Can combination metronomic therapy overcome chemoresistance in cholangiocarcinoma: A literature review.

Cholangiocarcinoma (CCa) is relatively resistant to chemotherapy as well as radiation therapy, and complete resection is the main curative therapy for these patients. The prognosis for patients with unresectable intrahepatic CCa (iCCa) is extremely poor. A 55‑year‑old woman presented at our hospital with abdominal pain. After evaluation, she was diagnosed to have multifocal iCCa. She did not opt for standard chemotherapy and therefore received oral metronomic therapy with a combination of celecoxib, etoposide, and cyclophosphamide for a total of 30 months. Presently, she is 57 months post diagnosis and 27 months post cessation of all treatment and continues to be in complete radiological remission. In the present report, we review the literature and discuss whether metronomic scheduling of biologic agents and anticancer drugs will be able to overcome chemoresistance and improve the outcome in cholangiocarcinoma. References for the review were identified through searches of Pubmed for the last 10 years as well as searches of the files of the authors themselves. The final list was generated on the basis of originality and relevance to this review.

A t(X; 18) SYT-SSX2 positive synovial sarcoma in the pelvis of a young adult male: A rare case report with review of literature.

Synovial sarcoma is uncommonly documented in the pelvis. Rarely, such cases have dealt with molecular analysis. A 19-year-old boy presented with pain and swelling in his left lower limb of two months duration. He developed acute urinary retention four days prior to his hospital admission, wherein radiological examination unraveled a large soft tissue mass, displacing his pelvic muscles, along with a lytic lesion involving his right pubic bone. Biopsy showed a cellular spindle cell sarcoma, exhibiting hemangiopericytoma-like vascular pattern with focal necrosis. Immunohistochemistry (IHC) showed positivity for vimentin, BCL-2, calponin and MIC 2. Cytokeratin (CK) and epithelial membrane antigen (EMA) were negative. MIB 1 count was 70% (high). P53 was positive. Diagnosis of a poorly differentiated synovial sarcoma was offered and confirmed with a positive t(X; 18) SYT-SSX2 translocation. This case highlights the value of molecular analysis in diagnosis of a synovial sarcoma at rare sites, especially when IHC results are equivocal and the biopsy material is limited.

Intra-abdominal follicular dendritic cell tumor: report of two cases.

Follicular dendritic cell (FDC) tumor is an uncommon entity described mainly in the lymph nodes. We report two men with intra-abdominal FDC tumors--one arising from the colon and other presenting as a mesenteric mass. Both patients underwent successful surgical excision of the tumor.

Mediastinal Castleman's disease complicated by follicular dendritic cell tumour.

We describe a rare case of follicular dendritic cell tumour which had arisen over the background of hyaline vascular type of Castleman's disease at the mediastinal location. Constellation of histology and immunohistochemistry using CD21 antibody and non-reactivity to CD15, CD30, cytokeratin and epithelial membrane antigen helped us diagnose this case. The literature is reviewed, specially with reference to the genesis of follicular dendritic cell neoplasm at the backdrop of Castleman's disease and its clinical relevance.

Long-term anti-inflammatory drug use and Helicobacter pylori infection: a clinical, endoscopic and histological study.

BACKGROUND: Non-steroidal anti-inflammatory drugs (NSAIDs) and Helicobacter pylori are independent risk factors for gastroduodenal damage and peptic ulcer. OBJECTIVE: To study the frequency and effect of H pylori infection on gastroduodenal mucosa in patients on long-term NSAID use. METHODS: A total of 125 subjects were studied: 65 patients (Group 1) on NSAID therapy (> 6 months), 30 patients (Group 2) with arthritic disorders prior to starting NSAID therapy, and 30 healthy volunteers (Group 3). Dyspeptic symptoms were evaluated using a questionnaire. All patients underwent endoscopy and antral and duodenal biopsies were obtained to assess the extent of gastroduodenal damage and H pylori status. RESULTS: H pylori infection was less frequent in Group 1 (37%) compared to Group 2 (57%, p = ns) and 3 (60%, p < 0.05). Among Group 1 patients, H pylori infection did not increase the risk of gastroduodenal damage (52% vs 45%) or ulceration (32% vs 27%). Group 1 patients with H pylori infection were more likely to be symptomatic (48% vs 27%) and have chronic active gastritis (76% vs 12%) and chronic active duodenitis (68% vs 5%). Gastric metaplasia was seen only in patients with H pylori infection, chronic active gastritis and duodenitis. Chemical gastritis was observed more commonly in Group 1 (34% vs 3%) compared to Group 2; its was not seen in Group 3. H pylori infection was less commonly observed in patients with chemical gastritis (8% vs 50%). CONCLUSION: Patients on long-term NSAIDs are not at increased risk of H pylori infection. Presence H pylori infection is not associated with increased risk of gastroduodenal damage in these patients. H pylori infection correlated with presence of chronic active gastritis, and NSAID with presence of chemical gastritis.

Primary malignant hemangioendothelioma of jejunum.

Primary malignant hemangioendothelioma is a rare tumor. We report a patient with a malignant jejunal hemangioendothelioma which had metastasized to the regional lymph nodes and the liver.