Scatterplot Variations Seen in Malaria Using Automated Hematological Analyzers: A Series of Ten Cases

Background: Malaria is a major health problem in India. Complete blood count and peripheral blood smear (PBS) is important for its diagnosis. Inter observer variation makes PBS fallible. Rapid diagnostic tests cannot detect low parasitemia and mixed infections. Scatterplot from automated analyzers have shown variations previously which might be exploited. Methods: Scatterplot patterns of ten samples of confirmed malaria and 100 control samples were derived and other infections ruled out by culture and serology as a part of descriptive study between July and August 2018. Each malarial scatterplot was compared with the control pattern for abnormalities and their frequency noted. Results: All the ten samples belonged to Plasmodium vivax species. Abnormalities detected included split in neutrophilic region, eosinophil-neutrophil merge, neutrophil graying, lymphopenia, ghost red blood cells (RBC), eosinophil split, reactive lymphocytes, monocytosis, pseudoeosinophilia, neutrophilic leukocytosis Conclusion: Variations in scatterplot patterns are seen in malaria and provide clues to the diagnosis of malaria

Primary vaginal Ewing’s sarcoma/primitive neuroectodermal tumour: diagnostic and treatment challenges

Extra osseous Ewing’s sarcoma/primitive neuroectodermal tumour (PNET) of the genital tract of women is scarcely\ud described in the literature and involvement of the vagina is even rarer with a very few cases reported so far. We present\ud 50-year-old-woman who presented with a vaginal mass that was diagnosed to be a malignant round cell tumour which\ud later was confirmed to be primary vaginal Ewing’s sarcoma/ PNET on light microscopy and immunohistochemical\ud staining. She was then treated with induction chemotherapy followed by local radiotherapy and further maintenance\ud chemotherapy. This rare case of primary vaginal Ewing’s sarcoma/PNET emphasizes the need for combining\ud morphological features with immunohistochemistry with a panel of antibodies in establishing the diagnosis of Ewing’s\ud sarcoma/PNET at an uncommon site. Further, the case also highlights the use of induction chemotherapy followed by\ud radiation therapy and subsequent maintenance chemotherapy as a treatment modality

Pulmonary infarct as a initial presentation of acute myeloid leukemia: a diagnostic difficulty

The incidence of acute myeloid leukemia (AML) is age dependent and increasing among the patient groups aged above 60 years. The overall presentations in a case of AML is due to marrow infiltration of leukemic cells which results in fever and chills due to neutropenia, bleeding due to thrombocytopenia, fatigue and weakness due to anemia. Incidence of venous thromboembolism is very rare in hematological malignancies. We describe a case of adolescent male presented with features of lung consolidation later found to be a pulmonary infarct and finally diagnosed to have acute leukemia (AL)

Overview of blood components and their preparation

The whole blood which is a mixture of cells, colloids and crystalloids can be separated into different blood components namely packed red blood cell (PRBC) concentrate, platelet concentrate, fresh frozen plasma and cryoprecipitate. Each blood component is used for a different indication; thus the component separation has maximized the utility of one whole blood unit. Different components need different storage conditions and temperature requirements for therapeutic efficacy. A variety of equipments to maintain suitable ambient conditions during storage and transportation are in vogue. The blood components being foreign to a patient may produce adverse effects that may range from mild allergic manifestations to fatal reactions. Such reactions are usually caused by plasma proteins, leucocytes, red cell antigens, plasma and other pathogens. To avoid and reduce such complications, blood products are modified as leukoreduced products, irradiated products, volume reduced products, saline washed products and pathogen inactivated products. The maintenance of blood inventory forms a major concern of blood banking particularly of rare blood groups routinely and common blood groups during disasters. PRBCs can be stored for years using cryopreservation techniques. New researches in red cell cultures and blood substitutes herald new era in blood banking

Negative images in the fine needle aspiration cytologic diagnosis of mycobacterial infections

