A 10-year-old girl presenting with jaundice, deterioration of school performance and itching

This article has no abstract. The first 100 words appear below: A 10-year-old immunized girl, 6th issue of consanguineous parents, presented with the complaints of jaundice for the last 2 years and deterioration of school performance for the same duration. She also had generalized itching for the last 6 months. She had no history of altered sleep pattern, any gastrointestinal bleeding, surgical or dental procedures, history of blood and blood products transfusion, taking any offending drugs, sib death or family history of such type of illness

A 3 year old girl presented with abdominal distention since birth with developmental delay

This article has no abstract. The first 100 words appear below: A 3 year old girl, 3rd issue of consanguineous parents from the Feni District (south part of Bangladesh) immunized as per EPI schedule presented at the outpatient department with the history of progressive abdominal distension and not growing well since birth. She had also the history of developmental delay and recurrent respiratory tract infection. Still she can not stand without the support and unable to make a sentence completely. Her brother died at 5 months of age with abdominal distention with unknown cause. She had no history of jaundice, hematemesis, melena, convulsion and craving for food

A 3 year old girl presented with abdominal distention since birth with developmental delay

This article has no abstract. The first 100 words appear below: A 3 year old girl, 3rd issue of consanguineous parents from the Feni District (south part of Bangladesh) immunized as per EPI schedule presented at the outpatient department with the history of progressive abdominal distension and not growing well since birth. She had also the history of developmental delay and recurrent respiratory tract infection. Still she can not stand without the support and unable to make a sentence completely. Her brother died at 5 months of age with abdominal distention with unknown cause. She had no history of jaundice, hematemesis, melena, convulsion and craving for food

Application of toluidine blue stain and neuron specific enolase immunohistochemical stain in the diagnosis of hirschsprung disease

Hirschsprung disease is one of the most common and problematic infancy and childhood maladies. Early and accurate diagnosis is a fundamental step in proper management and prevention of complications. The most reliable method for diagnosis is the histopathological analysis of colorectal biopsies and the typical finding of Hirschsprung disease is the absence of ganglion cells. Toluidine blue stain can act as a double check along with conventional H&E stain for ganglion cell detection. Neuron-specific enolase is an immune-histochemical marker that can also aid in better identifying ganglion cells, especially for small and immature ones. This study aimed to evaluate Toluidine blue stain and Neuron specific enolase immunostain along with conventional H&E stain as a panel for the diagnosis of Hirschsprung disease. This cross-sectional study was conducted from September 2019 to August 2021, involving 55 clinically suspected Hirschsprung disease cases. Paraffin blocks of colorectal biopsy samples were collected from the Department of Pathology, BSMMU. Hematoxylin & Eosin, Toluidine blue stain, and Neuron specific enolase immunohistochemical stain for Hirschsprung disease detection were performed on the sections from the paraffin blocks. Then the sections were examined and an evaluation of the stains was done. Statistical analysis was performed on the tabulated data by chi-square test. Among 55 cases, conventional H&E stain detected ganglion cells in 31 cases, that is 56.4%. Later, Toluidine blue stain and Neuron specific enolase immu- nohistochemical stain detected ganglion cells in 35 cases, that is 63.6%. So, these two addition- al stains were able to detect ganglion cells in four more cases compared to conventional H&E stain. In conclusion, conventional H&E stain, Toluidine blue stain, and NSE immunohisto- chemical stain can improve the diagnostic accuracy of Hirschsprung disease. BSMMU J 2022; 15(2): 102-10

Degree of fibrosis and its association with angiogenesis in the myelofibrotic bone marrow

