Soares A has completed her PhD from Beira Interior University, Portugal and Postdoctoral studies from Hospital Amato Lusitano-Castelo Branco.She is in the 3rd year Resident of General Surgery at Hospital Amato Lusitano.

The TAMIS technique is currently one of the most effective methods for resection of mid-inferior rectus lesions, namely large polyps not amenable to endoscopic removal, as well as in the case of early stage neoplasms in patients with significant comorbidities. We describe the case of a 71-year-old male sent to the surgery consultation due to a flat lesion of the distal 1/3 of the rectum occupying half of the lumen, not acessible to complete excision by endoscopy, whose biopsies revealed a villous adenoma with a low-grade dysplasia. During patient’s evaluation there was disagreement between staging MRI, which revealed a malignant rectal neoplasm infiltrating the entire thickness of the rectal wall and multiple adenopathies (T3 long N2) and ano-rectal echo-endoscopy in which submucosal involvement was observed without apparent further infiltration (T1N0Mx). We chose resection of the lesion by TAMIS, delaying radical surgery if pathological anatomy confirms malignant neoplasia.

Anatomopathological examination revealed a tubal reticular adenoma of the rectum, with focal high-grade dysplasia and free resection margins. The patient maintains follow-up without recurrences.

Seelamanthula V has completed his Graduation from Kathmandu Medical School and has obtained MRCS from Royal College of Surgeons, Edinburgh. He is

currently working as a Registrar in General Surgery at Caboolture Hospital, Queensland, Australia. He is also Associate Lecturer at the University of Queensland.

Colonic metastasis from breast carcinoma is extremely rare. Bony, pulmonary, pleural, hepatic and cerebral metastases are common. Here we discuss rare colonic metastatic presentation of a primary breast malignancy. A 72 year old female presented with a left breast mass in 1991 treated with breast conserving surgery, axillary clearance and adjuvant radiotherapy.Six years later she developed bony metastases requiring endocrine therapy and bisphosphonates. Following this, she was diagnosed with ovarian metastases requiring total abdominal hysterectomy and bilateral salpingo-oophorectomy. New retroperitoneal disease was detected subsequently on surveillance imaging mandating Aromasin reinstitution. Routine bowel screening few years later revealed a sigmoid growth histologically consistent with metastatic breast cancer, PET scan confirmed a locally invading proximal sigmoid mass. Anterior resection of mass was performed. Tissue was immuno histochemically

consistent with metastatic breast primary with nodal involvement. We present a rare case of breast cancer metastases to sigmoid colon that was detected on routine surveillance colonoscopy for polypoid disease and herewith, emphasize the importance of biopsying bowel polyps in the context of prior breast cancer, providing the pathologist with this crucial information for timely diagnosis. There are emerging case reports of this uncommon occurrence, which can also present with symptoms of dyspepsia,anemia and bowel occlusion. Early investigation with PET scan may aid timely diagnosis. Indications for surgery should be based on the risk of intestinal occlusion or bleeding. Clinical management can be challenging. Holistic care should be delivered via multidisciplinary approach.

Mehreen Khan Bhettani is Graduated from Khyber Medical University.She had the Fellowship training in General Surgery at Pakistan Institute of Medical sciences Islamabad, under the supervision of Professor Rakhshanda Rashid.She also has the Membership of Royal College of Surgeons, Edinburgh. She is currently working as a Senior Registrar in General Surgery at Shifa International Hospital.

Introduction: Fibroadenomas despite being benign cause undue anxiety to patients and place an enormous burden on physicians. Relationship of Body Mass Index and benign breast diseases is quite controversial. Despite multiple publications on relation of fibroadenoma and BMI in international literature, there are a few studies in Pakistan. Therefore it is need to time to ascertain any co-relation in our set of population.

Method: This was a descriptive cross-sectional study, conducted at the Department of General Surgery, Pakistan Institute of Medical Sciences, Shaheed Zulfiqar Ali Bhutto Medical University, Islamabad, Pakistan from 24-03-2016 to 23-09-2016. 300 patients having benign breast diseases were evaluated co-relation between fibroadenoma and BMI. The data was analyzed by SPSS software version 17. Univariate analysis was used to establish co-relation between BMI and fibroadenoma. A P value of less than 0.05 was considered as significant.

Result: The mean age was 23.05±4.17 years (13-35). The average size of fibroadenoma was 2.5±1.9 cm (1-5). The mean BMI was 21.8±1.3 (19-24.9). 60 (20%) had fibroadenoma, while 240 (80%) had other benign breast diseases. 42(30.8%) of patients with high BMI (136) had fibroadenoma. 8 (10.8%) of patients with low BMI (74), had fibroadenoma however 10 (11.1%) of patients with Normal BMI (90) had fibroadenoma. Our study population showed a statistically significant increased risk of fibroadenoma formation in adolescent age group with high BMI (P<0.001).

Conclusion: A high BMI seems to be a substantial risk factor for development of fibroadenoma particularly in young adolescent females. The most site of lesion in our population was the upper outer quadrant of breast. There was substantial association of body mass index with size and quantity of lesions.

Teffahi Sidahmed is a 3rd year Medical Resident in General Surgery at the University of Algiers’s. He is currently pursuing his Residency. He has completed his Residency subspeciality in Orthopedic Surgery and Traumatology, Pediatric Surgery, Thoracic Surgery , Urology and Plastic Surgery at the Teaching Hospital

Mustapha Pacha in Algiers.

Cutaneous squamous-Cell Carcinomas (SCC) are one of the main types of skin cancers, after basal cell carcinoma. Theoverall  cure rate for both types of skin cancer is related to the stage of the disease and the type of treatment employed.

This case involves a locally advanced cutaneous squamous cell carcinoma of the scalp with a deep invasion of the skull. A computed tomography showed full thickness scalp defect and occipital bone destruction. Gadolinium-enhanced MRI revealed no neoplastic invasion of the dura and both cerebral hemispheres. We performed a resection of the scalp craniectomy and dural resection followed by a reconstruction of the skin defect using a rotational flap closure, following the Orticochea’ method. The patient tolerated the procedure, recovered with minimal morbidity and good cosmetic result and addressed for radiotherapy.