Radio-cephalic fistula

Pectus excavatum

Carcinoma cheek

Carcinoma tongue

Gynaecomastia

Gynecomastia, is the development of abnormally large mammary glands in males resulting in breast enlargement. The term comes from the Greek (γυνή) gyne (stem gynaik-) meaning "woman" and (μαστός) mastos meaning "breast".

1. This condition can occur physiologically in neonates due to female hormone from mother and the discharge is known as 'Witches milk'.
   
   
   
2. 
   
   Breast prominence due solely to excessive adipose is often termed as pseudogynaecomastia or sometimes lipomastia.
   
   
   
3. 
   
   The condition should be differentiated from work hypertrophy of the pectoralis muscles caused by exercise.
   
   
   
4. 
   
   Types are:
   
   
   

• 
  
  Puffy nipples: very common, glandular tissue is concentrated under and typically confined to areola.
  
  
  
• 
  
  Pure glandular: In bodybuilders this may be a result of the use of anabolic steroids
  
  
  
• 
  
  Adolescent: Congenital/Hereditary- boys of 9-14 years.
  
  
  
• 
  
  Adult: most common.
  
  
  
• 
  
  Pseudogynaecomastia: This is generally the only type which can be improved by liposuction.
  
  
  
• 
  
  Asymmetrical/Unilateral.
  
  
  
• 
  
  Severe: is characterized by excess and/or saggy skin and severely enlarged breasts.
  

Treatment:

• 
  
  Correcting underlying cause.
  
  
  
• 
  
  Selective estrogen receptor modulator eg. tamoxifen, clomiphen or androgens or aromatase inhibitor such as letrozole.
  
  
  
• 
  
  Surgery: Reduction mammoplasty, liposuction, gland excision
  
  
  
• 
  
  Radiation therapy is sometimes used to prevent gynaecomastia in patients with prostrate cancer prior to estrogen therapy.
  
  
  

Trichobezoar

Hair balls.

Salient features:

1. 
   
   Unusual
   
   
   
2. 
   
   Virtually exclusively found in young female phychiatric patients
   
   
   
3. 
   
   Caused by pathological ingestion of hair.
   
   
   
4. 
   
   Presentation is often suggestive of Ulceration, GI bleeding, perforation or Obstruction.
   
   
   
5. 
   
   Endoscopy is diagnostic, Plain x-rays may help.
   
   
   
6. 
   
   Treatment is removal: endoscopically or sometimes open surgery.
   
   
   

Other similar condition is Phytobezoars which are made of vegetable material and found principally in patients with gastric stasis.

Local Gigantism

 Local gigantism is a condition in which a certain part of the body acquires larger than normal size due to excessive growth of the anatomical structures or abnormal accumulation of substances. It is more common in fingers and toes, where it is termed macroodactyly.

This is broadly classified into two:
CONGENITAL:

1. Klippel Trenaunay Weber syndrome
2. Maffucci syndrome
3. Macrodystrophia lipomatosa
4. Nerurofibromatosis
5. Lipoatrophic diabetes
6. 
   
   Proteus syndrome, which affected the elephant man:
   
   
   

ACQUIRED:

1. Inflammation
2. Tumors - osteoid osteoma, melorheostosis, lipofibromatous hamartoma

3. Arteriovenous malformations (before the closure of epiphysis in long bones)
4. Elephantiasis (S-E Asia, filariasis)
5. Still's disease
6. Amyloidosis
7. Acromegaly
Treatment ranges from antibiotics to correction of the underlying anatomic anomaly.

Squamous Cell Carcinoma

Cutaneous SCC