Cytologic diagnosis of mycobacterial infection has conventionally depended on the recognition of granulomatous inflammation with caseous necrosis and the identification of acid-fast bacilli with special stains. Immunocompromised patients however may not mount the expected response. Mycobacteria can be seen as negative images in fine needle aspiration cytologic smears from patients with acquired immunodeficiency syndrome. We report the cytologic findings of lymphnode aspiration from four patients where the mycobacteria were seen in the routine May Grunwald Giemsa-stained smear as unstained rod-shaped structures in the background and within histiocytes. These were confirmed to be acid-fast bacilli with the Ziehl-Neelsen stain

Nodal mantle cell lymphoma: A descriptive study from a tertiary care center in South India

Introduction: Mantle cell lymphoma (MCL) is a type of B-cell non-Hodgkin lymphoma (NHL) with distinctive morphologic, immunophenotypic and a characteristic cytogenetic abnormality, the t(11;14)(q13;q32) and overexpression of cyclin D1. The common histologic features include effaced lymphoid architecture by a monomorphic lymphoid population with a vaguely nodular, diffuse or mantle zone growth pattern. The classic cytomorphologic features include small to medium sized lymphoid cells with irregular nuclear contours and scanty cytoplasm, closely resembling centrocytes. Materials and Methods: This retrospective study comprises 13 cases of MCL over a period of 5½ years in our department, comprising 4% of all nodal NHL diagnosed. All cases were diagnosed on lymph node biopsy. Results: The mean age of the presentation was 57 years. There was a male preponderance (M:F = 2.25:1). The disease was nodal in all cases. Most patients (84.5%) had generalized lymphadenopathy and/or hepatosplenomegaly. Bone marrow involvement was seen in 81.8% of cases. Three cases showed a nodular pattern on lymph node biopsy while remaining ten had a diffuse pattern. Immunophenotyping showed positivity for CD20, CD5 and cyclin D1 and CD23 negativity. Conclusion: Despite certain morphological similarity to other low-grade/intermediate-grade lymphomas, MCL has a characteristic appearance of its own. Since it is more aggressive than other low-grade lymphomas it needs to be accurately diagnosed

Fine-needle aspiration cytology of granular cell tumor: A report of two cases

Granular cell tumors (GCTs) are uncommon soft tissue tumors, which are difficult to diagnose merely on clinical examination. Being an effective first-line investigation, the fine-needle aspiration cytology (FNAC) plays a significant role in its pre-operative recognition. However, as the tumor is likely to mimic certain other lesions, a cytopathologist needs to be aware of its characteristic cytomorphology. We report two cases of GCT who presented with subcutaneous swellings in the left lower back and the right-sided anterior abdominal wall for 6 and 2 months, respectively. Both the patients had a clinical diagnosis of lipoma/neurofibroma. FNAC was done in both. In the first case a cytodiagnosis of xanthogranuloma was suggested and GCT in the second. Subsequent histologic examination of both showed features of GCT. FNAC would aid in presumptive diagnosis of GCT

A case series of therapy-related leukemias: A deadly ricochet

Therapy-related leukemias(t-leukemia) are late complications arising from chemotherapy and radiotherapy. t-leukemia have a poor prognosis and are more difficult to treat compared to de novo leukemias. The authors present three cases of t-leukemia seen in our hospital in a three year period and discuss new updates concerning the treatment of t-leukemia

Low grade follicular lymphoma with high proliferation index; diagnostic and management issues

Follicular Lymphoma (FL) is the second most common B-Non Hodgkin Lymphoma after diffuse large B cell lymphoma (DLBCL). Low grade FL is known for its indolent behavior; however, one subset of FL behave aggressively and may require intensive therapy. One of the diagnostic issues in FL is to identify this subgroup of cases. Proliferation index can have prognostic importance in this subset of cases. We discuss one case of low grade FL with a paradoxically high proliferative index. A 63 year male presented with generalized lymphadenopathy of one year duration, which was gradually increasing in size. On examination, patient had bilateral cervical, axillary and inguinal nodes. Biopsy of the left cervical lymph node was reported as FL - Grade 2, with high proliferative Index (60%). The patient was put on CHOP regimen targeted for high grade lymphomas, and had complete remission. High proliferative index in FL is a poor prognostic factor irrespective of the histologic grade. So, proliferative index should be assessed in all cases of FL as an adjunct to histologic grading