Sai Krishna Medical College & Hospital

INTRODUCTION 
 Vitiligo is an acquired disorder of skin characterized by white macules. Though there are many studies describing clinical and epidemiological features of vitiligo; there are few studies which have attempted to see the differences between male and female. Understanding the gender differences in clinico-epidemiological features will help to find the direction for further research in understanding pathogenesis. The objective was to find the gender wise differences in clinico-epidemiological pattern of vitiligo.
 
 MATERIAL AND METHODS
 This was cross sectional study done at Dermatology and Venereology out-patient clinic of Universal College of Medical Sciences Teaching hospital, Bhairhawa, Nepal from January 1, 2015 to December 31, 2016. Consecutive sampling technique was used and the cases of 18 years and above were taken. Chi-square test, multi-variate logistic regression, two sample t-tests were used to analyze the data.
 
 RESULTS
 The total number of case was 190. Female to male ratio was 1.38:1. Vitiligo vulgaris was seen more in female and mucosal vitiligo more in male and the difference was statistically significant. However, there was no statistically significant difference among gender in family history, duration of disease, mucosal and hair involvement, history of recurrence and various age groups.
 
 CONCLUSION
 Vitiligo vulgaris is seen more in female and mucosal vitiligo is seen more in male. This study has strengthened the evidence regarding the difference noted in clinic-epidemiological aspect of vitiligo. There should be more studies, so that more patterns in gender differences could be understood, and this will help in understanding the pathogenesis of vitiligo.

Pulmonary mucoepidermoid carcinoma (MEC) is a rare malignant neoplasm with the clinical picture mimicking infectious aetiologies in most of the patients. Hence, this rare entity poses a great challenge to the pathologist in terms of diagnosis and to the oncologist in terms of treatment. This case report aims to look at the clinicopathological features of pulmonary MEC, the role of immunohistochemical analysis in diagnosis and choice of chemotherapeutic agent. The objective of reporting this case on MEC is not only the rare frequency of this carcinoma but also to highlight the importance of adequate immunohistochemical analysis in establishing the diagnosis.Key words: Lung cancer, mucoepidermoid carcinoma, chemotherapy

Purpose: The purpose of this study was to describe the biological behaviour of mucinous breast carcinoma (MBC) regarding their clinical presentations, pathological features, prognosis and survival.Methodology: We conducted this retrospective study from 2006 to 2015 (10-year duration) and included all the patients who presented with mucinous carcinoma of the breast at any age. We excluded all the patients who presented with invasive ductal carcinoma or other rare breast tumours. Each patient with mucinous carcinoma breast was categorised in terms of diagnosis, surgery, chemotherapy and outcome. For categorical variables, Chi-square test was used. Kaplan–Meier curves were used to determine estimated overall survival. Data analysis was carried out using the SPSS 20.Results: In total, 8841 patients with breast carcinoma presented during the study period. Of these, 74 patients were diagnosed as cases of MBC, constituting <1%. Family history of breast carcinoma was positive in 20% of patients. Most of the women were postmenopausal (66.2%) falling in BIRADS Category 4 and 5 (32.4% each). Considering laterality tumours had almost equal distribution between the right and left side. Breast-conserving surgery was performed in 47.3% of women as compare to modified radicle mastectomy in 52.7% of women. Most of the patients had pathological T2 (51.4%), N0 (81.1%) and moderately differentiated (69%) mucinous carcinoma. ER was positive in 85% of patients, PR in 80% and H2N in 74.6% of patients. Neoadjuvant chemotherapy was given to 20 patients (27%) and adjuvant chemoradiotherapy was given to 51 patients (69%). Metastasis occurred in 12 (16.2%) of our patients while 62 (83.8%) were metastasis free on long-term follow-up, with bones being the most common site of metastasis, occurring in 6 patients (8.1%) followed by lungs, occurring in 4 patients (5.4%). A total of 32 (43.2%) patients are alive, and on regular follow-up, 3 (4.1%) died during the course of follow-up and 39 (52.7%) are lost to follow-up with a median survival of 60 months and an overall 5-year survival rate of >95%.Conclusion: Mucinous carcinoma is a rare breast carcinoma with a good prognosis.Key words: Breast cancer, mucinous carcinoma, prognosis

