Surgical considerations for the familial cancer syndrome, neurofibromatosis 1: a comprehensive review.

Neurofibromatosis 1 is one of the more common inheritable disorders that surgeons may encounter. A plethora of systemic associations, both benign and malignant, can affect these patients, and an acute awareness of these associations is essential for proper surgical care. A complete review of this disorder from the surgical perspective follows, highlighting the importance of this awareness. A brief review on the management and follow-up of surgical malignancies associated with this disorder is included.

Single-Agent Thalidomide for Treatment of Malignant Paraganglioma of the Organ of Zuckerkandl.

The standard of care for benign pheochromocytomas and paragangliomas is surgical resection; however, there is no definitive curative or standard therapy for the treatment of malignant pheochromocytomas or paragangliomas. Current therapeutic options include surgical resection, chemotherapy (CVD therapy), MIBG-radiotherapy, somatostatin analogues, and combination targeted therapies such as temozolomide and thalidomide. Although some patients demonstrate short-lived responses to these various therapies, there has been no statistically significant survival benefit with any of the current regimens and therefore the aim is palliation and symptom control. Here, we present a 38-year-old man found to have an unresectable metastatic paraganglioma located in the Organ of Zuckerkandl who has been treated with single-agent thalidomide for over 15 years with minimal growth and stabilization of metastatic lesions. The management of our patient with single-agent therapy for this extended period of time challenges the efficacy and role of chemotherapy and other accepted therapies for malignant pheochromocytoma and paraganglioma.

Malignant blue nevus with lymph node metastases.

BACKGROUND: Malignant blue nevi arise within cellular blue nevi and contain atypical mitoses, necrosis, nuclear pleomorphism and prominent nucleoli. Malignant blue nevus has been described as a distinct identity, a rare form of malignant melanoma, and a misdiagnosed melanoma. METHODS: We present a patient with metastatic malignant blue nevus and studies on the histopathologic, immunohistochemical, and molecular features of the neoplasm. RESULTS: Histology showed a malignant blue nevus arising in a combined intradermal and cellular blue nevus. CD117 (c-kit) staining showed diffuse cytoplasmic expression within the cellular blue nevus, decreased staining in the malignant component, and variable positivity within the lymph node metastases. Molecular loss of heterozygosity analysis showed different allelic patterns at the hOGG-1 locus between the melanoma and control skin specimens with a varying heterozygous allelic pattern in both the benign and malignant blue nevus. CONCLUSIONS: Our case of malignant blue nevus with lymph node metastasis involved mutation of the hOGG-1 DNA repair gene. CD117 showed decreased staining of the primary malignant blue nevus with marked upregulation in the metastatic lesion, unlike most metastatic melanomas. Further study is needed to determine if hOGG-1 mutation or c-kit upregulation play a role in the pathogenesis of dendritic melanocytic lesions (either benign or malignant).

Chemistry and Pharmacology of Tinospora cordifolia.

Tinospora cordifolia (Menispermaceae) is an Ayurvedic medicinal plant distributed throughout the Indian subcontinent and China. The whole plant is used in folk and the Ayurvedic system of medicine alone and in combination with other plants. Due to its commercial importance, T. cordifolia has been of intense research interest for the last four decades with the isolation of diverse compounds such as alkaloids, sesquiterpenoids, diterpenoids, phenolics, steroids, aliphatic compounds and polysaccharides, along with the discovery of a wide spectrum of pharmacological properties like immunomodulation, anticancer, hepatoprotective and hypoglycemic. Although pharmacological activities of extracts and compounds of T. cordifolia have been studied both in vitro and in vivo, only few mechanisms of action have been explored and need further elaboration. In the present review, the pharmacological activities of compounds and different extracts of T. cordifolia are highlighted, along with those of the marketed products, showing the relevance of phytochemicals and the standardization of the marketed products for medicinal use. This compilation of the extensive literature of T. cordifolia here will be a referral point for clinical study and the development of standardized phytomedicines in healthcare.

A new triterpenoid from the rhizomes of Nelumbo nucifera.

A new triterpenoid, 2α,24-diacetoxy-3ß-hydroxyolean-12-en-28-oic acid (1), was characterised from the rhizomes of Nelumbo nucifera Gaertn by spectroscopic and chemical methods along with four known compounds, hyptatic acid-A (2α,3ß,24-trihydroxyolean-12-en-28-oic acid) (2), maslinic acid (2α,3ß-dihydroxyoleane-12-ene-28-oic acid), betulin and lupeol.

Reduction of andrographolide and its stereostructure by NMR and X-ray study.

Andrographolide (1) on asymmetric reduction with nickel boride in situ led to the identification of a product as 12,13 R-dihydroandrographolide (3) in de (>96%). The structure and stereochemistry of compound 3 were established by NMR study and confirmed by X-ray crystallographic analysis. ß-Substituent of γ-butyrolactone in andrographolide exerted diastereomeric selectivity in reduction. Neoandrographolide (2) under similar condition yielded 5.