EGFR L861Q Mutation in a Metastatic Solid-pseudopapillary Neoplasm of the Pancreas

Solid-pseudopapillary neoplasm of the pancreas (SPN) is a rare neoplasm that is typically indolent in nature. Surgical resection is the preferred method of treatment and often associated with a good prognosis. Local invasion and metastasis have been reported in a small subset of patients. Currently, there are limited data on the molecular mutation profile of invasive and metastatic SPN. In this report, we present the case of a 38-year-old female with a locally-invasive and unresectable SPN that, despite exhaustive chemoradiotherapy, progressed to liver metastasis. Pyrosequencing of the primary pancreatic tumor antecedent to metastasis showed an uncommon EGFR mutation at L861Q in the kinase domain of exon 21. This finding, if confirmed in additional cases of metastatic SPN, would support preoperative testing for EGFR mutation analysis to detect aggressive SPNs.

Systematic Review and Case Series Report of Acinar Cell Carcinoma of the Pancreas

BACKGROUND

Acinar cell carcinoma of the pancreas is a rare malignancy representing less than 1% of all pancreatic malignancies.

METHODS

We report on a case series of 21 patients with acinar cell carcinoma of the pancreas treated at a high-volume quaternary center. A systematic review of the medical literature was performed that described typical therapeutic management approaches for acinar cell carcinoma of the pancreas and reported on disease control and survival rates. Data for the case series were obtained from a prospective database.

RESULTS

In our systematic review of 6 articles, study patients had a median age of 61 years, 66% were male, 52% had stage I/II disease, and 55% of lesions were located in the pancreatic head. The rates of median survival were approximately 47 months after resection with adjuvant therapy, 38 months for nonmetastatic, locally unresectable disease, and 17 months for metastatic disease treated with chemotherapy. Combination fluoropyrimidine-based chemotherapy regimens had better rates of disease control than other therapies. Our case series included 21 study patients, 14 of whom required resection and 7 who had metastatic disease. The rates of median survival were 40.2 ± 31.9 months in those who underwent surgery and were treated with adjuvant therapy and 13.8 ± 11.3 months for patients with metastatic disease.

CONCLUSIONS

Multidisciplinary treatment for acinar cell carcinoma of the pancreas should be considered due to the rarity of the disease and its lack of high-level therapeutic data. Progress in the molecular analysis of this tumor may improve outcomes through the use of personalized therapy based on underlying tumor mutations.

Advances in the Endoscopic Diagnosis of Barrett Esophagus

BACKGROUND

Barrett esophagus (BE) continues to be a major risk factor for developing esophageal adenocarcinoma.

METHODS

We review the risk factors, diagnosis, and management of BE, with an emphasis on the most current endoscopic diagnostic modalities for BE.

RESULTS

Novel diagnostic modalities have emerged to address the inadequacies of standard, untargeted biopsies, such as dye-based and virtual chromoendoscopy, endoscopic mucosal resection, molecular biomarkers, optical coherence tomography, confocal laser endomicroscopy, volumetric laser endomicroscopy, and endocytoscopy. Treatment of BE depends on the presence of intramucosal cancer or dysplasia, particularly high-grade dysplasia with or without visible mucosal lesions.

CONCLUSIONS

Recent advances in endoscopic diagnostic tools demonstrate promising results and help to mitigate the shortcomings of the Seattle protocol. Future research as well as refining these tools may help aid them in replacing standard untargeted biopsies.

In the shadow of the temple: cross-cultural sensitivity in international health program development

Many authorities recognize the concept that sensitivity to a recipient people's culture during the formulation and implementation of international health programs is a basic component to the success of those programs. Nevertheless, international health agencies have consistently failed in realizing truly successful projects in recipient countries by their neglect to fully take culture into account. The reasons are complex, and their comprehension involves a understanding of who is involved in international health programs, the history of those programs, and the conflicts that arise when outside agencies fail to understand--or be understood by--those who are on the receiving end of programs. This paper will scrutinize international health care assistance and development from the points of view of both donor agencies and recipient countries. Examples are presented from countries and regions worldwide. The challenges in maintaining cultural sensitivity will be described, analyzed, and potential solutions will be offered.

Alkaloids of the Australian Eutaceae: Evodia xanthoxyloides F. Muell. II. Isolation of the Alkaloids from the Leaves

From the leaves of Evodia xanthoxyloides nine alkaloids, evoxanthine, melicopidine, evoxine, xanthevodine, xanthoxoline, evoxanthidine, evodine, evolidine, and evoxoidine were isolated. There was also obtained a tenth nitrogenous substance (X) which was shown to be 4-hydroxy-2,3-dimethoxy-10-methylacridone. This is not claimed to be an alkaloid as it may have been formed by demethylation during the isolation.

Alkaloids of the Australian Rutaceae: Evodia xanthoxyloides F. Muell. III. The Structures of the Coloured Alkaloids, Evoxanthidine, Xanthevodine, and Xanthoxoline

The coloured alkaloids, evoxanthidine, xanthevodine, and xanthoxoline, were shown to be 4-methoxy-2,3-methylenedioxyacridone, 1,4-dimethoxy-2,3-methylene-dioxyacridone, and 2.3-dimethoxy-4-hydroxyacridone, respectively. A total synthesis of xanthoxoline was achieved.

The synthesis of melicopicine and some Trimethoxy-10-methylacridones

1,2,3,4-Tetramethoxy-10-methylacridone has been prepared and shown to be identical with a natural specimen of melicopicine. The four related isomeric trimethoxy-10-methylacridones have been prepared and the 2,3,4-trimethoxy derivative was shown to be identical with the trimethoxy derivative obtained from evoxanthine. A new synthesis of 10-methylacridones is described.

Alkaloids of the Australian Rutaceae: Evodia xanthoxyloides. I. Evoxanthine

From the bark and leaves of E. xanthoxyloides four alkaloids, melicopidine, evoxanthine, xanthevodine, and kokusaginine, were isolated. The structure of evoxanthine was shown to be 2,3-methylenedioxy-4-methoxy-10-methylacridone.

The Isolation of d-Sparteine from Hovea Species

The fairly widespread alkaloid d-sparteine has been isolated from two Hovea species. The constants of four salts prepared from it agreed with those previously recorded.