Myelodysplastic syndromes/neoplasms: recent classification system based on World Health Organization Classification of Tumors – International Agency for Research on Cancer for Hematopoietic and Lymphoid Tissues

The myelodysplastic Syndromes (MDS) are a group of clonal hematopoietic stem cell diseases characterized by cytopenia(s), dysplasia in one or more of the major myeloid cell lines, ineffective hematopoiesis, and increased risk of development of acute myeloid leukemia. The classification and the diagnostic criteria have been redefined by the recent World Health Organization Classification of Tumors – International Agency for Research on Cancer for Hematopoietic and Lymphoid Tissues. The myelodysplastic syndromes are now classified into the following categories – refractory cytopenia with unilineage dysplasia, refractory anemia with ring sideroblasts, refractory cytopenia with multilineage dysplasia, refractory anemia with excess blasts, myelodysplastic syndrome associated with isolated del (5q), myelodysplastic syndrome – unclassifiable, and childhood myelodysplastic syndrome. The clinicopathologic features, morphology, differential diagnosis, immunophenotyping, cytogenetics, prognosis and predictive factors are presented in the light of recent World Health Organization Classification of Tumors – International Agency for Research on Cancer

Basal Cell Adenocarcinoma in the Tongue: An Unusual Presentation

We present a case of basal cell adenocarcinoma (BCAC) in the tongue in a 65-year old male. This is an extremely rare presentation. BCAC generally occurs in the parotid gland and rarely involves the minor salivary glands. Few cases have been reported in literature with a variable presentation. The biopsy was formalin-fixed and paraffin-embedded. The sections were stained with routine Hematoxylin and Eosin. Immunohistochemistry was performed. Hematoxylin and eosin staining showed tumour composed of variable sized and shaped, nests and sheets of basaloid epithelial cells having hyperchromatic to vesicular nuclei. Immunohistochemistry was positive for Pancytokeratin, Epithelial membrane antigen and p53. The clinicopathological features and the cellular immunophenotype addressed the diagnosis towards BCAC of the tongue. The goal of this report is to increase awareness of this rare disease and to review and discuss the differential diagnosis and important considerations in treatment

Prevalence and clinico-mycological profile of vulvovaginal candidiasis in a tertiary care hospital

Background: Vulvovaginal candidiasis is an infectious condition caused by Candida and its species remains a global health morbidity among females especially in the reproductive age group. Vulvovaginal candidiasis has been associated with variable clinical profile and being a potential relationship with obstetric morbidities, the prevalence still remains high. The emergence of Non albicans species and its diagnosis at laboratory levels remains a challenge to the pathologists often warranting a supportive diagnostic modalities. The present study had been aimed to monitor the prevalence of vulvovaginal candidiasis in our tertiary care hospital and correlate the clinic-mycological profile with pathological findings on light microscopy.Methods: All patients presented with specific clinical symptoms of reproductive age group were included. With few exclusion criteria, the clinical history was obtained and high vaginal smears were collected and stained with Papanicalou stain and pathological interpretation was documented. In few available and indicated cases, culture procedure was performed. The data obtained were compared and correlated with clinical and laboratory diagnostic findings.Results: Among 125 cases studies, 62 positive cases for Candidiasis were reported with an approximate incidence of 50%. Further speciation identification showed C. albicans positivity in 45 cases and 17 cases for non albicans species. Women of second and third decade were predominantly affected by vulvovaginal candidiasis with abdominal pain and pruritis being a common clinical presentation. Conclusions: The prevalence of vulvovaginal candidiasis is on higher margin especially among reproductive age group. Clinical profile must be further correlated with laboratory data for speciation, thereby guiding in prompt and appropriate treatment modalities on best patient care

Xanthogranulomatous Pyelonephritis in a male child with renal vein thrombus extending into the inferior vena cava: a Case Report

<p>Abstract</p> <p>Background</p> <p>We present a case of Xanthogranulomatous pyelonephritis (XGPN) in a male child with renal vein thrombus extending into the inferior vena cava. This is a rare presentation. XGPN is a rare type of renal infection characterised by granulomatous inflammation with giant cells and foamy histiocytes. The peak incidence is in the sixth to seventh decade with a female predominance. XGPN is rare in children.</p> <p>Case presentation</p> <p>An 11 year old male child presented with a history of high grade fever and chills, right flank pain and progressive pyuria for two months. He had a history of vesical calculus for which he was operated four years back. In our case, a subcapsular right nephrectomy was performed. The surgical specimens were formalin fixed and paraffin embedded. The sections were stained with routine Hematoxylin & Eosin stain. Grossly; the kidney was enlarged with adherent capsule and thickening of the perinephric tissue. The pelvicalyceal system was dilated and was filled with a cast of pus. Histological evaluation revealed diffuse necrosis of the renal parenchyma and perinephric fat. Neutrophils, plasma cells, sheets of foamy macrophages and occasional multinucleate giant cells were seen. The renal vein was partially occluded by an inflammatory thrombus with fibrin, platelets and mixed inflammatory cells. The thrombus was focally adherent to the vein wall with organization.</p> <p>Conclusions</p> <p>The clinical presentation and the macroscopic aspect, together with the histological pattern, the cytological characteristics addressed the diagnosis towards XGPN with a vena caval thrombus. Our case illustrates that the diagnosis of XGPN should be considered even in paediatric age group when renal vein and vena caval thrombi are present.</p

