Increased expression of anti-apoptotic survivin in high-grade tumors suggests that survivin is likely to contribute significantly to apoptosis resistance in response to therapy.

No abstract

Metastatic melanoma to the gall bladder is extremely rare and is associated with a very poor prognosis. We report a case of choroidal melanoma metastatizing to the hepatobiliary system, with an unusual presentation. Our patient presenting with obstructive jaundice was misdiagnosed as having carcinoma of the gall-bladder, but the diagnosis of metastatic melanoma to the gallbladder was confirmed by ultrasonography guided fine needle aspiration cytology (USG-FNAC). On reviewing the past history, the patient had a history of enucleation for choroidal melanoma. Even though the liver ‘is’ a common site for metastasis of choroid melanoma, the patient presenting with a suspected gall bladder mass ‘is’ a rare presentation. Hence, gastrointestinal symptoms and a history of melanoma should be investigated for the presence of gastrointestinal or liver metastases, even if the original primary malignancy was diagnosed years before the patient‘s presentation.

A 20−year−old, married, primigravida presented with a history of epigastric dis− comfort, nausea, and vomiting for 3 days. On the day of admission, she gave a his− tory of vomiting up a 3 ± 4−cm, pear− shaped, reddish−brown worm, which moved for a few seconds after it was vom− ited and then died. On further enquiry, the patient gave a history of consumption of vegetables that had been washed in pond water.

Pancreatic adeno- Mixed neuroendocrine non-endocrine (pMINEN) are extremely rare. [1] They are known to have distal metastasis at presentation and also have a comparatively lower survival rate as compared to similar staged neuroendocrine carcinoma, adenocarcinoma, and small cell lung tumor from which its treatment patterns are extrapolated. [2,3] Also, very less is known about its molecular structure and natural courses. There is a dearth of data about pMINEN in literature also there is a lack of large multicentral trials due to which the MINEN do not have a standard universal management protocol. We here discuss the clinical dilemmas that arise during diagnosis, reporting, and urge to formulate a multi-centric trial to formulate a focused protocolized approach. We here describe our encounter with a pancreatic head lesion which on immunohistochemically turned out to be a pMINEN with moderately differentiating ductal adenocarcinoma and low-grade neuroendocrine tumor. Radical R0 surgery with multimodal treatment (chemotherapy + radiotherapy) gains improved survival in long term.