A 50-year-old man presented with a 5-month history of swelling over the right side of neck. The swelling was associated with dull aching pain radiating to the forearm without associated weakness of upper extremity or sensory loss. There was no history of trauma. On examination a fixed mass approximately 8×6 cm in size, smooth, firm in consistency, with ill-defined margins was present in the right posterior triangle. MRI scan of the neck revealed well-defined, lobulated, heterogeneously enhancing altered signal intensity mass at the root of neck. Debulking of the tumour was performed in view of its close proximity to the brachial plexus. Histopathology revealed aggressive fibromatosis (AF). AF is a benign fibrous neoplasm arising from fascia, periosteum and musculoaponeurotic structures of the body. AF in the head and neck region tends to be locally aggressive with a nature to invade bone and soft tissue structures.

A 49-year-old multiparous woman presented with a swelling in the left groin of 6 months duration. The swelling was associated with a dull aching pain. The patient reported increase in size of the swelling during lifting of heavy weights. Menstrual history was normal and there was no increase in pain over the swelling during menstruation. She underwent a caesarean section 20 years ago and the scar had healed by primary intention. She was provisionally diagnosed to have a left-sided inguinal hernia. Ultrasonography showed a multiloculated cyst measuring 5.3×1.5×5.2 cm within the inguinal canal. The patient had excision of the cyst under spinal anaesthesia. Intraoperatively the cyst was found to arise from the left round ligament. It measured 7×6 cm extending to the left lateral vaginal wall. Histopathology revealed endometriosis of the round ligament. Her gynaecological assessment was normal and they recommended no further treatment. On follow-up the patient was asymptomatic and wound had healed well.

No abstract

DESCRIPTIONA 35-year-old man presented with complete rectal prolapse which was irreducible for 2 days. He was diagnosed to have a rectal prolapse 6 years ago when he noticed a mass protruding through the anus. Initially, the mass protruded from the anus only after a bowel movement and retracted spontaneously. As the disease progressed, the mass protruded more often, especially with straining and sneezing or coughing and he had to manually replace it. The patient never came for follow-up in 6 years. He does not have bleeding per rectum or pain in the abdomen. He does not have faecal incontinence. On examination the patient was anxious and dehydrated. His pulse rate was 100/ min and his blood pressure was 90/60 mm Hg. He had a full thickness rectal procidentia with mucosal congestion and oedema with whitish flakes over the rectal mucosa (figure 1). There was no evidence of ulceration or bleeding. Routine blood investigations revealed iron-deficient anaemia (haemoglobin: 9 g %) and elevated blood urea nitrogen (urea: 40 mg %). The patient was anxious and the mass could not be reduced at the bedside; hence he was shifted to the operation theatre where he was sedated, 2% lignocaine jelly was applied over the rectum and the mass was reduced with gradual pressure.Decreased anal sphincter tone was noted. Two per cent lignocaine was infiltrated around the anal orifice and 1'0 prolene suture was placed around the anal orifice in subcutaneous plane and tightened over a finger (as a purse string suture; figure 2) to prevent excessive narrowing of the anal orifice. The rectal procidentia was completely reduced (figure 3). Postprocedure there was no rectal prolapse after performing a Valsalva manoeuvre. The patient was resuscitated meanwhile and planned for elective abdominal rectopexy on a later date.Rectal prolapse is a condition in which the entire layer of the rectal wall protrudes through the anal canal. Haemorrhage occurs frequently in cases in which the prolapsed rectum is left unreduced. If severe haemorrhage or strangulation is detected, emergency treatments should be administered. Thiersch procedure (anal encirclement) is performed frequently in patients with old age or high risks with rectal prolapse. It is a simple procedure using a suture or prosthesis that narrows the anus. When it was reported for the first time by Figure 1 Full thickness rectal procidentia (12×6 cm) with mucosal congestion and oedema associated with whitish flakes over the mucosa.Figure 2 1-0 prolene placed around the anal orifice in the subcutaneous plane and then tightened over a finger (as a purse string suture).

Dermatofibrosarcoma protuberans is a rare soft tissue neoplasm arising from mesenchymal cells, making up about 6% of all soft tissue tumours. Often found on the scalp, neck, trunk and extremities, it has an intermediate-to low-grade malignancy potential except the fibrosarcomatous variant (high-grade), which is more likely to metastasize than other types. Here we present the case of a 46-year-old male who presented with an erythematous swelling on his upper back. MRI scan suggested a mesenchymal mass, which was then excised. Histopathology was reported as fibrosarcomatous variant of dermatofibrosarcoma protuberans. He is receiving radiation at present.