Chondroid syringoma (CS) represents the cutaneous counterpart of mixed tumor (pleomorphic adenoma) of salivary glands. The malignant counterpart of CS, termed as “malignant CS” is a malignant eccrine neoplasm which lacks distinctive clinical features, often delaying initial diagnosis. Unlike its benign counterpart which often localizes in the head and neck region, malignant CS most often encountered in the trunk and the extremities. We report a rare case of an aggressive malignant CS of the left pinna with cervical lymph node metastasis. Our patient, to the best of our knowledge, possibly is the first case of malignant CS of the pinna and the fourth to arise in the head and neck region. The diagnostic challenges with an added emphasis on the role of positron emission tomography-computed tomography in aiding the management of this rare tumor are discussed.

Extralevator abdominoperineal excision (ELAPE) results in a large perineal defect which needs reconstruction by a flap or biological mesh. The incidence of perineal wound complications is thought to be higher following an ELAPE compared to conventional abdominoperineal excision (APE). WE aimed to analyze the perineal wound complications following ELAPE in our institution. This was a retrospective analysis of all consecutive patients who underwent an APE (conventional and ELAPE) procedure in our institution between 2012 and 2015. We retrieved the demographic data, treatment data, and pathological data from the case records. Reconstruction of the perineal defect after a prone perineal dissection was performed using a local muscle flap. The incidence of perinealwound complications, hospital stay, and time to initiate adjuvant chemotherapy was compared between the two groups. A total of 71 patients underwent APE over a period of 41 months of which 21 patients underwent ELAPE. The perineal dissection during ELAPE was done in the prone position in 18 patients and in the supine position in 3 patients. Perineal wound complications were seen in 9 patients (42%) who underwent ELAPE compared to 17 patients (34%) who underwent conventional APE (p = 0.52). The mean duration of hospital stay was significantly longer in patients who underwent ELAPE when compared to those who underwent conventional APE (22.9 ± 3.6 days vs 14.6 ± 1.0 days, p = 0.03). The median interval between ELAPE and initiation of adjuvant chemo was 54 days (range 32-120 days) compared to 50 days (range 30-100 days) in patients undergoing conventional APE. A delay in initiating adjuvant chemotherapy of more than 12 weeks was seen in 4 patients (19%) following ELAPE. The incidence of perineal wound complications following ELAPE in this study was comparable to that reported in literature. Although the hospital stay following ELAPE was significantly longer than that following conventional APE in our institution, it did not unduly prolong initiation of adjuvant chemotherapy. Improving the perineal reconstruction techniques and selecting patients who will benefit from ELAPE may help to reduce the wound complications.

Background: Diabetes is a chronic metabolic disorder and has become the one of the most challenging global health problem of 21 st centuary. Diabetic nephropathy is a major complication of diabetes and an established risk factor for cardiovascular events. Lipid abnormalities occur in patients with diabetic nephropathy, which further increase their risk for cardiovascular events. We aimed to research association between extended lipid profile and urine albumin-creatinine ratio (UACR), hypothesizing that early detection and treatment of lipid abnormalities can minimize the risk for atherogenic cardiovascular disorder and cerebrovascular accident in patients with type 2 diabetes mellitus. Methods: A hospital based cross- sectional study was conducted on 48 patients with type 2 diabetes mellitus. All patients fasting blood glucose (FBG), HbA1c, total cholesterol (TC), high density lipoprotein (HDL), low density lipoprotein (LDL), triglyceride (TG), apolipoprotein-A (apo-A), apolipoprotein-B (apo-B), lipoprotein (a){Lp(a)} and urine-albumin creatinine ratio (UACR) evaluated. Patients taking steroids, any renal disease other than diabetic nephropathy and patients of uncontrolled hypertension were excluded from study. Based on UACR level patients were divided into three sub groups: normal (<30 mg/g), microalbumiuria (30-300 mg/g) and macroalbuminuria (>30 mg/g). Comparison between three subgroups of UACR and extended lipid profile was made using non parametric test (Kruskal Willis Test). Fisher’s exact test was used to explore the association between UACR and extended lipid profile. Result: 20.8% patients had UACR<30 mg/g, 54.2% patients had UACR:30-300 mg/g, 25.0% patients had UACR:≥300 mg/g; 62.5% patients had Lipoprotein(a): <30 mg/dl and 37.5% patients had Lipoprotein(a): > 30 mg/g. Significant association was found between UACR and Lipoprotein(a): · 100.0% of the patients with [UACR: <30 mg/g] had [Lipoprotein-a: <30mg/dL]. · 57.7% of the patients with [UACR: 30-300 mg/g] had [Lipoprotein-a: <30 mg/dL]. · 42.3% of the patients with [UACR: 30-300 mg/g] had [Lipoprotein-a: ≥30 mg/dL]. · 41.7% of the patients with [UACR: >300 mg/g] had [Lipoprotein-a: <30 mg/dL]. · 58.3% of the patients with [UACR: >300 mg/g] had [Lipoprotein-a: ≥30 mg/dL]. Conclusion: The study showed that diabetic nephropathy resulting in raised UACR has significant association with increased lipoprotein (a) and consequently increased risk of atherosclerotic cardiovascular disease (ASCVD). Since Lipoprotein(a) investigation is not widely available, accessible and has varied estimation technique, UACR can be used as a marker of risk for ASCVD in place of Lipoprotein(a) in type 2 DM.