Microscopic examination, although an integral part of pathological examination as some of these women may require subsequent treatment, reveals significant pathology in very few cases.

Our results demonstrate in a subset of cases that decline in BRCA1 expression that may be associated with potentially compensatory increase in BRCA2 protein, which may depend on tumor grade as well as menopausal status.

No abstract

Spontaneous small intestinal perforations are common in India. Surgeons operating on patients with an obscure peritonitis should be aware of the diverse aetiologies of small intestinal perforations in order to be able to provide the appropriate management. We reviewed the pathology records of 165 patients operated on for nontraumatic perforations of the small intestines in our hospital between 2005 and 2007. Perforation edge biopsy was diagnostic in 53 cases, with typhoid being the most common aetiology, followed by TB. The majority of cases, however, revealed only a non-specific inflammatory granulation tissue. However, the sensitivity of biopsy diagnosis could be increased by taking additional biopsy material from the mesenteric lymph nodes, tubercles or omental nodules. We conclude that perforation edge biopsy is useful in a third of cases, but the diagnostic rate could be improved by taking additional biopsy material.

Dear Editor,Melanocytic nevus with primary anorectal melanoma: a rare associationa ns_5291 380..387 Primary mucosal melanomas are rare and biologically aggressive. Anorectal melanomas accounts for <1% of all colorectal malignancies and have no known associated risk factors or nevus association documented so far. We report a case of a primary rectal melanoma associated with and probably arising from a nevus in a young male patient.A 30-year-old male presented with complaints of bleeding per rectum for 4 months. There were no complaints of altered bowel habits, fever, abdominal pain, past history of tuberculosis or any other systemic complaints. Per rectal examination revealed a pigmented growth in the posterior wall of anal canal. Rectal biopsy performed from two adjacent sites of anorectal junction showed malignant melanoma in one and a melanocytic nevus in the other. The patient underwent abdominoperineal resection with descending colostomy. The surgical specimen showed a 6 ¥ 5 cm, brown-black, partially ulcerated polypoidal growth at the anorectal junction. Few black-coloured nodular mucosal lesions were seen near the base of polypoidal main tumour mass (Fig. 1). Histology of the anorectal growth showed a melanoma extending up to muscularis externa. The adjacent mucosal lesions were melanocytic nevi with junctional activity. The proximal and distal resection margins were free of tumour. The patient had uneventful post-operative period.Melanoma has been described in nearly every organ besides skin. The mucosal melanomas are morphologically similar to the cutaneous ones; however, the prognosis varies with the site and extent of the local disease. Anorectum is the third most common site for melanoma after skin and eye. Unlike cutaneous melanomas, there are no known predisposing factors or nevi association, known so far, for anorectal melanomas. 1 Anorectal melanomas originate from the melanocytes present at the transitional zone above the dentate line. 2 No reports of anal nevus could be found in English literature. The skin nevi are well known to be associated with an increased risk of malignant transformation. Saida et al. found no association of mucosal nevi with malignant melanoma. 3 Thus, we have described an anal melanocytic nevus associated with malignant melanoma. The recognition of a nevus in anorectal region can avoid a mistaken diagnosis of melanoma in these regions.