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Giant cell tumor of the tendon sheath (GCTTS) is a benign tumor and is the second most common tumor of the hand after ganglion cysts. It is a slow-growing benign lesion of the soft tissues. The etiology of GCTTS is not clear. Although GCTTS most commonly presents in a digit of the hand, it may also present in the palm, wrist, foot, knee, ankle, elbow, or hip. Here, we present a rare case of GCTTS originating at the inguinal region, which has not been previously reported. A 52-year-old male presented with a 2 cm × 1 cm swelling at the right inguinal region. The clinical impression was inguinal lymph node enlargement. Ultrasonography (USG) showed the presence of large inguinal lymph node. Fine-needle aspiration cytology (FNAC) showed the features suggestive of giant cell lesion, possibly GCTTS. Repeat ultrasound revealed a large oblong-shaped hypoechoic lesion with mild internal vascularity in the right inguinal region above the external oblique aponeurosis, suggestive of aponeurotic giant cell tumor. Histopathology was confirmatory. Here, we report this case to highlight the role of FNAC in diagnosing GCTTS at a rare site, i.e., inguinal region. Due to its location at inguinal region, along with clinical suspicion of tubercular lymphadenitis and USG findings showing large inguinal lymph node in the right inguinal area, it needs to be differentiated from other causes of lymph node enlargement. It would be prudent to state that FNAC along with radiology can help reach the final diagnosis.

Desmoplastic small round cell tumor (DSRCT) is an extremely rare malignancy mainly located in the abdominal and pelvic peritoneal cavity. A few published studies have reported the involvement of testicular/paratesticular region. The present study describes an unusual case of paratesticular DSRCT that was discovered incidentally during imaging of an obstructed inguinal hernia in an old-age patient. After radical orchiectomy, the patient was administered treatment consisting of a multidrug combination chemotherapy and adjuvant radiotherapy and remained disease free during the 24-month followup period, with only one attachment of local tumor recurrence in the right inguinal region.

Ileo-ovarian knotting in a case of strangulated inguinal hernia, reported herein, has never been reported before. We believe this case is of great importance because of its absolute rarity. A 46-year-old female came with right inguinal swelling, vomiting, and abdominal distension for 2 years but aggravated during the last week. She had passed stools 24 h ago and was vomiting since then. The abdomen was distended as well as tenderness and guarding was noted in the lower abdomen. Examination revealed strangulated right inguinal hernia with abdominal X-ray suggestive of acute small bowel obstruction. Abdominal ultrasonography revealed dilated small bowel loops and aperistaltic edematous intestines in the right inguinal region; an urgent surgery was, hence, planned. Exploration revealed ileo-ovarian knotting with one-foot gangrene of small bowel and strangulated right ovary. Resection of the right ovary, bowel resection, and end-to-end anastomosis with hernioplasty were performed. The patient recovered well in the postoperative period.

Background: Hydatid disease (HD) is an ancient disease and even was known to Hippocrates. This disease involves all human parts and most common affected organs are liver and lungs. Incidence of unusual site is about 8‑10%. The clinical picture depends upon the involved organs, its effects on adjacent structures, complications due to secondary infection, rupture, and anaphylaxis caused by hydatid cysts. Aim: The aim of this study was to find out incidence of unusual location of hydatid cyst in the human body. Materials and Methods: A retrospective study of HD was carried in a medical college between July 2007 and June 2012. A total 79 cases of HD were treated during this period. Information on clinical presentation and management were reviewed, and results presented as summary statistics. Results: Sixty one cases were of liver HD, and 11 were with hydatid lung disease. Fifty cases were with right lobe involvement, and rest 11 were with both lobe involvement. Out of 11 lung hydatid only one case was with bilateral lung involvement. Only eight cases of HD of uncommon locations and presentations were encountered during this period. First case presented with left hypochondriac mass as splenic HD, second with pelvic HD along with obstructive uropathy, third with non‑functioning right kidney with bilateral psoas muscles HD, fourth with HD involving mesentery, fifth with pelvic pain due to right ovary HD, sixth with simultaneous involvement of the liver and right subdiaphragmatic region, seventh with HD of right inguinal region, and eighth with hydatid cyst of the left kidney. Even though, there was no mortality found in these patients, there was high morbidity. Conclusion: We conclude that Echinococcus granulosus can affect any organ in the body from head to toe, and a high suspicion of this disease is justified in endemic regions. Moreover, medical treatment should be given in the pre‑operative period as well as in the post‑operative period for 4‑6 weeks.Keywords: Hydatid disease, Ovary, Psoas muscle, Renal, Spleen, Unusual locations

We report a rare case of a 62-year-old male who presented to surgical emergency department with the complaints of sudden onset pain and swelled in the right inguinal region with nausea, vomiting and abdominal distension. There was a history of a reducible swelling in the right inguino-scrotal region for the last 1 year. Based on history, clinical examination and investigations a provisional diagnosis of right-sided strangulated inguinal hernia was made and patient was planned for an emergency surgery. On the exploration, the hernial sac revealed a gangrenous vermiform appendix and the diagnosis of Amyand′s hernia was made. Appendectomy was performed through the same incision, and hernial repair was done using a polypropylene mesh.

