In Samuel Beckett’s play Waiting for Godot, the protagonists Vladimir and Estragon wait endlessly in vain for Godot. The tragedy is that despite both claiming Godot as an acquaintance, they hardly know him and he never arrives. Physicians treating

and patients with posttransplant recurrence of HCV have similarly waited for safer and more efficacious treatments. For Vladimir and Estragon the combination of impatience and ignorance was nearly lethal. Thanks to the study by Garg et al., we know enough about telaprevir and, by inference, boceprevir to avoid turning frustration into tragedy. “
“A 21-year -old man presented with left neck pain and high-grade fever for 1 week. His past and family histories were unremarkable. Physical examination revealed a submandibular mass, maxillar swelling with RG7204 purchase erosion and multiple subcutaneous tumors. Smoothened Agonist Laboratory examination

showed abnormalities as follows: white blood cell counts, 10 300/mm3; hemoglobin, 12.7 g/dL; C-reactive protein, 2.37 mg/dL and soluble interleukin 2 receptor; 7452 U/mL. Positron emission tomography/CT demonstrated multiple foci of uptake. Upper gastrointestinal endoscopy identified elevated lesions with central ulcer or erosion on the anterior and posterior wall of the gastric body (Figure 1a) and in the second portion of the duodenum (Figure 1b). There were no lesions in the other small intestine and colorectum on colonoscopy and capsule endoscopy. Magnified endoscopic observation with narrow band imaging (NBI) was performed for the gastric lesion and revealed that it was surrounded by an elevation of gastric mucosa showing normal gastric pits, indicating the submucosal tumor of non-epithelial origin 上海皓元医药股份有限公司 (Figure 1c). Microscopic examination of endoscopic biopsies taken from the gastric and duodenal lesions showed diffuse and solid infiltration of large atypical lymphoid cells with abundant cytoplasm and pleomorphic nuclei (Figure 1d). Immunohistochemistry revealed that the neoplastic cells were positive for CD30 (Figure 1e), CD45RO and ALK (anaplastic lymphoma kinase) (Figure 1f) but negative for CD20, CD79a

and epithelial membrane antigen. Excisional biopsies taken from the maxillar and submandibular lesions showed the similar features. Polymerase chain reaction-based technologies revealed rearrangement of T cell receptor γ and chromosomal translocation of t(2;5) resulting in the ALK overexpression. Thus, a definitive diagnosis of anaplastic large cell lymphoma (ALCL) of T cell origin involving multiple organs including the stomach and duodenum was made, and combined chemotherapy was entertained. ALCL consists of a subgroup of non-Hodgkin’s lymphoma. About 15–85% of systemic (nodal) ALCLs contain the t(2;5)(p23;q35) translocation, which fuses the ALK gene at 2p23 with the nucleophosmin (NPM) gene at 5q35, resulting in a fusion protein NPM–ALK.