Gastrointestinal stromal tumor (GIST) is a nonepithelial, mesenchymal tumor first described by Mazur and Clark in 1983. Since then, its molecular biology has been studied in great detail. Special interest in the role of tyrosine kinase in its regulation has been the target by different drug research. Mutation in c-kit exons 9, 11, 13, 17 and PDGFRA mutation in exons 12, 14, 18 are responsible for activation of gene signaling system resulting in uncontrolled phosphorylation and tissue growth. However, 5 to 15% of GISTs does not harbor these mutations, which raises additional questions in another alternate signaling pathway mutation yet to be discovered. Diagnosis of GISTs relies heavily on KIT/CD117 immunohistochemical staining, which can detect most GISTs except for a few 3% to 5% that harbors PDGFRA mutation. Newer staining against PKC theta and DOG-1 genes showed promising results but are not readily available. Clinical manifestation of GISTs is broad and highly dependent on tumor size. Surgery still remains the first-line treatment for GISTs. The advancement of molecular biology has revolutionized the availability of newer drugs, Imatinib and Sunitinib. Together with its advancement is the occurrence of Imatinib/Sunitinib drug resistance. With this, newer monoclonal antibody drugs are being developed and are undergoing clinical trials to hopefully improve survival in patients with GISTs.

Systemic sarcoidosis is a disease of unknown etiology, with the liver being the third most commonly affected organ. Most cases of hepatic sarcoidosis are not clinically apparent, but a few can progress to liver cirrhosis, portal hypertension and ultimately liver failure. The diagnosis of hepatic sarcoidosis is difficult, considering that no single laboratory test or radiographic finding can definitively diagnose this systemic disease. Diagnosis of hepatic sarcoidosis relies heavily on histopathologic evaluation of two or more organs, a diagnostic modality that is invasive and may not be applicable to all patients. The treatment of hepatic sarcoidosis is challenging, with no large randomized controlled trials done to date. Physicians must be aware of the complications of hepatic sarcoidosis, and must include the same in the differential diagnosis of liver cirrhosis. We present a case of hepatic sarcoidosis complicated by portal hypertension and liver cirrhosis.

Mantle cell lymphoma (MCL) accounts for less than 10 percent of all non-Hodgkin’s lymphoma (NHL). Pathologic or spontaneous rupture of the spleen has been reported in patients with lymphoma; however only 5 cases have been reported in patients with MCL. Although splenomegaly occurs frequently in patients with MCL, spontaneous splenic rupture is rare. We present a case of a 51-year-old female with MCL, who presented to the medical emergency room with splenic rupture. This case illustrates that clinicians should be aware of the incidence and presentation of patients with MCL and spontaneous splenic rupture, as early detection and heightened suspicion may prevent potentially fatal outcomes.

Blastocystis hominis and Endolimax nana exist as two separate parasitic organisms; however co-infection with the two individual parasites has been well documented. Although often symptomatic in immunocompromised individuals, the pathogenicity of the organisms in immunocompetent subjects causing gastrointestinal symptoms has been debated, with studies revealing mixed results. Clinically, both B. hominis and E. nana infection may result in acute or chronic diarrhea, generalized abdominal pain, nausea, vomiting, flatulence and anorexia. We report the case of a 24-year-old immunocompetent male presenting with chronic diarrhea and abdominal pain secondary to B. hominis and E. nana treated with metronidazole, resulting in symptom resolution and eradication of the organisms. Our case illustrates that clinicians should be cognizant of both B. hominis and E. nana infection as a cause of chronic diarrhea in an immunocompetent host. Such awareness will aid in a timely diagnosis and possible parasitic eradication with resolution of gastrointestinal symptoms.

Background: Postoperative delirium in the elderly is a growing concern. Data regarding significant differences in postoperative cognitive dysfunction (POCD) in elderly persons undergoing laparoscopic versus open colon resection are not well established. Objectives: The goal of this study was to compare the incidence of POCD in laparoscopic versus open colon surgery in an elderly population. Design and Setting: A prospective nonrandomized pilot study was conducted at an urban tertiary care hospital. Participants: The study included patients aged 65 years and above, without documented dementia who underwent elective colon surgery. Measurements: We collected demographic and clinical data, including age, sex, polypharmacy, and comorbidities. The subjects underwent pre- and postoperative Cambridge Neuropsychological Test Automated Battery (CANTAB) testing. Worsening individual scores from the Paired Associated Learning (PAL) and Spatial Working Memory (SWM) portions of CANTAB determined the presence of POCD. Inflammatory cytokine (i.e., IL-6) levels were measured pre- and postoperatively. Results: We enrolled 44 subjects (26 laparoscopic and 18 open surgery). The two groups did not differ significantly in age, sex, polypharmacy, and comorbidities. The average incidence of POCD was 47%. PAL scores worsened in 12/23 (52%) in the laparoscopic group and in 7/15 (47%) in the open group. These group differences lacked statistical significance (p = 0.75). SWM scores worsened in 14/25 (56%) in the laparoscopic group and in 6/18 (33%) in the open group, which was also not statistically significant (p = 0.12). No age difference occurred between the ‘worsened scores' group and ‘stable scores' group, and older age was not associated with POCD. IL-6 levels were higher in the open versus the laparoscopic group (p < 0.0001). Conclusion: In this pilot study, the average incidence of POCD was not statistically different between elderly subjects undergoing open versus laparoscopic surgery. Age did not influence the occurrence of POCD. Although inflammatory markers were significantly higher in the open group, consistent with a higher degree of stress response, this group did not have higher rates of delirium. This association is worth to be investigated in a larger sample. © 2014 S. Karger AG, Basel