Background: Primary and secondary myelofibrosis has become a global burden due to its increased mortality and morbidity. Angiogenesis is a significant driving force in the development of fibrogenesis in the bone marrow, which leads to myelofibrosis. The microvascular density (MVD) with immunomarker CD34 can be used to assess the degree of angiogenesis. The objective of this study was to examine the association between degree of myelofibrosis and angiogenesis in hematological malignancies. Methods: Forty-six trephine biopsy specimens of various hematological malignancies with myelofibrosis were studied at the Department of Pathology of Bangabandhu Sheikh Mujib Medical University. Extent of myelofibrosis in each case was assessed by examining the reticulin and Masson’s trichrome stained sections using a semiquantitative grading system of bone marrow fibrosis (MF) within a scale of MF-0 to MF-3. Angiogenesis was measured by counting MVD in the ‘hotspots’ after immunostaining with CD34 antibody. Results: The trephine biopsy cases were grouped into early fibrotic (MF-1) and advanced fibrotic (MF-2,3) consisting of 16 (34.8%) and 30 (65.2%) patients, respectively. Angiogenesis was estimated as mean MVD count which revealed 16.7 ± 5.4 and 32.0 ± 11.5 in these groups, respectively.  Significant difference of mean MVD values     (P<0.001) between the early and advanced fibrotic groups revealed the association of angiogenesis and degree of myelofibrosis. Conclusion: MVD may be used to measure angiogenesis in myelofibrotic marrow along with other clinical and laboratory indices as a marker of disease activity in hematological malignancies, thus aiding disease prognosis.

Application of toluidine blue stain and neuron specific enolase immunohistochemical stain in the diagnosis of hirschsprung disease

Hirschsprung disease is one of the most common and problematic infancy and childhood maladies. Early and accurate diagnosis is a fundamental step in proper management and prevention of complications. The most reliable method for diagnosis is the histopathological analysis of colorectal biopsies and the typical finding of Hirschsprung disease is the absence of ganglion cells. Toluidine blue stain can act as a double check along with conventional H&E stain for ganglion cell detection. Neuron-specific enolase is an immune-histochemical marker that can also aid in better identifying ganglion cells, especially for small and immature ones. This study aimed to evaluate Toluidine blue stain and Neuron specific enolase immunostain along with conventional H&E stain as a panel for the diagnosis of Hirschsprung disease. This cross-sectional study was conducted from September 2019 to August 2021, involving 55 clinically suspected Hirschsprung disease cases. Paraffin blocks of colorectal biopsy samples were collected from the Department of Pathology, BSMMU. Hematoxylin & Eosin, Toluidine blue stain, and Neuron specific enolase immunohistochemical stain for Hirschsprung disease detection were performed on the sections from the paraffin blocks. Then the sections were examined and an evaluation of the stains was done. Statistical analysis was performed on the tabulated data by chi-square test. Among 55 cases, conventional H&E stain detected ganglion cells in 31 cases, that is 56.4%. Later, Toluidine blue stain and Neuron specific enolase immu- nohistochemical stain detected ganglion cells in 35 cases, that is 63.6%. So, these two addition- al stains were able to detect ganglion cells in four more cases compared to conventional H&E stain. In conclusion, conventional H&E stain, Toluidine blue stain, and NSE immunohisto- chemical stain can improve the diagnostic accuracy of Hirschsprung disease. BSMMU J 2022; 15(2): 102-10

Degree of fibrosis and its association with angiogenesis in the myelofibrotic bone marrow

Background: Primary and secondary myelofibrosis has become a global burden due to its increased mortality and morbidity. Angiogenesis is a significant driving force in the development of fibrogenesis in the bone marrow, which leads to myelofibrosis. The microvascular density (MVD) with immunomarker CD34 can be used to assess the degree of angiogenesis. The objective of this study was to examine the association between degree of myelofibrosis and angiogenesis in hematological malignancies. Methods: Forty-six trephine biopsy specimens of various hematological malignancies with myelofibrosis were studied at the Department of Pathology of Bangabandhu Sheikh Mujib Medical University. Extent of myelofibrosis in each case was assessed by examining the reticulin and Masson’s trichrome stained sections using a semiquantitative grading system of bone marrow fibrosis (MF) within a scale of MF-0 to MF-3. Angiogenesis was measured by counting MVD in the ‘hotspots’ after immunostaining with CD34 antibody. Results: The trephine biopsy cases were grouped into early fibrotic (MF-1) and advanced fibrotic (MF-2,3) consisting of 16 (34.8%) and 30 (65.2%) patients, respectively. Angiogenesis was estimated as mean MVD count which revealed 16.7 ± 5.4 and 32.0 ± 11.5 in these groups, respectively.  Significant difference of mean MVD values     (P<0.001) between the early and advanced fibrotic groups revealed the association of angiogenesis and degree of myelofibrosis. Conclusion: MVD may be used to measure angiogenesis in myelofibrotic marrow along with other clinical and laboratory indices as a marker of disease activity in hematological malignancies, thus aiding disease prognosis. Bangabandhu Sheikh Mujib Medical University Journal 2023;16(1): 26-34

