A spontaneous, intramural, intestinal haematoma is a rare complication of the anticoagulant therapy. We are reporting here, a rare case of a 63-years-old male, who presented with intestinal obstruction which was caused by an intramural and a submucosal colonic haematoma, which had resulted from warfarin administration. This patient rapidly improved after taking conservative treatment. A history of anticoagulant use with a prolonged INR value in patients who present with abdominal pain, should alert the physicians or surgeons to search for this entity. It is extremely important to recognize this syndrome at its early stages, to avoid an unnecessary operation, since the outcome is usually excellent after a conservative treatment.

Malignant proliferating trichilemmal tumour (MPTT) is a rare cutaneous tumour predominantly affecting the scalp, eyelids, neck and face of elderly women. It is a large, solitary, multilobulated lesion that may arise within a pilar cyst. These tumours are largely benign, often cystic and are characterized by trichilemmal keratinisation. However at times, the tumour has an aggressive clinical course and a propensity for distant metastasis. We report a case of a 29-year-old male who presented with a scalp swelling. Histology revealed malignant proliferating trichilemmal tumour of scalp. CT thorax showed multiple nodules in both lungs suggestive of lung metastasis. The patient underwent palliative radiotherapy and chemotherapy and expired 2 months after palliation. To the best of our knowledge, malignant proliferating trichilemmal tumour of the scalp with intracranial extension and lung metastasis is a rare condition, and only a handful of cases are reported till date. We report a case of malignant proliferating trichilemmal tumour of the scalp with intra-cranial extension and lung metastasis with relevant discussion at the same time.

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Introduction: Gastric cancer (GC) is the fourth most prevailing cancer globally, attributing to more than 70% of cases in developing countries. Protein cancer biomarkers, such as CEA, CA- 125, AFP and PSA, are clinically helpful diagnostic tools, but they have low sensitivity and specificity for GC. Hence, it is essential to discover better markers for GC diagnosis. Interleukin-18 (IL-18) is the member of Interleukin-1 family. It is hypothesized to be a potent inhibitor of gastric acid secretion, leading to gastric atrophy and causing an increased risk of GC. This study was to evaluate the association between the serum IL-18 in GC.   Methodology: We included cases who underwent UGI Scopy and were proven to have GC histopathologically. The patients who presented to the out-patient who underwent UGI scopy and was found to have no growth were selected as controls. Twenty-eight cases and 84 control sample sizes were derived from nMaster V2. Blood samples from patients and controls were collected, and serum IL-18 levels were estimated using a solid-phase sandwich ELISA method.   Results: We found that the cut-off value of serum IL-18 was 85.59 pg/ml, had a sensitivity of 63.1% and specificity of 57.1%, with a positive predictive value of 81.5% and a negative predictive value of 34% in diagnosing GC. The study plotted the receiver operating characteristic curve against IL-18 for sensitivity and specificity. Statistically, we found through the Area Under the Curve (AUC) that the rise in serum IL-18 levels was a poor indicator of GC with a p-value of 0.078.   Conclusion: Statistically, a cut-off of 85.59pg/ml showed good sensitivity and specificity; however, the probability was insignificant, suggesting that IL-18 may not be of diagnostic importance. Studies with a larger sample size are required to further probe into the usefulness of estimating IL-18 in GC.

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