Hanaganahalli B Sridevi

Volume Conductivity and Scatter Parameters as an Indicator of Acute Bacterial Infections by the Automated Haematology Analyser.

INTRODUCTION Complete blood picture is the first and foremost investigation ordered for evaluation of acute infectious processes which require early and prompt intervention. With the advent of automated Coulter (®) Haematology analysers, the Volume, Conductivity & Scatter parameters of the leucocytes could be analysed for the early detection of the infections. AIM To evaluate the clinical usefulness of Volume, Conductivity & Scatter parameters of neutrophils & monocytes in predicting the onset of acute bacterial infections. MATERIALS AND METHODS Peripheral blood samples from 94 patients with infections (systemic infections n=36 & localised infections n=58) and 46 control subjects were studied using the Volume, Conductivity & Scatter parameters by the Coulter Haematology analyser. RESULTS We observed a significant increase in the mean channel of neutrophil volume & mean channel of monocyte volume from patients with infections (both systemic & localised) as compared with control subjects (Mean Neutrophil Volume: 158.3 ± 13.7 vs 137.2 ± 4.3; p<0.001) & (Mean Monocyte Volume: 177.8± 16 vs 161.7 ± 6.04; p <0.001). However, there was no significant difference in the Mean Neutrophil Volume of patients with systemic infection & localised infections (160.5±17.5 vs 156.8±10.5, p>0.05). CONCLUSION The Volume, Conductivity & Scatter parameters like Mean Neutrophil Volume & Mean Monocyte Volume are more sensitive parameters and could prove to be a quick diagnostic indicator of acute bacterial infections.

HER2 and Helicobacter pylori Status in Resected Gastric Cancers: A Pathological Study of a Gastroenterological Issue

Introduction: Human epidermal growth factor receptor 2 (HER2)/neu is a critical target for gastric carcinoma treatment utilizing trastuzumab. Helicobacter pylori is a well known causative agent of gastric carcinoma. Aim: To study association of HER2/neu expression with the presence of H. pylori infection in resected carcinoma stomach patients. Materials and Methods: A cross-sectional study of 85 gastrectomies received in the department from January 2010 to September 2014 was done. HER2/neu was studied using Immunohistochemistry (IHC) and Giemsa stain was used to detect presence of H. pylori. Chi-square test and Fisher’s exact test were used, to test the correlation between the various parameters. A p-value <0.05 was considered significant. Results: Our study population included 67 (78.8%) males, and 18 (21.2%) females, ranging from 22 to 84 years, mean 57.68±12.12 years. HER-2 expression, graded from 0 to 3± was correlated with location, histologic type, grade, local invasion, metastasis to lymph nodes, TNM tumour staging and H. pylori infection, graded from 0 to 3+ using Giemsa stain. HER2/neu 3+ was observed in intestinal type of gastric cancer (5/55, 9%) only. Scores 2+ and 3+ were more common in H. pylori-negative patients (5/26, 19.2%) than H. pylori-positive patients (4/59, 6.8%) (p=0.02). TNM stage, extent of local invasion and lymph node metastasis in intestinal gastric carcinomas correlated significantly with HER2/neu expression. H. pylori was present in 59 (69.4%) and absent in 26 (30.6%). Conclusion: H. pylori-negative gastric cancer showed significant immunophenotypic HER2/neu overexpression i.e., H. pylori might protect against HER2 overexpression that correlated significantly with higher TNM stages of intestinal-type gastric cancer. In contrast, H. pylori infection correlated significantly with Lymph-Vascular Invasion (LVI) but was pN1/2+, thereby diminishing prognostic importance. H. pylori induced intestinal metaplasia was not significantly associated with intestinal-type gastric cancer.

