Shivali Sehgal

Abnormal WBC scattergram: a clue to the diagnosis of malaria

Abstract Objective Malaria is highly prevalent and endemic in tropical countries and carries a significant health burden. The detection of malaria by light microscopy of Giemsa-stained smears is the gold standard. There are many hematological abnormalities associated with malaria like anemia, thrombocytopenia, and leucopenia; however, none of these abnormalities are specific. The present study was undertaken to assess the utility of WBC scattergram in predicting the diagnosis of malaria. Methods In this study all cases diagnosed as Plasmodium vivax/Plasmodium falciparum infection on peripheral smear examination were included. Their complete blood counts and WBC scattergrams obtained from XT2000i were critically evaluated. Accordingly, sensitivity, specificity, positive predictive value (PPV), and negative predictive value of detection of malaria by abnormal WBC scattergram with and without abnormal blood counts were also calculated. Results A total of 2251 ethylendiaminetetraacetic acid samples were run on XT2000i hematology autoanalyzer. Out of these 148 cases of malaria were diagnosed on peripheral smear (128 P. vivax and 20 P. falciparum). While analyzing the WBC scattergrams, 233 cases including 124 (83.8%) malaria cases showed different abnormalities. Sensitivity and PPV for the diagnosis of malaria by abnormal WBC scattergram were 83.78 and 53.20%, respectively. This had increased to 98.60 and 57.25%, respectively, when cytopenias were included. Discussion Sysmex XT-2000i is capable of detecting specific abnormalities in WBC scattergram in patients with malaria. Therefore, the presence of an abnormal WBC scattergram with thrombocytopenia in a febrile patient helps the pathologist to clinch the diagnosis of malaria.

Bilateral myoid hamartoma of breast: an exceptionally rare lesion.

Breast hamartomas (BH) or Fibroadenolipoma are extremely rare breast lesions. They are benign, focal malformations that resemble a neoplasm in the tissue of its origin. We describe a case of a 48 year old woman with bilateral breast lumps for the past 18 months and 6 months which were gradually increasing in size. FNAC smears revealed only clusters of benign ductal epithelial cells. Lumps were excised and histopathology revealed predominantly stromal smooth muscle bundles (proved by immunohistochemistry) along with scattered intact terminal duct-lobular units, dilated ducts and entrapped islands of mature fibroadipose tissue. A diagnosis of Bilateral Myoid hamartoma of breast was given. To the best of our knowledge till date no case of bilateral MH of breast has been reported in the literature. We report the first case of bilateral MBH highlighting its morpho-immunophenotypic features.

Strongyloides stercoralis hyperinfection causing eosinophilic ascites.

Strongyloidiasis is associated with Strongyloides stercoralis, an intestinal nematode with greater prevalence in tropical and subtropical regions. Hyperinfection syndrome with dissemination may occur in immunosuppressed individuals. However, invasion of peritoneal cavity with peritoneal effusion is rarely reported in the literature. We report a case of S. stercoralis hyperinfection in a young alcoholic patient with Diabetes mellitus, liver disease and ascites. Diagnostic paracentesis showed numerous filariform larvae of S. stercoralis against a background of eosinophils. Diagn. Cytopathol. 2015;43:731–733.

Disseminated histoplasmosis diagnosed on bone marrow aspiration in an immunocompetent patient.

A 35-year-old woman presented with pallor, intermittent fever associated with chills, and body ache that had started 6 months earlier. There was no history of joint pain, vomiting, loose stools, cough, or dysuria. Respiratory and cardiovascular system examinations were normal. In the abdomen, non-tender hepatosplenomegaly was present, 5 cm and 1 cm below the costal margin. The patient had no history of steroid intake or diabetes, the results of the recombinant K39 and rapid malaria antigen tests were negative, and human immunodeficiency virus serology was non-reactive. However, a complete blood count revealed pancytopenia, and bone marrow aspirate smears showed many intracellular and extracellular yeast forms of H. capsulatum. These organisms were periodic acid Schiff-positive and gave a positive Prussian blue reaction with Perl’s staining (Fig. 1). A diagnosis of disseminated histoplasmosis

Acral steatocystoma multiplex

Sir, Steatocystoma mult iplex (SM) is a hamartomatous malformation of the pilosebaceous duct junction.[1] It is a distinct condition characterized by numerous small, skin‐colored or yellowish, cutaneous cysts. SM can appear anywhere on the body but is more common in areas where the pilosebaceous apparatus is well developed such as the trunk, neck, axilla, inguinal region, scalp and the proximal extremities.[2] Acral SM is a rare condition and has been described in only three reports.[1‐3]

Malignant transformation in an atypical endometrial cyst of the ovary

Editor, Endometriosis is the occurrence of endometrium (glandular epithelium and endometrial stroma) outside the endometrial cavity, most commonly in the ovary. Like the uterine endometrium, ectopic endometrium may proliferate and transform into atypical hyperplasia and carcinoma. Atypical endometriosis is characterized by architectural proliferation and cytological atypia, and is reported to possess premalignant potential. The incidence of malignancy in endometriosis is 1.1%–3%.[1]

