Dawood Khan

Spontaneous perforation of jejunal gastrintestinal stromal tumour (gist). Case report and review of literature

GIST is the commonest mesenchymal tumour of the gastrointestinal tract. Jejunal GIST is rare and spontaneous perforation of asymptomatic jejunal GIST is unique. A review of the English literature reveals only fifteen cases of perforated GIST till date. Pre-operative diagnosis is difficult. Diagnosis is confirmed on histopathology and immuno-histochemistry. Complete removal with postoperative imatinib therapy entails optimal treatment. Perforated GIST is associated with high recurrence.

Primary scrotal tuberculosis: A rare but intriguing entity

IntroductionTuberculosis (TB) of the genitourinary tract is usually secondary to a primary site in another part of the body. Primary scrotal TB is an extremely rare condition and it may mimic viral orchitis, epididymitis, hydrocele, spermatocele, testicular torsion, scrotal trauma, or a tumour.Case presentationA 45-year-old man presented with a 3-month history of diffuse scrotal enlargement followed a month later by swelling in the left groin. Scrotal ultrasonography revealed a 4 cm x 4 cm hypoechoic, heterogeneous, inflammatory mass with multiple fistulae at the bottom of the scrotum without any extension to the deeper structures, and bilateral multiple inguinal adenopathy.DiscussionGenitourinary TB may present with adrenal insufficiency, renal disease, obstructive uropathy and chronic cystitis with sterile pyuria. Although scrotal USG is very helpful, it is not a definitive diagnostic tool. Histopathology is mandatory either in the form of FNAB or formal biopsy. Most cases respond well to antitubercular drugs only.ConclusionAn optimum diagnostic and therapeutic protocol is urgently needed for cases of primary scrotal TB to prevent misuse of costly investigations and treatments and to avoid unnecessary surgical interventions when the patient can be cured by antitubercular treatment only.

A rare and interesting case of primary mammary tuberculosis mimicking breast carcinoma

IntroductionMammary tuberculosis (MT) is an extremely rare form of extrapulmonary tuberculosis (TB), which is uncommon even in countries where TB is considered to be endemic. It can occur in primary and secondary forms, clinically and radiologically, both of which can mimic breast carcinoma or persistent breast abscess.Case presentationA 35-year-old multigravida presented with a history of swelling in the right breast and axilla that had begun six months earlier, to be followed three months later by a yellowish dirty discharge, and five months later by blackish discolouration of the overlying skin. Ultrasonography (USG) showed cutaneous oedema and lymphatic dilatation in the right breast with a lump measuring 6 cm × 7 cm, as well as three significantly enlarged pectoral lymph nodes in the right axilla.DiscussionThe most common type of MT is the nodular pattern which may be mistaken for carcinoma or fibroadenoma. MT may present as multiple heterogeneous, hypoechoic masses with irregular margins, or on USG as thickwalled cystic lesions with septa and sinus tracts. It can only be accurately diagnosed by histological identification of typical necrotising granulomas in the tissue sections. Conservative surgery (local excision of the mass) if needed, followed by antitubercular therapy is the standard treatment protocol.ConclusionAn atypical rare entity, primary MT may mimic adenoma or carcinoma and may often be misdiagnosed without formal histopathology due to its intriguing clinical and radiological features.

Tuberculosis of the glans penis mimicking as carcinoma

Penile tuberculosis (TB) is an uncommon variety of genitourinary TB. It is either primary (via local spread) or secondary (spread of infection from other organs). We encountered a case of rapidly growing penile ulceration, resembling carcinoma. Biopsy revealed the classic picture of TB, which responded well to antitubercular treatment.

Syringocystadenoma papilliferum on the breast: An unusual location

IntroductionSyringocystadenoma papilliferum (SCAP), otherwise known as naevus syringocystadenomatosus papilliferus, is a skin hamartoma originating from apocrine or exocrine sweat glands [1], microscopically characterized by papillary invaginations lined by bi-layered epithelium and decapitation secretion rich in plasmacytes [3].Case ReportA 29-year-old female presented with a cluster of large fleshy, irregular, sessile, moist, pinkish tumours located over her left breast, with pain, itching, discharge and bleeding upon friction with undergarments.DiscussionSCAP is an uncommon skin tumour usually seen in children or adolescents as a firm plaque of skincoloured to pinkish-brown hairless grouped nodules or a solitary nodule. Verrucous, papillary, hyperkeratotic, fleshy transformations are often seen in puberty [4,5]. Uncommon sites, such as the buttock, vulva, scrotum, pinna, eyelid, outer ear canal, postoperative scar, thigh, axilla, arms, lower limb, inguinal and perineal regions, have also been reported [6–9].ConclusionSCAP is a rare adnexal tumour commonly arising in association with congenital Sebaceous Naevus of Jadassohn. A watchful alertness is mandatory as adulthood malignancies can occur in more than one-third of this deceptively docile tumour.

Adult benign multicystic nephroma: A diagnostic dilemma

Cystic nephroma, also called multilocular cystic nephroma, is a relatively rare, non-genetic, benign, unilateral renal multicystic lesion. The non-specific clinical findings and the paucity of information from imaging techniques make the preoperative dilemma from othercystic renal neoplasia; thus nephrectomy seems to be the most preferable treatment. We report a case of cystic nephroma in forty years male patient presented with asymptomatic lump in abdomen.

A rare presentation of gastrointestinal stromal tumors as small bowel perforation: A single institution based clinical experience of three cases

Gastrointestinal stromal tumors (GIST) of intestine presenting as acute abdomen due to perforation of the tumor is extremely rare.We present three cases of jejunal GIST which presented as acute abdomen resulting from perforation of the tumor. All the three cases underwent emergency laparotomy and resection of the tumor with clear margin. Histopathological examination was compatible with GIST and c-Kit/CD 117 was positive in immunohistochemistry. All the three patients received adjuvant chemotherapy with imatinib.

Spigelian hernia: An unusual presentation of an uncommon entity

IntroductionSpigelian hernia (SH) is an uncommon defect of the abdominal wall that occurs through the spigelian fascia. SH has varied, non-specific, dubious clinical features which makes diagnosis extremely difficult at times. Pain is common and is invariably associated with the narrow neck of the sac; atypically, our patient had no history of pain at any time.Case ReportHerein, we present the case of an extremely rare variety of hernia in an 83-year-old male patient. Clinical examination revealed globular, subcutaneous, soft, reducible swelling measuring 6 × 8 cm over the left iliac fossa of this patient with visible cough impulse. Ultrasonography (USG) showed a 2.5 × 2.5 cm muscle defect in the anterior abdominal wall above and lateral to the left inguinal region.DiscussionSH is a rare form of ventral hernia. The commonest presenting feature is pain, or an anterior abdominal wall lump or incarceration. Real-time USG can easily detect the defect and demonstrate the cough impulse. Both open and laparoscopic approaches have been elected for repair.ConclusionRadiological investigations must be undertaken, and surgery should always be performed to avoid risk of strangulation or incarceration of the hernia. Although laparoscopic repair has gained popularity, the open approach remains the gold standard in emergency situations.