. A 62year-old female presented with complaints of swelling over the back of her scalp for three months, which rapidly increased in size. She also had a throbbing headache, alopecia in that area, and multiple episodes of pustules in that area. On examination, she had an ulceroproliferative lesion measuring 5*5*3 cm with an irregular surface and varying consistency over the occipital area in the midline surrounded by ulcerations and crusted discharge and fixed to the bone. Contrast-enhanced magnetic resonance imaging (MRI) showed an irregular lesion with the destruction of the right parietal and occipital bones involving both inner and outer tables with intracranial and extracranial components, and the lesion was abutting the superior sagittal sinus. The treatment is surgical resection of the tumor with margin clearance. The treatment plan was designed using a multidisciplinary approach with the collaboration of oncosurgery, neurosurgery, and plastic surgery. The patient underwent wide local excision of the tumor with adequate skin and cranial bone clearance. The tumor was found to have infiltrated the dura mater overlying the superior sagittal sinus. The defect was then closed using a vault prosthetic cover and a scalp transposition flap from the left parietal area. This case report intends to highlight the need for a multidisciplinary approach to the proper management of advanced squamous cell carcinoma to decrease the morbidity and mortality in patients.
Background: As breast cancer remains a major fraction of cancer cases worldwide, the options for minimalizing postoperative morbidity and mortality remain an area for ardent research and improvement. The ability to identify patients at low risk of axillary metastases, would be of great value in limiting extensive axillary dissection which causes signicant morbidity, thereby improving the postoperative quality of life amongst patients. We conducted a study to identify characteristics of primary tumors highly associated with axillary lymph node metastases by comparing various demographic and tumor characteristics against nodal status. Methodology: 288 cases of the axillary dissection specimens of all inltrating duct carcinoma cases who underwent MRM in Government Medical College, Thrissur for 5 consecutive years were studied (n=256). Pathology was interpreted by a select group of Pathologists and then reanalyzed by another set to avoid bias. Various other aspects were studied including age distribution, histology, tumour size and nodal status. Analysis was done using SPSS 26 software. Results: The mean age of the study population was 50.58 years. The most common histopathological type encountered was Invasive ductal carcinoma – NOS (89.58%). Most of the patients (78.29%) belonged to T2 stage, with most patients (76.39%) having 1- 3 nodes involved. On analysis, a signicant association between T status ( T2 ,T3 ) and N status (p = 0.001) was found. However, there was no signicant correlation between age against tumor size or nodal status (p = 0.528, and p = 0.614 respectively). Conclusions: This study found that while tumor size is independently can predict the amount of axillary lymph node metastasis especially in T2 and T3 tumors , there is no signicant predictor value for age in predicting the nodal status or tumor size in invasive ductal carcinoma. However, the factors which modifying tumor behavior like the grade, ER status, Her2 neu status and Cerb 2 will have an inuence on the prediction of Axillary Lymph node involvement that offers further scope of prospective research
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