Coagulation profile during induction chemotherapy in childhood acute lymphoblastic leukemia

Context: Thromboembolism in children with acute lymphoblastic leukemia (ALL) is most commonly reported after the initiation of antileukemic therapy, indicating a possible interaction of disease and therapy. Aims: To study the effect of induction chemotherapy on coagulation parameters in pediatric ALL patients. Settings and Design: Thirty-seven newly diagnosed patients of ALL up to 18 years of age were evaluated along with 30 age- and sex-matched controls. Subjects and Methods: At the time of diagnosis (day 0), various coagulation parameters were tested. These were sequentially analyzed on day 14 (after the completion of L-asparaginase doses) and on day 28 of therapy (after the completion of induction). Prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen, protein C (PC) activity, and protein S (PS) activity were done by a clot-based method. Antithrombin (AT) assay was performed by chromogenic method. D-dimer (D-DI), tissue plasminogen activator (tPA), and plasminogen activator inhibitor type 1 (PAI-1) levels were assayed by ELISA method. Statistical Analysis Used: The statistical analysis was done using Statistical Package for Social Sciences version 17.0. Results: No major change in PT and APTT was observed during chemotherapy; however, fibrinogen levels declined significantly (P = 0.04), following L-asparaginase treatment. D-DI levels were significantly raised at diagnosis (P < 0.001) and throughout induction therapy (P < 0.001). PC, PS, and AT were reduced in the initial part of induction, followed by a rise in the second half of therapy, reaching their respective baseline levels (P < 0.05). The tPA levels were significantly reduced in the patients at diagnosis and throughout therapy (P < 0.001). PAI-1 levels were comparable to controls at presentation and showed a rising trend during therapy. Conclusions: The results of this study indicated that both the malignant process and the drugs used in combined chemotherapy cause thrombin activation, decrease in natural inhibitors, and hypofibrinolysis, resulting in hypercoagulability. Thus, ALL per se is a hypercoagulable state and the prothrombotic condition at the time of diagnosis gets enhanced during induction chemotherapy.

Congenital presentation of a solitary superficial angiomyxoma in the parotid region masquerading as parotid tumor

Superficial angiomyxoma is a rare cutaneous and benign lesion. We present a case of congenital presentation of a superficial angiomyxoma in the parotid region in a 9-year- old female that was misdiagnosed as a parotid tumor. Appropriate diagnosis is important since such lesions have a good prognosis and rarely affect deeper structures. Possibility of superficial angiomyxoma should be kept in mind in the differential diagnosis of lesions of the parotid region.

Incomplete Small Bowel Obstruction Due to Isolated Ileal Endometriosis: A Mimic of Tuberculosis

Endometriosis is an estrogen-dependent disease characterized by the presence of functional endometrial tissue outside the uterus. It can be intraor extraperitoneal. Intraperitoneal disease usually is genital and commonly involves the ovaries, uterine ligaments, fallopian tubes, pelvic peritoneum and pouch of Douglas [1]. The most common site of extragenital endometriosis is the gastrointestinal tract (GIT), the other sites being the omentum, peritoneum and occasionally other intra-abdominal organs. Extraperitoneal disease may be seen in the cervix, vagina, abdominal scars and hernia sacs, and is uncommon. Rarely, endometriosis affects the urinary system, lungs, skin, diaphragm and central nervous system [1, 2]. The GIT is involved in 3–37 % of the females with endometriosis; the most common site being the rectosigmoid colon (72 %) followed by ileum (7 %), cecum (3.6 %) and appendix (3 %) [1–3]. Usually, the disease takes the form of small asymptomatic serosal implants, but these can progress and become symptomatic. The symptoms are usually chronic and cyclical (occurring at the time of menses) [1–3]. Acute presentations such as intestinal obstruction, appendicitis, appendicular intussusception, rectal bleeding and bowel perforation are relatively uncommon. We present a case of a young female who presented with incomplete small bowel obstruction due to an ileal Dr Kiran Agarwal is a Professor in Department of Pathology at Lady Hardinge Medical College and Associated Hospitals. Dr Shivali Sehgal is Senior Resident in Department of Pathology at Lady Hardinge Medical College and Associated Hospitals. Dr Mona Bargotya is a Senior Resident in Department of Pathology at Lady Hardinge Medical College and Associated Hospitals.

Yolk sac tumor of cryptorchid testis diagnosed by fine needle aspiration cytology.

Yolk sac tumor is the most common germ cell tumor in infants and children. Majority of them arise in the gonads. Yolk sac tumor of undescended testis has been rarely diagnosed. We present a case of yolk sac tumor in right undescended testis in a 2-year-old child primarily diagnosed by fine needle aspiration cytology.