Atypical polypoid adenomyoma with extensive morular metaplasia - Case report

Atypical polypoid adenomyoma (APA) is a rare and benign endometrial polypoid lesion. APA was found in a 38-year-old woman who presented with excessive vaginal bleeding. Histopathological examination of the polyp was consistent with “APA” with extensive morular metaplasia. Immunohistochemical marker CD10 was done to establish the diagnosis of morular metaplasia. Morular metaplasia is dissimilar to squamous metaplasia. It is sometimes misreported as adenosquamous carcinoma. This case illustrates the significance of morular metaplasia as a differential diagnosis

Generation of an integration-free iPSC line (CSCRi005-A) from erythroid progenitor cells of a healthy Indian male individual

Reprogramming of somatic cells with higher genome integrity, and use of non-integrating gene delivery methods and xeno-free cell culture conditions aid in the generation of iPSCs which are more suitable for disease modelling and clinical applications. We describe here an iPSC line generated using such conditions, which expressed all the pluripotency markers, retained normal karyotype and exhibited the potential for tri-lineage differentiation, both in-vitro and in-vivo. This is the first iPSC line available from a healthy Indian individual for researchers

Atypical Morphological Presentation of Neoplastic Plasma Cells: A Series of Five Cases

The diagnosis of Multiple Myeloma (MM) is made by demonstration clonal plasma cells in Bone Marrow (BM) aspiration/biopsy, in addition to assessing serum biochemical parameters, conducting radiological examinations, and considering the clinical presentation. In most cases, predominantly mature plasma cells are observed, along with scattered immature forms in the BM. Several morphological variants of plasma cells have been reported, including Auer rod-like inclusions, small lymphocyte-like cells, hairy cell-like cells, anaplastic variants, promonocyte-like cells, crystal-storing histiocytes, Burkitt-like cells, and blastoid cells. In this series of five cases, most showed a typical clinical presentation and laboratory findings suggestive of plasma cell dyscrasia. However, the morphology of each case exhibited unusual morphological variants, posing diagnostic challenges. These variants included Auer rod-like inclusions, small lymphocytes/lymph-plasmacytoid cells, hairy-like cells, multilobulated nuclei, and anaplastic variants mimicking dysplastic megakaryocytes, leading to various differential diagnoses. The age range of these cases was 57-76 years. Most of the cases presented with generalised dull aching body pain. Imaging studies revealed lytic lesions involving various parts of the bone, including the skull, ribs, vertebrae, and femur. Biochemical assays suggested the possibility of plasma cell dyscrasia. Two of the cases had primary Plasma Cell Leukaemia (PCL), which is a rare and highly aggressive plasma cell neoplasm. The anaplastic variant is associated with a poor prognosis, aiding in predicting treatment responses. However, due to the unusual morphological presentation, the diagnosis of MM or PCL was made after conducting ancillary studies such as Serum Protein Electrophoresis (SPEP), serum free light chain assay, Immunofixation Electrophoresis (IFE), and immunophenotyping through Immunohistochemistry (IHC) or flow cytometry

Haploidentical Natural Killer Cell Therapy as an Adjunct to Stem Cell Transplantation for Treatment of Refractory Acute Myeloid Leukemia

Refractory acute myeloid leukemia (AML), defined as failure of two cycles of induction therapy at diagnosis or of one cycle at relapse, represents a subgroup with poor outcomes. Haploidentical natural killer cell (NK) therapy is a strategy that is being explored in refractory malignancies. Historically, at our center, patients with refractory AML have been treated with cytoreductive therapy (fludarabine + cytosine + granulocyte colony-stimulating factor ± idarubicin or mitoxantrone + etoposide) followed by 1-week rest and then reduced-intensity transplant with fludarabine + melphalan. We used the same backbone for this trial (CTRI/2019/02/017505) with the addition of CD56-positive cells from a family donor infused 1 day after the completion of chemotherapy. CD56-positive selection was done using a CliniMACS Prodigy system (Miltenyi Biotec, Bergisch Gladbach, Germany) followed by overnight incubation in autologous plasma with 2 micromolar arsenic trioxide and 500 U/mL of interleukin-2. From February 2019, 14 patients with a median age of 29 years (interquartile range [IQR]: 16.5–38.5) were enrolled in this trial. Six were females. Six had primary refractory AML while eight had relapsed refractory AML. The median CD56-cell dose infused was 46.16 × 106/kg (IQR: 25.06–70.36). One patient withdrew consent after NK cell infusion. Of the 13 patients who proceeded to transplant, five died of immediate post-transplant complications while two did not engraft but were in morphologic leukemia-free state (both subsequently died of infective complications after the second transplant). Of the remaining six patients who engrafted and survived beyond 1 month of the transplant, two developed disease relapse and died. The remaining four patients are alive and relapse free at the last follow-up (mean follow-up duration of surviving patients is 24 months). The 2-year estimated overall survival for the cohort was 28.6% ± 12.1% while the treatment-related mortality (TRM) with this approach was 38.5% ± 13.5%. Haploidentical NK cell therapy as an adjunct to transplant is safe and needs further exploration in patients with AML. For refractory AML, post-transplant NK infusion and strategies to reduce TRM while using pre-transplant NK infusion merit exploration