Purpose: Synchronous primary endometrial and ovarian cancers are infrequent. The objective of this study is to evaluate clinicopathological characteristics of synchronous endometrial and ovarian cancers treated in our institution.Materials and Methods: The clinicopathological characteristics of 12 patients with synchronous ovarian and endometrial cancers treated at Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan, from July 2005 to July 2015, were reviewed retrospectively in depth from hospital database. The WHO committee classification was used for the histologic determination and staged based on International Federation of Gynaecology and Obstetrics (FIGO) staging. Results: The median age at the time of diagnosis was 50 years (range 23–66 years). The incidence of synchronous primary endometrial and ovarian cancers was 2.01% in patients with endometrial cancer. A total of seven patients were menopausal (58%) and eight patients were nulliparous (66%); the median body mass index (BMI) was 29 kg/m2 (range, 20–38). Abnormal uterine bleeding was the most common presenting symptom. According to FIGO stage, 10 cases of endometrial were Stage I/II (84%) and two cases were Stage III (16%). Of the ovarian cancers, nine cases were Stage I/II (83.3%) and two cases were Stage III (16.7%). Endometrial cancer was the main pathological type in uterine carcinoma (86%) followed by serous carcinoma (14%), and similarly, for ovarian cancer, endometrial was the most common pathology (67%) followed by serous/clear cell (16%) and mucinous (16.7%). Most endometrial and ovarian primaries in our series were Grade I and II tumours, 83% and 66%, respectively. 8 patients (66%) had similar histology in both primaries. All patients underwent surgical intervention. Only one patient did not receive any post-operative adjuvant therapy. 10 patients received platinum-based adjuvant chemotherapy and six patients received adjuvant radiotherapy. Conclusion: Synchronous primary endometrial and ovarian cancers are infrequent and distinct set of patients. Abnormal per vaginal bleed was the most common symptom which helped in early detection. Majority of the patients belong to concordant endometrial histology, low grade, had younger age and high BMI. Treatment should be tailored to the stage, histology and grade of the individual tumours. Key words: Endometrial cancer, ovarian cancer, synchronous tumours

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Objective: The ob j e c t i v e of t he s t ud y is to e v al uat e t he effectiveness of rubber band ligation in the treatment of internal hemorrhoids. Methods: This is a prospective study of 120 cases who underwent rubber band ligation as an outpatient procedure for internal haemorrhoids. Binomial probability pre-post test were used for statistical analysis, pvalue less than 0.0001 was taken as significant. Results: One hundred twenty patients underwent rubber band ligation as a outpatient procedure for internal haemorrhoids. No major post procedure complications as sepsis, vasovagal reflex were observed. Only 36 patients had moderate discomfort following procedure, which lasted for 3-4 days and none had severe discomfort, and 84 patients did not need pain relief; 84 patients returned to work just after procedure .of symptom improvement post procedure compared to at presentation only 49% patients had bleeding post procedure out of 108 patients who had bleeding at presentation p-value of which was significant as pvalue = 0.00055, 6 patients had pain post procedure out of 36 patients who had pain at presentation p-value = 0.00024 was found significant. None patient after procedure had prolapse out of 24 patients who had prolapse on presentation (p-value = 0.0025). No patient had irritation or discharge post procedure (p-value = 0.00036). Ninety-six patients assessed rubber band ligation as excellent and 24 patients as of moderate help. Conclusion: Rubber band ligation for internal haemorrhoids is an effective modality of treatment mainly in 2° grade haemorrhoid which is convenient, simple, high patient acceptance with limitations as post procedure discomfort and pain.