The pitfalls in cytology diagnosis of poorly differentiated neuroendocrine carcinoma of lung and their treatment response

Context: Lung is the most common site of small cell carcinoma (SCLC) – a poorly differentiated neuroendocrine carcinoma (PDNEC). SCLC comprises 15–20% of the invasive cancers of the lung. Aim: This study was conducted to appraise the accuracy and pitfalls of the diagnosis of PDNEC on cytology along with treatment responses if available. Settings and Design: Retrospective study for 2 years yielded 21 cases on cytology. Subjects and Methods: Slides of fine-needle aspiration of lymph nodes, the tumor, bronchial brush, and bronchoalveolar lavage specimens were used. The histological correlation was obtained as were treatment responses. Results: Eighteen SCLCs were confirmed on review. Of these, 13 initial reports were concordant and five, discordant. The rest three cases which initially reported as SCLC were found to be negative (2) and combined SCLC (1). One SCLC with concordant initial and reviewed diagnoses failed to confirm on histopathology. The patients, all heavy smokers, were predominantly males in the seventh to eighth decade age group. The sensitivity and specificity of reviewed diagnoses were better than that of the original. The difference between histopathology and cytology diagnoses (reviewed and original) was statistically insignificant. All patients were categorized as “extensive stage” by positron emission tomography-computerized tomography, and five were treated with etoposide and cisplatin with/without radiotherapy. Conclusion: Age group (61–70) and gender (males) distribution were statistically significant. Intermediate variants of SCLC may be misdiagnosed as adenocarcinoma. Similarly, combined SCLC may be missed on cytology if the observer does not sustain a high index of suspicion. Unequivocal cytology diagnosis opposed to negative histopathology report demands repeat biopsy.

A Case of Multifocal Eosinophilic Granuloma Involving Spine and Pelvisin a Young Adult: A Radiopathological Correlation

We present a case of multiple osteolytic lesions in a 28-year-old adult who presented with headache, back pain, and hip pain of 6 months. There was no history of localized swelling or rise of temperature, no history of weight loss or evening rise of temperature. On examination, there were no focal neurological deficits. Routine laboratory investigations, including total leukocyte counts, differential leukocyte counts, hemoglobin, and platelet counts, were within normal limits. There was a borderline elevation of erythrocyte sedimentation rate. Non enhanced computer tomography (NECT) demonstrated no abnormality in the brain or skull bones. However, incidentally, a lytic lesion involving the third cervical (C3) vertebral body and the neural arch was detected which also demonstrated a soft tissue component adjacent to the lytic lesion. These findings warranted further work up; and magnetic resonance imaging of whole spine and pelvis was performed that revealed multiple bony lesions involving the cervical vertebrae, head and neck, bilateral femur, sacrum, and iliac bones. Computed tomography-guided biopsy was performed from the C3 vertebral lytic lesion which showed features of eosinophilic granuloma on histopathological evaluation.

Fine needle aspiration cytology of salivary gland lesions: Our experience

Introduction: Fine needle aspiration cytology (FNAC) of salivary glands is one of the most commonly done first line investigations in the head and neck region. Objectives: To study the cytological features of various salivary gland lesions and to correlate with histopathological diagnosis wherever possible. Materials and Methods: All the FNAC slides of salivary gland lesions received at cytology lab of a tertiary hospital for a period of 3 years that is, from January 2011 to December 2013 were reviewed retrospectively. Histopathological correlation was done for cases wherever available. Results: During the study period salivary gland FNAC was done for 100 cases. Among them, 51 (51%) were reported as nonneoplastic and 49 as neoplastic (49%). Histopathological correlation was available in 18 cases (18%). The accuracy of salivary gland cytology is 77.7% (14/18 cases). The mean age of presentation of all the salivary gland lesions ranged from 12 years to 92 years with the mean age being 47.7 years. The male:female ratio was 1.5:1. Parotid gland was involved in 74 cases and submandibular gland in 26 cases. Bilateral involvement was noted in 1 case (1%). Conclusion: Being a minimally invasive procedure, FNA of salivary glands continues to be an important diagnostic tool in the preoperative diagnosis of salivary gland lesions in spite of few pitfalls in diagnosing due to cytomorphological overlapping.

