Extraperitoneal hernia repair has become increasingly popular for inguinal hernia repair. Incisional hernia repairs are routinely repaired through an open procedure or a transabdominal laparoscopic approach. We present a patient who presented with both inguinal hernias and an incisional hernia. Our patient underwent a totally extraperitoneal hernia repair of both his inguinal hernias and his incisional hernia.

Myofibroma is a rare, benign tumor of soft tissues representing the most common fibrous tumor of infancy. It has a wide array of presentations, most commonly in the head and neck region, constituting unique diagnostic and therapeutic challenges. Myofibromas have typically a predilection for the mandible, and parapharyngeal involvement is extremely rare. This is the case of a six-year-old girl with an unusual presentation of myofibroma in the right parapharyngeal space compressing on the trachea and causing stridor and dyspnea. The patient was treated surgically and the mass was excised due to mass effect. She presented several months later with recurrence of the mass and the patient had to undergo a right modified radical neck dissection for better exposure and access of the tumor. This is the second case of parapharyngeal myofibroma reported in the literature and the first to have been excised using a modified radical neck dissection approach.

Background: spontaneous small bowel evisceration through vagina is an extremely rare condition.

Case: A 57 years old alone female brought to the emergency department with the complaints of irreducible mass protruding through vagina since 12 hours. There was no significant past history elicitable due to lack of recalling from her. The small bowel loops were put back into abdominal cavity by laparotomy and the pelvic floor defect was sutured per vaginally with correction of uterine prolapse. The postoperative recovery was uneventful.

Conclusion: spontaneous vaginal evisceration of small bowel with uterine prolapse is an emergency condition which needs immediate surgical intervention.

Sebaceous cyst is common in daily surgical practice. But it can presents with very unusual way. Here we have reported 4 such cases of very rare presentation.

Background: At the 13th St Gallen International Breast Cancer Conference in 2013, a new definition of luminal A-like and luminal B-like breast cancer was proposed, involving the expression of Estrogen Receptor (ER), Progesterone Receptor (PgR), and Ki-67. We examined the rate of concordance between the risk groups using the Oncotype DX Recurrence Score (RS) and the previous and newly proposed luminal subtypes with the standardized Ki-67 assessment.

Method: The relationship between a previously and newly proposed, immunohistochemically defined luminal A and B subtype with the Oncotype DX RS of 41 cases of T1-2 N0-1 M0 (ER positive, HER2 negative) breast cancer was assessed. We first classified the patients into the previously defined luminal A and B subtypes, according to the level of Ki-67 as either “low” (<14%) or “high” (≥14%), as assessed by local pathologists. Next, to consider the necessity for standardizing Ki-67 measurement methods, we re-examined Ki-67 with a central review. By introducing PgR positivity (≥20%), we classified these patients to newly proposed luminal subtypes and compared them with the risk groups stratified by Oncotype DX RS.

Results: In the previously proposed luminal subtypes, the concordance rate between luminal A and the low RS category was 76.5% according to local pathologists and 90.1% by central review, whereas the rate between luminal B and the intermediate to high RS category was 46.7% and 45.8%, respectively. In newly proposed luminal subtypes, the concordance rate between luminal A and low RS category was 100% and between the luminal B and intermediate to high RS category was 53.6%.

Conclusion: Although this study was based on a retrospective chart review of a small sample size, the newly proposed luminal subtypes, including addition of PgR positivity, appeared to improve the precision of selecting patients with intermediate to high RS categories.