Metastatic malignant melanoma in bone marrow with occult primary site – a case report with review of literature

<p>Abstract</p> <p>Background</p> <p>Metastases of malignant melanoma to the bone marrow are very rare. A few case reports are published in the literature with a known primary site.</p> <p>Case presentation</p> <p>Herein we present a case of metastatic malignant melanoma in bone marrow with occult primary site in a 22- year-old-male. Diagnosis was confirmed by morphology and immunohistochemistry. A pertinent review of literature is also presented by using relevant articles indexed in PubMed (National Library of Medicine) database. The search was based on the following terms: metastasis or metastases, malignant melanoma and bone marrow.</p> <p>Conclusion</p> <p>In this report we discuss a rare case of metastatic malignant melanoma to the bone marrow with an unknown primary. Clinicians must be aware of the varied clinical manifestations of disseminated malignant melanoma even if the primary site is not evident.</p

Infection of Human Papillomavirus Type 18 and p53 Codon 72 Polymorphism in Lung Cancer Patients From India

Study objectives: Infection with specific high-risk HPV types 16 and 18 and polymorphism of p53 codon 72 has been strongly associated with the genesis of various neoplasms in humans, but such study in lung cancer is limited and the results are controversial. In India, the role of these two factors has been strongly implicated in cervical and other cancers, but the occurrence of HPV or p53 codon 72 polymorphism has not been examined in lung cancer, which is the most common cause of cancer-related death in India. Design and patients: A total of 40 tumor biopsy specimens from advanced lung cancer patients and blood samples from 40 matching control subjects were obtained for the analysis of high-risk HPV types 16 and 18 infection and p53 codon 72 polymorphism by polymerase chain reaction. Results: Only HPV type 18 was detected in 5% (2 of 40 lung cancer patients), but no other HPV could be detected. A significantly increased frequency of Arg/Arg homozygotes was observed in patients with advanced lung cancer when compared to that of control subjects (p = 0.004; odds ratio, 5.13; 95% confidence interval, 1.59 to 17.26). However, no significant correlation could be made between p53 polymorphism and different clinical stages, except for advanced stage IV patients, who showed a higher proportion of Arg/Pro heterozygous genotype. Conclusions: HPV detected in a small proportion of lung cancer patients in India demonstrated an exclusive prevalence of HPV type 18, and there was a significantly higher frequency of p53 Arg/Arg genotype when compared to that of control subjects. Observation of a shorter duration of symptoms (≤ 4 months) in as many as 78% (seven of nine stage IV patients) with Arg/Pro genotype may be an indication that lung cancer patients with the heterozygous p53 genotype are more susceptible to early progression

Rare association of Visceral leishmaniasis with Hodgkin's disease: A case report

We present here a case of young male with complaints of fever and swelling in the neck for eight months. History of progressive weakness associated with weight loss was present. Physical examination revealed pallor, multiple enlarged cervical lymph nodes and hepatosplenomegaly. Investigations showed pancytopenia, hyperglobinemia and Leishman-Donovan bodies on bone marrow aspiration. Serological test confirmed diagnosis of visceral leishmaniasis. However, cervical lymph node aspiration and biopsy were suggestive of Mixed cellularity Hodgkin's disease. This made it a very rare case of Leishmaniasis as an opportunistic infection in a patient of pre-chemotherapy Hodgkin's disease. There was marked improvement in haematological profile and regression of hepatosplenomegaly with Amphotericin B treatment followed by favourable response to chemotherapy. The case emphasizes the suspicion for leishmaniasis as a masquerader and as an opportunistic infection in haematological malignancies

Comparison of various immunoassay kits for rapid screening of pandemic influenza H1N1-2009 viruses

The success of therapeutic measures is predicted on the basis of rapid and precise diagnosis of infection. A comparison of three rapid influenza immunoassay (RIIA) kits, the Directigen Flu A+B test, QuickVue influenza A+B test and the Quick S-INFLU A.B, for detection of pandemic influenza H1N1 (2009) viruses, have been made on 105 patients with flu like syndrome. The sensitivity, specificity and ability to screen influenza type A and B viruses were evaluated. The clinical specimens detected positive by real-time RT-PCR for pandemic influenza H1N1 (2009) viruses and the reference influenza strain [A/PR/8/34 (H1N1)] were cultured in MDCK cells to determine TCID50 and the performance of kits were compared against the current gold standard, real-time RT-PCR. The diagnostic sensitivity of Directigen kit was 103 TCID50/ml where as the QuickVue and Quick S-INFLU A.B were 103.5 TCID50/ml in case of the pandemic H1N1 viruses which was comparable to the reference H1N1 virus (103 TCID50/ml for QuickVue and Directigen and 103.5 TCID50/ml for Quick S-INFLU A.B). Our findings suggest that although RIIA kits are not as sensitive as the conventional and real-time RT-PCR yet they are very useful in preliminary bedside screening of large number of critically ill patients during pandemic situation

Quantification of viral load in clinical specimens collected from different body sites of patients infected with influenza viruses

Viral shedding profile of infections caused by the novel influenza A (pH1N1) virus has not been extensively studied. In the present study we aimed to compare the influenza viral load in clinical specimens collected from different body sites of patients to analyze the best specimen for detecting viral load and predicting disease severity. The respiratory specimens (throat and nasal swabs), urine and serum were collected from patients on first day of their hospital visit within 48 h of onset of influenza like illness (ILI) and screened for influenza positivity in respiratory specimens by real-time RTPCR. A total of 10 pandemic H1N1 and 15 seasonal influenza positive cases were included in this study and viral load was estimated in all the types of specimens by real-time RT-PCR. Our findings revealed that the nasal swab had the highest mean viral load of 21.406 × 104 followed by throat swab (12.777 × 104), urine (0.026 × 104), serum (0.0007 × 104). These findings confirm that nasal secretions are the best specimen, followed by throat swab, urine and serum. The importance of this study is to show the viral shedding profile in different specimen types and to suggest alternatives to respiratory specimens for the diagnosis of influenza