Angiokeratomas are benign vascular lesions that can occur anywhere in the body. Fordyce angiokeratomas, also known as genital angiokeratomas, often develop on the vulva in women and the scrotum in males. A subtype of genital angiokeratoma in males is called penile angiokeratoma (PEAKER). In females, clitoral angiokeratoma (CLANKER) is the embryologic equivalent. As a result of the underlying pathophysiology, these lesions are often bilateral. Unilateral Fordyce angiokeratoma instances are infrequent, and unilateral PEAKER cases have never been previously documented. We describe a case of Fordyce's unilateral angiokeratoma with unilateral PEAKER. To the best of our knowledge, such a variation in presentation of this rare disease has not been previously reported.

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Chondroid syringoma (CS) is a sporadic skin appendage tumor that manifests as slow-growing, subcutaneous, non-tender, non-ulcerating dermal nodules, most often in the head and neck. The tumor is more common in men, has a biphasic age distribution, and usually attains a size of 0.5 to 3 cm. Larger lesions up to 9 cm in size have been recorded in the literature, with the majority of them containing malignancies. Rare cases of malignant CS have been described, with local recurrence and metastasis. We report a case of an 85-year-old man presenting with complaints of a significantly large swelling in the inner aspect of his right thigh for the past 25 years. Clinical and radiological differential diagnoses of a large uncomplicated dermoid cyst, sebaceous cyst, epidermal inclusion cysts, neurogenic tumours, or myxoid tumours with cystic degeneration were suggested. Under general anaesthesia, the lesion was completely excised with a 1 cm margin of healthy surrounding tissue. The histopathological examination of the complete surgical specimen was consistent with CS. Patient has been on regular follow-up and has shown excellent response to treatment, with no evidence of recurrence, metastasis, or disfigurement. With this paper, we report a case of benign CS in an unusual location, attaining a huge size (>10 cm) and, even then, not turning malignant. We hope to add to the current knowledge on CS, allowing for early and accurate diagnosis and successful disease management.

IntroductionAcute appendicitis is a frequent illness that manifests as an emergency and most of the cases necessitate surgical intervention. One of the most critical processes in a laparoscopic appendicectomy is the closure of the appendicular stump. For the closure of the stump of the appendix, several approaches have been employed and explored, but the one with the best outcomes has yet to be proved. The purpose of this study was to evaluate the medical results and cost analyses of laparoscopic appendicectomy with two of the commonly used stump closure techniques -ENDOLOOP ® and Hem-o-lok ® . Materials and methodsA two-year prospective hospital-based cohort study was conducted from June 2019 to July 2021. All the patients in the study were randomly assigned to one of two experimental arms (ENDOLOOP ® and Hem-olok ® ). The clinical and follow-up data of these patients were collected and tabulated into a data sheet and analyzed. ResultsIn total, 180 individuals were included in the research (90 in each arm). No statistically significant difference was found in comparing the age, gender or diameter of the appendix among the two groups. The time taken for surgery showed significant differences among the two study groups. The time taken for the procedure in the Hem-o-lok® group was significantly lower than the ENDOLOOP® group (40.3 ± 12.3 minutes vs 50.83 ± 10.5 minutes, p < 0.001). No intraoperative or immediate postoperative complications were noted in either of the groups. The average duration of hospital stay was 2.7 ± 0.9 days in the Hem-o-lok® group, while it was 3.1 ± 0.8 days in the ENDOLOOP® group (p = 0.986). The material cost for the stump ligation with Hemo-lok® was Rs. 310 ± Rs. 76 while that using ENDOLOOP ® was Rs. 630 ± Rs. 118 (p < 0.001). In the Hem-olok ® subset of patients, the mean direct expenses of laparoscopic appendicectomy were considerably lower. During the 12-week follow-up period, none of the patients had any post-operative complications. ConclusionAccording to the results of this study, both the technical variations of appendix stump closure are equal in terms of postoperative complications. When compared to the ENDOLOOP ® group, the Hem-o-lok® group had a shorter duration of surgery and ended up spending less money. Hem-o-lok® clips have the potential to become the preferred way of anchoring the appendix base during laparoscopic appendicectomy.

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