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 Contents
SECTION 1: DEFINITIONS
Definitions .................................................................................................................................................... 1

SECTION 2: LONG CASES

1. Toxic Goiter ............................................................................................................................................... 16
2. Solitary Thyroid Nodule (Nontoxic) ....................................... ·················:························..····........... 38
3. Papillary Carcinoma Thyroid with Lymph Node Metastases ................................................... 45
4. Multinodular Goiter ............................................................................................................................... 60
5. Early Breast Cancer ................................................................................................................................. 67
6. Advanced Breast Cancer....................................................................................................................... 87
7. Epigastric Lump ....................................................................................................................................... 98
8. Right Hypochondria! Lump without Jaundice........................................................................... 113
9. Right Iliac Fossa Mass (Suspected lleocecal Tuberculosis) ..................................................... 121
10. Suspected Carcinoma of the Cecum.............................................................................................. 127
11. Appendicular Mass............................................................................................................................... 139
12. Obstructive Jaundice ........................................................................................................................... 144
13. Varicose Veins ......................................................................................................................................... 158
14. Peripheral Occlusive Vascular Disease........................................................................................... 176
15. Lymphoma .............................................................................................................................................. 194
16. Renal Swelling ........................................................................................................................................ 209
17. Pseudocyst of Pancreas ...................................................................................................................... 220
18. Retroperitoneal Tumor........................................................................................................................ 226
19. Testicular Malignancy.......................................................................................................................... 233
20. Portal Hypertension............................................................................................................................. 245
21. Mesenteric Cyst ..................................................................................................................................... 260

SECTION 3: SHORT CASES

22. Nonthyroid Neck Swelling ................................................................................................................. 265
23. Tuberculous Cervical Lymph Node................................................................................................. 268
24. Cervical Metastatic Lymph Node (Carcinoma of Unknown Primary)
and Neck Dissections ......................... �............................................................................................... 277
25. Carcinoma Tongue with Submandibular Lymph Node ............................................." ........... 289
26. Carcinoma of Gingivobuccal Complex (Indian Oral Cancer) ................................................. 299
27. Parotid Swelling..................................................................................................................................... 304
28. Submandibular Sialadenitis .............................................................................................................. 316
29. Ranula, Plunging Ranula, Sublingual Dermoid and Mucous Cyst.. ..................................... 320

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- Clinical Surgery Pearls

30. Thyroglossal Cyst, Lingual Thyroid, Ectopic Thyroid, Subhyoid

Bursa and Carcinoma Arising in Thyroglossal Cyst ................................................................... 323
31. Branchial Cyst, Branchial Fistula, Cystic Hygr0ma and Carotid Body Tumor ................... 329
32. Soft Tissue Sarcoma of the Extremities .........................................................................................336
33. Neurofibroma, Von Recklinghausen's Disease ........................................................................... 344
34. Lipoma (Universal Tumor).................................................................................................................. 350
35. Sebaceous Cyst/Epidermoid Cyst/Wen/Dermoid Cyst............................................................353
36. Ulcer ........................................................................................................................................................... 358
37. Malignant Melanoma .......................................................................................................................... 367
38. Basal Cell Carcinoma/Rodent Ulcer ................................................................................................ 380
39. Squamous Cell Carcinoma (Epithelioma).....................................................................................385
40. Carcinoma Penis ....................................................................................................................................392
41. Congenital Arteriovenous Fistula/Hemangioma/Compressible Swelling .......................400
42. Unilateral Lower Limb Edema ..........................................................................................................409
43. Hydrocele ofTunica Vaginalis Sac (Epididymal Cyst, Spermatocele, Varicocele,
Hematocele, Chylocele, etc.) ............................................................................................................. 418
44. Inguinal Hernia/Femoral Hernia ......................................................................................................426
45. lncisional Hernia (Ventral Hernia, Postoperative Hernia) ....................................................... 444
46. Epigastric Hernia (Fatty Hernia of the Linea Alba) ................................................................... .450
47. Paraumbilical Hernia, Umbilical Hernia in Adults and Children .......................................... .452
48. Desmoid Tumor, lnterparietal Hernia (Interstitial), Spigelian Hernia ................................. 457
49. Gynecomastia/Male Breast Carcinoma ......................................................................................... 460
SO. Fibroadenoma/Cystosarcoma/Breast Cyst/Fibroadenosis/Fibrocystic
Disease/Mastalgia/Mastopathy/Chronic Mastitis/Nipple Discharge ................................. 467

SECTION 4: RADIOLOGY AND IMAGING

Radiology Questions and Answers ..................................................................................................476

SECTION 5: IMPORTANT TABLES AND CHARTS

General ..................................................................................................................................................... 537
Trauma .................................................................................................................................................. •..543
Burns.......................................................................................................................................................... 548
Neck ........................................................................................................................................................... 551
Breast ............................................................................................................................... .......................... 552
Abdomen ................................................................................................................................................. 555
Vascular ..................................................................................................................................................... 563
Limbs ......................................................................................................................................................... 566
Anorectal..................................................................................................................................................570
Jndex .................................................................................................................................................................. 573

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 Early Breast Cancer -

Contd...
Stage 118 T2 Nl MO
T3 NO MO
Stage IIIA UptoT3 Upto N2 MO
Stage 1118 AnyT4 NO/Nl/N2 MO
Stage IIIC AnyT N3 MO
Stage IV AnyT Any N Ml

Note:
• Tl includes Tlmi
• TO and Tl tumors with nodal micrometastases
only are excluded from Stage II A and classified
as Stage IB. Fig. 5.2: Breast and terminal duct lobular unit
Ifa patient presents with MI prior to neoadjuvant
systemic therapy, the stage is considered stage from TDLU. Both may be in situ cancer or
IV and remains Stage IV regardless of response invasive cancer.
to neoadjuvant therapy.
Post-neoadjuvant therapy is designated with "ye" lnsltu lnvasMQnllltratlng)
or "yp" prefix of note, no stage group is assigned Lobular LCIS (lobular Infiltrating
if there is a complete pathologic response (CR) carcinoma carcinoma in situ) lobular carcinoma ,,,
to neoadjuvant therapy. Ductal DCIS (ductal Infiltrating ductal
carcinoma carcinoma in situ) carcinoma ,,
Summary of Staging The invasive carcinoma is classified into:
• Earlybreast cancer • Special types (ST)
- Stage I and II • No special type (NST)/not otherwise
- TlNl, T2Nl and T3N0 specified (NOS).
• Locally advanced breast cancer (LABC) Note:
- Stage IIIA and IIIB • The special types are having good prognosis
• Metastatic breast cancer (MBC) but forms only 15% of the total. The examples of
- StageN special types are tubular, mucinous, cribriform,
medullary, etc.
Q 29. What is the staging in this case? • NOS or NST is having bad prognosis (85%).
Since the size of the tumor is T2 and patient
Q 32. What is the most common pathological
is having a single clinically positive axillary
type of carcinoma breast?
lymph node the stage is IIB that is (T2, Nl,
MO). Infiltrating carcinoma (NOS type is the most
common pathology).
Q 30. What is the origin of carcinoma breast?
Q 33. What is Genomic prognostic panel?
Thecarcinoma breast originates from terminal
duct lobular unit (TDLU) (Fig. 5.2). There are two types:
a. Oncotype Dx-21 gene recurrence score
Q 31. What is the new pathological classifi­ assay (cost 4 lakh rupees) this is done for
cation? small ER positive with uninvolved axillary
It is classified into ductal carcinoma and nodes and done by RT-PCR. This is done
lobular carcinoma depending on the origin postoperatively.

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