Fluorescent In-Situ Hybridization is the Hand Mirror of Cytogenetics: A Rare Case of Near Tetraploidy in Pediatric Acute Lymphoblastic Leukemia

Identification of specific chromosomal changes has important prognostic and biological implications in childhood Acute Lymphoblastic Leukemia (ALL). ALL cases with 90 chromosomes are rare. Here, we report a case of near-tetraploidy in a 4 year old boy diagnosed with B-cell ALL, where the ploidy was identified by Fluorescent In- Situ Hybridization (FISH) and confirmed by Conventional Cytogenetics. Our aim was to enumerate multiple signals observed by FISH, and to confirm the same by cytogenetics. FISH on cytogenetically fixed air-dried slides was performed by using BCR/ABL and MLL probe .Two hundred cells were scored. BMA was cultured and G-banded metaphases were analyzed in accordance with ISCN 2013. The results of the FISH test showed more than two signals and cytogenetics revealed clones of near-tetraploidy with mn 90, karyotype: 90-92, 4nXXY,-Y,-10,-10,-13, +14, +17, along with normal clones. The tetraploidy condition compared to hyperdiploid ALL has a poorer prognosis and the rarity of these cases makes accounting on treatment decisions a supposition. Presently, the patient is on standard treatment for ALL (UK ALL regime A). The numerical abnormality detected by FISH was confirmed by cytogenetics, which facilitated in reporting the results of this case earlier than the defined turnaround time. Therefore author opines that FISH reports should also contain observed additional information along with positive or negative status of the requested test

A telepathology based screening tool for COVID-19 by leveraging morphological changes related to leukocytes in peripheral blood smears

As we approach the aftermath of a global pandemic caused by Severe Acute Respiratory Syndrome-Corona Virus (SARS-CoV-2), the importance of quickly developing rapid screening tests has become very clear from the point of view of containment and also saving lives. Here, we present an explorative study to develop a telepathology-based screening tool using peripheral blood smears (PBS) to identify Coronavirus Disease (COVID-19)-positive cases from a group of 138 patients with flu-like symptoms, consisting of 82 positive and 56 negative samples. Stained blood smear slides were imaged using an automated slide scanner (AI 100) and the images uploaded to the cloud were analyzed by a pathologist to generate semi-quantitative leukocyte morphology-related data. These telepathology data were compared with the data generated from manual microscopy of the same set of smear slides and also the same pathologist. Besides good correlation between the data from telepathology and manual microscopy, we were able to achieve a sensitivity and specificity of 0.83 and 0.71, respectively, for identifying positive and negative COVID-19 cases using a six-parameter combination associated with leukocyte morphology. The morphological features included plasmacytoid cells, neutrophil dysplastic promyelocyte, neutrophil blast-like cells, apoptotic cells, smudged neutrophil, and neutrophil-to-immature granulocyte ratio. Although Polymerase Chain Reaction (PCR) and antibody tests have a superior performance, the PBS-based telepathology tool presented here has the potential to be an interim screening tool in resource-limited settings in underdeveloped and developing countries