Correlation between lymphopenia and other hematological parameters with duration of hospital stay as a measure of severity in Covid-19: a retrospective study

Abstract Purpose The SARS-CoV-2 (corona) virus is evolving fast because of the scale at which it has infected people around the world. Updated data is needed to manage Covid-19 efficiently with limited resources. After thorough literature review, there were very few studies that correlated variation of hematological parameters with duration of hospital stay. Here, the aim of the study was to determine correlation between variation in hematological parameters and duration of hospital stay as a predictor of severity of disease. Methodology The study was conducted at central laboratory of HIMS, Varanasi. The present study was an observational study done retrospectively. The study duration was from 1st July, 2020 to 30th October, 2020. RT-PCR-positive confirmed cases admitted in the institute whose CBC data was available over a period of multiple days were included in the study to find out the correlation. Study design Patients were categorized into two study groups. Group I (A and B): duration of hospital stay from 2 to 10 days and Group II (A, B, and C): duration of hospital stay more than 11 days. Chi-square test was applied to both the groups to see whether correlation between variation in hematological parameters and duration of hospital stay was significant or not. Result A total of 276 Covid-19 patients were included in the study. Patients were divided into groups and subgroups according to the duration of hospital stay. A total of 50% (103) of patients in Group I (hospital stay from 2 to 10 days) had lymphopenia as compared to 72.86% (51) of patients with lymphopenia in Group II (hospital stay from 11 to 40 days). Similarly, 44.17% (91) of patients in Group I had leukocytosis as compared to 72.86% (51) of patients with leukocytosis in Group II. The percentage increase in lymphopenia and leukocytosis in Group II was same, and this increase was found to be statistically significant (p-value < 0.05). Both these variables were increasing with increase in days of hospital stay. Conclusion Hence, to conclude, complete blood count parameters especially lymphopenia and leukocytosis are most significant and economical in guiding the management protocol of Covid-19 patients as well as in predicting the number of days of hospital stay

Evaluation of Spectrum of Prostatic Biopsies Using the Revised Gleason Grading System and Prostate Specific Antigen Assay

Introduction: The incidence of prostatic adenocarcinoma is rising worldwide, and a stratified uniform diagnostic approach is required to develop a treatment protocol for patients. This study was undertaken in a medical college in eastern Uttar Pradesh with the aim to estimate the burden of prostatic lesions in the area and to classify them according to the revised Gleason’s grading system.Materials and Methods: This was a descriptive type of observational study of three years duration were 238 cases of prostatic biopsies in Pathology department of Heritage institute of medical sciences, Varanasi. The lesions were classified on histopathology according to the revised Gleason’s grading system and association of prostatic lesions with serum Prostate Specific Antigen was also evaluated. The results were tabulated as pie chart and percentage and comparison was described. Results: The mean age of patients with benign prostatic hyperplasia was 56.74 years while it progressed to 75.5 years in patients with prostatic adenocarcinomas. The most common histopathological diagnosis was benign prostatic hyperplasia followed by BPH with chronic prostatitis. The most common Gleasons score in adenocarcinoma was 7. Serum PSA was found to be significantly raised in patients with prostatic adenocarcinomas in comparison to benign prostatic lesions.Conclusion: Benign prostatic hyperplasia is the most common prostatic lesion among adult males in eastern Uttar Pradesh. Implementation and awareness of Revised Gleason’s grading system will help in proper stratification and uniformity needed for better communication among pathologist and treating clinicians required for adequate treatment approach

Bilateral benign phyllodes tumor of breast

Phyllodes tumor or cystosarcoma phyllodes are rare type of fibroepithelial breast neoplasms consisiting of 1% of all mammary tumors.They are biphasic in nature and have very low incidence of bilateral occurrence.The median age of presentation is 40-50 years.We present a case of 37 years female with phyllodes tumor developing in both the breasts metachronously with a gap of 5 years.Patient underwent widelocal excision and histopathological report confirmed benign type of cystosarcoma phyllodes in bilateral breasts

Bombay blood group: Is prevalence decreasing with urbanization and the decreasing rate of consanguineous marriage

Context: Bombay blood group although rare is found to be more prevalent in the Western and Southern states of India, believed to be associated with consanguineous marriage. Aims: To estimate the prevalence of the Bombay blood group (Oh) in the urban population of Puducherry. To find the effect of urbanization on consanguineous marriage and to establish whether consanguinity plays a part in the prevalence of Oh group. To compare Oh group prevalence with that of other neighboring states, where population is not predominantly urban. Settings and Design: This is a descriptive study in a tertiary care hospital in Puducherry, over a period of 6 years. Materials and Methods: All blood samples showing ′O′ group were tested with anti-H lectin. Specialized tests like Adsorption Elution Technique, inhibition assay for determination of secretor status were performed on Oh positive cases. Any history of consanguineous marriage was recorded. Statistical Analysis Used: All variables were categorical variable and percentage and proportions were calculated manually. Results: Analysis of the results of 35,497 study subjects showed that the most common group was ′O′ group constituting 14,164 (39.90%) of subjects. Only three "Oh" that is, Bombay phenotype (0.008%) were detected. Consanguinity was observed in two cases (66.66%). Conclusions: This study shows the prevalence of Bombay blood group representing the urban population of Puducherry, to be high (0.008%) and associated with consanguineous marriage (66.66%). Thus, consanguinity is still an important risk factor present, even in an urban population in Southern India