Degree of fibrosis and its association with angiogenesis in the myelofibrotic bone marrow

Background: Primary and secondary myelofibrosis has become a global burden due to its increased mortality and morbidity. Angiogenesis is a significant driving force in the development of fibrogenesis in the bone marrow, which leads to myelofibrosis. The microvascular density (MVD) with immunomarker CD34 can be used to assess the degree of angiogenesis. The objective of this study was to examine the association between degree of myelofibrosis and angiogenesis in hematological malignancies. Methods: Forty-six trephine biopsy specimens of various hematological malignancies with myelofibrosis were studied at the Department of Pathology of Bangabandhu Sheikh Mujib Medical University. Extent of myelofibrosis in each case was assessed by examining the reticulin and Masson’s trichrome stained sections using a semiquantitative grading system of bone marrow fibrosis (MF) within a scale of MF-0 to MF-3. Angiogenesis was measured by counting MVD in the ‘hotspots’ after immunostaining with CD34 antibody. Results: The trephine biopsy cases were grouped into early fibrotic (MF-1) and advanced fibrotic (MF-2,3) consisting of 16 (34.8%) and 30 (65.2%) patients, respectively. Angiogenesis was estimated as mean MVD count which revealed 16.7 ± 5.4 and 32.0 ± 11.5 in these groups, respectively.  Significant difference of mean MVD values     (P<0.001) between the early and advanced fibrotic groups revealed the association of angiogenesis and degree of myelofibrosis. Conclusion: MVD may be used to measure angiogenesis in myelofibrotic marrow along with other clinical and laboratory indices as a marker of disease activity in hematological malignancies, thus aiding disease prognosis. Bangabandhu Sheikh Mujib Medical University Journal 2023;16(1): 26-34

Flow cytometry of lymph node aspirate can effectively differentiate the reactive lymphadenitis from the nodal non-Hodgkin lymphoma

The purpose of the present study was to compare the routine cytology, histology, immunohistochemistry and flow cytometry in the diagnosis of nodal lymphoma cases. Thirty five cases of clinically suspected lymphoproliferative disorder were included in this study. After preparation of smears from the fine needle aspirates on the glass slides for cytology, the residual material was processed for flow cytometric immunophenotyping accordingly. Subsequently, histopathology and immunohistochemistry findings of selected cases of lymph node biopsy were correlated to confirm and compare the diagnosis. Flow cytometric immunophenotypes of most of the cases corresponded to the histological and immunohistochemical diagnoses, five cases showed marked shift in diagnosis (e.g. aggressive NK cell leukemia) which were later validated by clinical outcomes. Flow cytometry immunophenotyping had shown high sensitivity (96.4%) and specificity (100%) if we considered both histopathology and immunohistochemistry combined as gold slandered, while in comparison to immunohistochemistry, flow cytometry immunophenotyping had shown 100% sensitivity and specificity. However, despite the improved diagnostic capacity provided by flow cytometry, morphologic analysis obtained from histopathology remains the cornerstone in the diagnosis of lymphoma

Flow cytometry of lymph node aspirate can effectively differentiate the reactive lymphadenitis from the nodal non-Hodgkin lymphoma

The purpose of the present study was to compare the routine cytology, histology, immunohistochemistry and flow cytometry in the diagnosis of nodal lymphoma cases. Thirty five cases of clinically suspected lymphoproliferative disorder were included in this study. After preparation of smears from the fine needle aspirates on the glass slides for cytology, the residual material was processed for flow cytometric immunophenotyping accordingly. Subsequently, histopathology and immunohistochemistry findings of selected cases of lymph node biopsy were correlated to confirm and compare the diagnosis. Flow cytometric immunophenotypes of most of the cases corresponded to the histological and immunohistochemical diagnoses, five cases showed marked shift in diagnosis (e.g. aggressive NK cell leukemia) which were later validated by clinical outcomes. Flow cytometry immunophenotyping had shown high sensitivity (96.4%) and specificity (100%) if we considered both histopathology and immunohistochemistry combined as gold slandered, while in comparison to immunohistochemistry, flow cytometry immunophenotyping had shown 100% sensitivity and specificity. However, despite the improved diagnostic capacity provided by flow cytometry, morphologic analysis obtained from histopathology remains the cornerstone in the diagnosis of lymphoma