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Teratomata, by reason of their bizarre nature and relatively rare occurrence, have aroused interest for many centuries. The main sites of occurrence in order of frequency are the gonads, the retroperitoneal region, the anterior mediastinum, presacral and coccygeal regions and the base of the skull (Willis, 1953). Calbet (cited by Riker and Potts, 1948) calculated that a sacro-coccygeal tumour occurred in every 34,582 births; of these a relatively small proportion were teratomata. The first known record of a sacro-coccygeal teratoma was made on a cuneiform tablet in about 2000 B.C. and was stored in the Royal Library of Nineveh (Ballantyne, 1894). Amongst thousands of tablets found there, one dealt with the portents of ' I 1 monstrous births and various deformities found in newly born infants. On this tablet it was stated that ' when a woman gives

BackgroundInguinal lymph node involvement is an important prognostic factor in penile cancer. Inguinal lymph node dissection allows staging and treatment of inguinal nodal disease. However, it causes morbidity and is associated with complications, such as lymphocele, skin loss and infection. Video Endoscopic Inguinal Lymphadenectomy (VEIL) is an endoscopic procedure, and it seems to be a new and attractive approach duplicating the standard open procedure with less morbidity. We present here a critical perioperative assessment with points of technique.MethodsTen patients with moderate to high grade penile carcinoma with clinically negative inguinal lymph nodes were subjected to elective VEIL. VEIL was done in standard surgical steps. Perioperative parameters were assessed that is - duration of the surgery, lymph-related complications, time until drain removal, lymph node yield, surgical emphysema and histopathological positivity of lymph nodes.ResultsOperative time for VEIL was 120 to180 minutes. Lymph node yield was 7 to 12 lymph nodes. No skin related complications were seen with VEIL. Lymph related complications, that is, lymphocele, were seen in only two patients. The suction drain was removed after four to eight days (mean 5.1). Overall morbidity was 20% with VEIL.ConclusionIn our early experience, VEIL was a safe and feasible technique in patients with penile carcinoma with non palpable inguinal lymph nodes. It allows the removal of inguinal lymph nodes within the same limits as in conventional surgical dissection and potentially reduces surgical morbidity.

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Clinical presentation of an extraabdominal metastasis from carcinoma of the gall bladder is rare. Orbital metastasis from gall bladder carcinoma has not been previously reported. We report a case of a 40-year-old woman who developed orbital metastasis from carcinoma of the gall bladder.

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