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Introduction: Endometriosis is a chronic disease with the presence of endometrium-like tissue containing endometrial glands and stroma outside the uterus. The incidence of episiotomy scar endometriosis after vaginal delivery is 0.06–0.7%. Case presentation: A 28-year-old parous woman with two previous vaginal deliveries with episiotomy presented to the outpatient department with severe pain and swelling in the perineal region over the past year, leading to difficulty in sitting, coitus and routine essential activities like defecation. She had undergone local perineal nodule excision surgery twice, which confirmed her perineal scar endometriosis diagnosis one year earlier at another hospital with no improvement in symptoms. Physical examination revealed a firm, tender, deeply embedded palpable nodule measuring approximately 3 ‐ 4 cm in the left posterolateral aspect of the distal vagina. Wide local excision of the nodule with a clear margin of 1 cm was performed. The nodule extended up to the left ischial tuberosity and apex up to the pudendal vessels complex. Discussion: The classic diagnostic triad of perineal endometriosis were present in this patient. Surgical intervention with wide local excision with a clear margin of approximately 1 cm of healthy tissue reduces the chance of recurrence. Conclusion: Awareness of this condition among medical practitioners will lead to early diagnosis and excision. Timely intervention in the form of excision with free margins is the definitive treatment and provides complete pain relief and good quality of life for endometriosis patients.

Introduction: Presence of lymph node metastases in colorectal cancer (CRC) is well recognized as one of the most important prognostic factors. Almost no data is available on Apical Lymph Node (ALN) positivity and its impact on survival and recurrence in India. Our study aims to bridge this gap. Material and Methods: 40 CRC patients deemed resectable on standard preoperative work up were included in the study. Apical lymph node and specimen were sent separately for histopathological examination and patients were divided into ALN positive (ALN+) and ALN negative (ALN-) groups. Patients were followed up for a period of 24 months. All patients were followed up with 3 monthly Carcinoembryonic Antigen (CEA) and Ultrasound abdomen, colonoscopy at 1 year and Computerized tomography (CT) abdomen at 1 year. Results: Of 40 patients 8 (20%) were ALN+. 30% (12/40) had recurrences of which 100% ALN+ cases(8/8) had recurrence but only 12.5% (4/32) of ALN- group had recurrence. In ALN+ group, all recurrences were distant metastasis whereas recurrences in ALN- group were 50% local and 50% distant metastasis. Mean recurrence free survival was 6months in ALN+ group while in ALN- group it was 10.5 months. 75% of ALN+ patients had elevated CEA level compared to 18.7% of ALN- group. Lymph Node ratio (LNR) was statistically higher in ALN+ group (60% versus 2.7% in ALN- group). Conclusions: ALN positivity was found to be 20% and correlated with higher preop CEA. ALN+ status was a significant risk factor for recurrence. ALN positivity is an indicator for higher recurrence rates and distant metastasis.