Effect of the Citrus Flavone Nobiletin on Circadian Rhythms and Metabolic Syndrome.

The importance of the circadian clock in maintaining human health is now widely acknowledged. Dysregulated and dampened clocks may be a common cause of age-related diseases and metabolic syndrome Thus, circadian clocks should be considered as therapeutic targets to mitigate disease symptoms. This review highlights a number of dietary compounds that positively affect the maintenance of the circadian clock. Notably the polymethoxyflavone nobiletin has shown some encouraging results in pre-clinical experiments. Although many more experiments are needed to fully elucidate its exact mechanism of action, it is a promising candidate with potential as a chronotherapeutic agent.

Cutaneous leishmaniasis in Nepal: Leishmania major as a cause.

Nepal is endemic for visceral leishmaniasis; however, recently a solitary report of cutaneous leishmaniasis (CL) was recorded. The present report describes a CL case in a Nepalese woman, initially referred as a case of basal cell carcinoma. Histopathological examination, culture and PCR analysis of lesions revealed it to be a case of CL. Molecular methods, including kDNA PCR, ITS-1 PCR-RFLP and sequence analysis, revealed the species as Leishmania major. The patient was cured with sodium stibogluconate. This report suggests that the extent to which L. major causes CL in the Indian subcontinent needs to be monitored.

Benign nerve sheath myxoma (myxoid neurothekeoma) in the leg.

Myxoid neurothekeoma is a rare benign cutaneous neoplasm of nerve sheath origin and is also called as benign nerve sheath myxoma. This entity is seen in head, neck and upper extremity and seldom on the lower limb. A myxoid neurothekeoma in the lower leg of a 33-year-old woman is described.

Papillary meningioma: a rare but distinct variant of malignant meningioma.

BACKGROUND: Papillary meningiomas are rare meningeal tumors and are associated with aggressive clinical behavior as compared with other meningiomas. Because of their rare occurrence, they may pose a diagnostic dilemma to the unwary pathologist. We report a case of papillary meningioma in a 16-year-old boy. CASE PRESENTATION: A 16-year-old boy presented with complaints of headache, progressively diminishing vision and more recently generalized seizures. MRI revealed a large bifrontal meningioma which showed presence of a predominantly papillary pattern with areas of focal necrosis, frequent mitoses and bone invasion. He underwent radical excision of the tumor and is free from recurrence or metastasis at 15 months follow-up. CONCLUSION: Papillary meningiomas are rare but well recognized variants of meningioma. They need to be differentiated from other intracranial tumors with a papillary pattern. They are malignant, frequently show bone and parenchymatous invasion and have the potential for extracranial metastasis. Their timely recognition could prevent local and distant metastasis and the mortality or morbidity associated with it.

Clear cell odontogenic carcinoma: a diagnostic and therapeutic dilemma.

BACKGROUND: Clear cell odontogenic carcinoma is a rare odontogenic tumor occurring in the anterior region of the mandible in 5th-7th decades and shows a female preponderance. It is potentially aggressive, capable of frequent recurrences and loco-regional and distant metastases. CASE PRESENTATION: A 45-year-old woman presented with a radiolucent left mandibular swelling associated with loss of teeth. Left cervical lymph nodes were enlarged on palpation. The patient underwent resection of the tumor but consequent to resected margins being positive for tumor cells underwent left hemimandibulectomy with ipsilateral functional neck dissection and was free of recurrence at 8 months follow-up. CONCLUSION: Clear cell odontogenic carcinoma should be considered in the differential diagnosis of jaw tumors with conspicuous clear cell component. Curettage or conservative resection inevitably results in recurrences and/or metastasis and more radical resection is warranted in these tumors, especially when they are large and show soft tissue invasion.

Infiltrating ductal carcinoma of the breast, metastatic to axillary lymph nodes harboring primary tuberculous lymphadenitis.

A 46-year-old female presented with lump in the left breast. Fine-needle aspiration cytology (FNAC) from breast and axillary lymph node revealed infiltrating ductal carcinoma with metastasis in axillary node. The patient underwent radical mastectomy with axillary lymph node dissection. Histopathological examination showed concomitant presence of metastatic tumor deposits and tubercular lymphadenitis in 8/18 nodes. The case is presented for its rarity and illustrates that FNAC can fail to detect mixed lesions unless multiple punctures from many sites are performed.

Gemistocytic astrocytomas: histomorphology, proliferative potential and genetic alterations--a study of 32 cases.

Gemistocytic astrocytomas (GAs) are a distinct variant of astrocytomas, generally classified as WHO grade II, and are associated with an aggressive biological behavior. This study was undertaken to determine the histomorphological spectrum, and correlate these with their proliferative potential and genetic alterations, in order to establish a biological basis for their unfavorable prognosis.A total of 32 GAs diagnosed during an 11-year period (1993-2003) were included in the study. Immunoreactivity for CD3 (T-cells), CD20 (B-cells) and CD68 (macrophages) were evaluated to characterize the perivascular inflammatory infiltrates, while p53, epidermal growth factor receptor (EGFR), cyclin D1 and p27-immunolabeling were studied to analyze the tumor biology.Overall, the mean gemistocytic index in the study was 39.6% (range, 12.2-80.8%), with multinucleation in gemistocytes and mitosis being present in 56.2% and 15.6% respectively. Perivascular mononuclear cell cuffing was seen in 56.2% cases, which was immunopositive for CD3 and CD68 in 14 cases each, with 13 cases being immunopositive for both. Similar type of inflammatory infiltrates was also present within the tumor parenchyma. Proliferation index depicted by MIB-1 LI was low (mean: 3.7%; range: 0.5-10.5%), with 70% cases having LI of <5%. MIB-1 labeling was restricted to the small astrocytic cells, similar to p27 and cyclin D1 immunoreactivity, both of which were present in 71.5% cases. In contrast, p53 protein expression was present in 75% cases, and was strongly positive in both gemistocytes and small cells, denoting neoplastic population. However, EGFR protein expression was consistently negative in all cases. Gemistocytes lack proliferative activity possibly indicating terminal differentiation, while small cells are the proliferating cells and their overall percentage may reflect the biological aggressiveness of these tumors and help to identify GAs of higher grade undergoing malignant progression. Therefore it appears that GAs should not be uniformly graded as grade II but should be subdivided into grades II and III neoplasms based on histological features and MIB-1 LI. The poor prognosis in GAs could be attributed both to the high frequency of p53 mutations and low p27 LI.

Isolated splenic metastasis from colorectal mucinous carcinoma.

Metastatic tumors of the spleen are rare and occur in the presence of disseminated visceral metastasis. Isolated splenic metastases from colorectal carcinoma are rare and only 19 cases have been reported in English literature. We report a case of isolated splenic metastasis in a 52-year-old man, occurring 9 years after the primary colorectal mucinous carcinoma was treated by anterior resection. The patient underwent splenectomy along with adjuvant chemotherapy and is alive and asymptomatic at 22 months follow-up.