sj-jpg-6-cll-10.1177_09636897231198178 – Supplemental material for Haploidentical Natural Killer Cell Therapy as an Adjunct to Stem Cell Transplantation for Treatment of Refractory Acute Myeloid Leukemia

Supplemental material, sj-jpg-6-cll-10.1177_09636897231198178 for Haploidentical Natural Killer Cell Therapy as an Adjunct to Stem Cell Transplantation for Treatment of Refractory Acute Myeloid Leukemia by Uday Kulkarni, Arun Kumar Arunachalam, Hamenth Kumar Palani, Reeshma Radhakrishnan Nair, Nithya Balasundaram, Arvind Venkatraman, Anu Korula, Sushil Selvarajan, Sharon Lionel, Poonkuzhali Balasubramanian, Madhavi Maddali, Aby Abraham, Biju George and Vikram Mathews in Cell Transplantation</p

sj-docx-1-cll-10.1177_09636897231198178 – Supplemental material for Haploidentical Natural Killer Cell Therapy as an Adjunct to Stem Cell Transplantation for Treatment of Refractory Acute Myeloid Leukemia

Supplemental material, sj-docx-1-cll-10.1177_09636897231198178 for Haploidentical Natural Killer Cell Therapy as an Adjunct to Stem Cell Transplantation for Treatment of Refractory Acute Myeloid Leukemia by Uday Kulkarni, Arun Kumar Arunachalam, Hamenth Kumar Palani, Reeshma Radhakrishnan Nair, Nithya Balasundaram, Arvind Venkatraman, Anu Korula, Sushil Selvarajan, Sharon Lionel, Poonkuzhali Balasubramanian, Madhavi Maddali, Aby Abraham, Biju George and Vikram Mathews in Cell Transplantation</p

sj-jpg-4-cll-10.1177_09636897231198178 – Supplemental material for Haploidentical Natural Killer Cell Therapy as an Adjunct to Stem Cell Transplantation for Treatment of Refractory Acute Myeloid Leukemia

Supplemental material, sj-jpg-4-cll-10.1177_09636897231198178 for Haploidentical Natural Killer Cell Therapy as an Adjunct to Stem Cell Transplantation for Treatment of Refractory Acute Myeloid Leukemia by Uday Kulkarni, Arun Kumar Arunachalam, Hamenth Kumar Palani, Reeshma Radhakrishnan Nair, Nithya Balasundaram, Arvind Venkatraman, Anu Korula, Sushil Selvarajan, Sharon Lionel, Poonkuzhali Balasubramanian, Madhavi Maddali, Aby Abraham, Biju George and Vikram Mathews in Cell Transplantation</p

sj-jpg-3-cll-10.1177_09636897231198178 – Supplemental material for Haploidentical Natural Killer Cell Therapy as an Adjunct to Stem Cell Transplantation for Treatment of Refractory Acute Myeloid Leukemia

Supplemental material, sj-jpg-3-cll-10.1177_09636897231198178 for Haploidentical Natural Killer Cell Therapy as an Adjunct to Stem Cell Transplantation for Treatment of Refractory Acute Myeloid Leukemia by Uday Kulkarni, Arun Kumar Arunachalam, Hamenth Kumar Palani, Reeshma Radhakrishnan Nair, Nithya Balasundaram, Arvind Venkatraman, Anu Korula, Sushil Selvarajan, Sharon Lionel, Poonkuzhali Balasubramanian, Madhavi Maddali, Aby Abraham, Biju George and Vikram Mathews in Cell Transplantation</p