We present a patient with complete androgen insensitivity syndrome (CAIS) diagnosed with a serous papillary cystadenofibroma. A 41-year-old married female with a mass in the left inguinal region and a history of primary amenorrhea. A bulging mass of 13.7 cm × 8 cm × 12.4 cm in the left inguinal region extending from the hip joint to the level of labia majus, and a 3.2 cm × 2.8 cm mass in her right inguinal region were found by ultrasonography and magnetic resonance imaging. We performed bilateral gonadectomy. The pathology showed testicular tissue in the right inguinal mass and a serous papillary cystadenofibroma in the left one. CAIS is an infrequent clinical entity, occurrence of serous papillary cystadenofibroma is even rarer in this syndrome serous cystadenofibroma should come to mind in patients with a huge inguinal mass. Gonadectomy should be performed right after puberty to prevent the risk of malignancy development in the testes.

Introduction: Handlebar hernia is a specific type of traumatic abdominal wall hernia that is caused by impact of the abdominal wall against a blunt object, usually bicycle handlebars. The rarity of handlebar hernia and its frequent presentation without physical signs makes it highly susceptible to misdiagnosis which may be attended with serious consequences. We discuss the presentation and management of a case of handlebar hernia and a review of literature. Case Report: A 14-year-old boy presented to emergency department with pain at right inguinal area where the abdomen had impacted on the handlebar of the bicycle. Immediately after the accident, he noticed a swelling at the site of impact. He had no history of inguinal hernia. His examination revealed normal vital signs. There was abrasion in the right inguinal region and a reducible swelling with positive cough impulse. Abdominal ultrasound showed normal abdominal viscera and the swelling was noted to contain loop of bowel. A diagnosis of handlebar hernia was made. Through an incision over the bulge, a 10 cm loop of normal bowel found in the subcutaneous plane was reduced and the 5-cm defect in the anterior abdominal wall muscles repaired in layers. The boy remains well at 2½ years of follow-up. Conclusion: Handlebar hernia can be diagnosed based on history of mechanism of injury, careful physical examination, and high index of suspicion. Abdominal ultrasound or computed tomography is an important adjunct of management. Prompt surgical repair of the hernia is recommended to prevent incarceration or strangulation.

Sir, Small bowel cancers are rare; primary small intestinal lymphoma accounts for 15–20% of these tumours. Patients with small intestinal lymphoma frequently present with abdominal emergencies to the surgeon.[1] A 50-year-old man presented with a 6-month history of a right groin swelling. On further questioning, the patient reported weight loss and reduced appetite. He reported no abdominal pain and changes in bowel habits. Physical examination revealed a large right groin swelling measuring approximately 15 cm in diameter. The swelling had the features of an abscess (red, hot, tender, and fluctuant) extending downwards into the right thigh and upwards into the right lower quadrant of the abdomen. Laboratory tests showed a mild leucocytosis of 12.3 × 109/L, a haemoglobin concentration of 11.4 g/100 mL and a C-reactive protein of 311 mg/L. A computed tomography (CT) scan revealed a soft tissue mass measuring 12 cm × 12 cm × 23 cm occupying the right hemipelvis and extending into the right inguinal region [Figure 1]. There was no thoracic or abdominal lymphadenopathy. Figure 1 CT image showing mass extending into the right side of the pelvis The patient underwent incision and drainage of this abscess. There was a large amount of faeculant material filling the entire abscess cavity; this appeared to be extending upwards medial to the femoral vessels, along the femoral canal. Laparotomy through a right lower transverse incision was made. Surprisingly, there was no intraperitoneal faecal contamination. Exploration revealed a full thickness retroperitoneal perforation of the terminal ileum with fecal contamination of the retroperitoneal space of the right iliac fossa. It was evident that part of the circumference of the terminal ileum was incarcerated in the femoral ring resulting in a femoral hernia and consequent perforation. An ileocaecal resection was performed. Histopathological examination confirmed diffuse large B-cell lymphoma. Two months later, a repeat CT scan showed a reduction of the right pelvic mass to 7.5 cm × 12 cm, with no evidence of lymph node involvement elsewhere. The patient has currently fully recovered from surgery and is receiving chemotherapy. The gastrointestinal tract is the most common site of extranodal non-Hodgkin lymphoma.[1] In 20–30% of cases, the small intestine, particularly the ileum, is affected.[2] Small intestinal lymphomas most commonly cause abdominal pain (82%).[3,4] Other presenting symptoms include changes in bowel habits (16%), a palpable abdominal mass (16%), and blood in the stool (15%).[2] In approximately 30–50% of patients, however, the initial presentation of small bowel lymphoma is an abdominal emergency,[1,5] with perforation present in up to 37% of cases.[5] A review of literature in English revealed no cases of small intestinal lymphoma presenting as a groin abscess. What was unique about this patient was that despite having a small bowel perforation, he did not present with an abdominal emergency. As the perforation was extraperitoneal, the presentation was that of a chronic right groin swelling, which was diagnosed clinically as an abscess. The duration of the symptoms before seeking medical advice was also unusually long (6 months). This perhaps reflected the patients own beliefs and character. This is believed to be the first documented case of primary small intestinal lymphoma causing a groin abscess as a result of intestinal perforation. This case highlights the variable and somewhat unusual presentation of these tumours.