Nescient Aetiology of Splenic Laceration – An Enigma Unveiled

Malaria is a common endemic disease prevalent in developing countries like India that presents with wide spectrum of clinical symptoms and complications. Splenic rupture is an uncommon but life-threatening complication which can be either spontaneous or as a result of trauma. We present a case of 50-year-old man with left upper quadrant pain following a polytrauma. Based on the radiological evidence of laceration and rupture of markedly enlarged spleen, emergency splenectomy was performed. Postoperative haematological evaluation established the co-infection of Plasmodium falciparum and vivax with high parasitaemia and marked thrombocytosis. The incidences of splenic rupture due to malaria are under-reported. In endemic areas, the management of splenic rupture in malaria should be focused on splenic preservation, thereby reducing the risk of future attacks of malaria in those patients who are highly susceptible to Plasmodium species and also reducing the incidence of overwhelming sepsis.

Pancytopenia in Multiple Myeloma- An Enigma: Our Experience from Tertiary Care Hospital.

INTRODUCTION Multiple myeloma is a plasma cell neoplasm that is characterized by clonal proliferation of malignant plasma cell in the bone marrow along with M-protein in the serum and/or urine. Pancytopenia as a initial presentation of multiple myeloma is quite unusual. We are presenting a case series having pancytopenia as the presenting complaint. MATERIALS AND METHODS A retrospective study was conducted for a period of 30 months, wherein all the cases of multiple myeloma presenting with pancytopenia were included. The complete blood picture, peripheral smear examination, bone marrow aspirate & protein electrophoresis of all the cases were reviewed & analysed. RESULTS During the study period, 10 cases presented with pancytopenia with a mean age of 66.3 years (range: 59-72 years) at presentation with male: female ratio being 8:2. Fatigue and weakness was the most common symptom (100%) & average ESR was 104 mm/hour. High-resolution serum electrophoresis, showed a dense, sharp to wide M band in the gamma globulin region. Bone marrow plasma cell percentage was increased with an average of 63.1%. Bone marrow biopsy correlation was obtained in 100% cases. CONCLUSION Diagnosing multiple myeloma, presenting as pancytopenia requires a high degree of suspicion to avoid delay in initiation of treatment.

Reticulum vs Inclusions: A Learning Experience in Haemoglobin H Disease

Haemoglobin H disease, also known as the alpha-thalassaemia is characterized by the presence of HbH inclusions in red blood cells, detectable on supra-vital stain. We present a case of a previously asymptomatic 31-year-old male, who insidiously developed anaemia and had prominent splenomegaly. Peripheral smear examination revealed microcytic hypochromic anaemia with numerous spherocytes and moderate polychromasia. In reticulocyte preparation with Brilliant cresyl blue, HbH inclusions were mistakenly identified as granulofilamentous reticulum of reticulocytes, giving a spuriously high reticulocyte percentage. After the literature review, repeat assessment was performed and with the aid of high performance liquid chromatography result, it was possible to delineate the HbH inclusions.

A rare case of ALK negative CD30+ primary cutaneous anaplastic large cell lymphoma in a young adult.

Cutaneous anaplastic large cell lymphoma can present either as a primary disease or as secondary to a pre-existing systemic anaplastic lymphoma. Distinguishing primary cutaneous anaplastic lymphoma (PC-ALCL) from its systemic counterpart requires a complete clinical and laboratory workup. We hereby report a case of PC-ALCL in a young adult, who presented with unusual rapidly progressive ulcerated mass in the neck. Biopsy showed anaplastic large cells, which were strongly positive for CD30 and CD25 but ALK1 gene product was negative. Clinical examination and computed tomography (CT) scan ruled out extracutaneous involvement. Chemotherapy with 6 cycles of CHOP regimen was planned and on follow-up, a complete remission of the lesion was attained.

Pulmonary plasmacytoma in multiple myeloma: a rare case of extramedullary spread

© 2015 Egyptian Journal of Bronchology | Published by Wolters Kluwer Medknow DOI: 10.4103/1687-8426.165938 Multiple myeloma (MM) is a systemic disease primarily involving the bone marrow, constituting about 1% of all malignancies and 10% of hematological malignancies [1]. It is a neoplastic proliferation of monoclonal plasma cells that can result in renal impairment, osteolytic lesions, hypercalcemia, bone marrow failure, and the production of serum monoclonal proteins. Although usually restricted to the bone marrow, extraskeletal spread in the form of plasmacytoma, which represent localized extramedullary collections of malignant plasma cells, can occur in a significant number of patients. However, symptomatic pulmonary involvement during the course of MM has rarely been reported [2].