Bone marrow aspiration in haematological disorders: study at a tertiary care centre

Background: The bone marrow examination is an essential investigation for the diagnosis and management of many disorders of the blood and bone marrow. Bone marrow aspiration (BMA) alone is usually sufficient to diagnose nutritional anaemias, and most of the acute leukaemias. Aim was to study the spectrum of haematological disorders diagnosed on bone marrow aspiration.Methods: This study was conducted in the Department of Clinical Haematology in Sher e Kashmir Institute of Medical Sciences, Kashmir for a period of 2 years from December 2015 to December 2017. Bone marrow examination of 2131 cases of suspected hematological disorders was carried out. Bone marrow was aspirated from posterior superior iliac spine under local anaesthesia. Aspirates of dry tap were excluded from the study. Aspiration smears where stained with Leishmann stain for morphological examination.Results: A total of 2131 cases were included in this study. Male to female ratio in our study was 1.9:1. The age range of cases was from 1-80 years and the mean age was 47.3 years. Anemia was the most common haematological disorder in our study accounting for 25.6% of cases followed by acute leukaemia accounting for 22.3% and multiple myeloma (13.3%). Among anemias, megaloblastic anemia was most common followed by dual deficieny anemia. Among leukaemias, acute myeloid leukaemia (13.2%) was more common than acute lymphoblastic leukaemia (9.1%).Conclusions: Bone marrow aspiration cytology is a mildly invasive technique which can diagnose many hematological and non-hematologic diseases that can be confirmed by more advanced investigations viz. serological, biochemical or molecular. It is a highly informative test procedure performed for evaluating blood and blood related diseases in our environment

Human Epidermal Growth Factor Receptor 2 (HER2) as Surrogate Prognostic Marker in Gastric and Gastro Esophageal Junction Cancer

Background: HER2 is an important biomarker in gastric and gastroesophageal junction tumors. Expression of HER2 status by immunohistochemistry is heterogeneous in various patient populations. This overexpression appears to be an important prognostic factor in gastric cancer and its association with other poor prognostic factors may therefore act as a surrogate marker for poor prognosis in gastric carcinoma. We studied our patient population to look for any such association between HER2 status and various clinicopathological parameters. Objective: To study the association between HER2 status and various clinicopathological parameters. Methods: Patients were prospectively enrolled from August 2013 to March 2015. All relevant patient parameters were recorded. After curative resection, surgical specimens of gastric and gastroesophageal junction adenocarcinoma were analyzed for immunohistochemistry for HER2 by using standard methods. IHC score followed Hofmann's criteria. Statistical analysis of relation between HER2 status and relevant patient and disease characteristics such as gender, age at diagnosis, tumor location, histological type of tumor, stage, and size of tumor, was performed. Results: 106 patients were enrolled into this study. Only 18 (17%) cases had HER2 score of 3+, whereas 5 (4.7%) had equivocal score (2+) and the remaining 84 (78%) tumors tested negative. HER2 status was significantly associated with location of primary tumor, gender, histopathological type of cancer, and size of primary tumor. There was no significant relation between HER2 status and age of patient, depth of invasion, nodal metastasis, or overall stage. Conclusion: Further studies are necessary to determine the significance of HER2 status in upper gastrointestinal cancers especially that the patients need follow up where we can predict the HER2 status as an independent prognostic factor for overall survival

Pattern of Bone Marrow Involvement in B-cell Non-Hodgkin’s Lymphoma - Experience from a Tertiary Care Center in North India

Background: Bone marrow (BM) examination is an important investigation for staging or primary diagnosis of malignant lymphomas. The frequency of BM infiltration by lymphoma is quite variable. There are limited data available from developing countries on the pattern of BM involvement in patients of non-Hodgkin’s lymphoma (NHL). The aim of this study was to see the pattern of BM involvement by B-Cell NHL from a Tertiary Care Hospital in North India. Materials and Methods: All cases of B-cell NHL with BM involvement were included in this study. Peripheral blood smear, BM aspiration, and biopsy were performed for diagnosis and staging in all patients. Results: A total of 43 patients were diagnosed as B-cell NHL on BM aspiration and biopsy. The median age of our patients was 54.26 ± 15.07 years with a male: female ratio of 2.9:1. Twenty-four were indolent B-cell NHL cases and 19 patients had aggressive B-cell NHL. Indolent lymphomas such as SLL/CLL, MCL, FL, and marginal zone lymphoma are more common compared to aggressive NHL such as DLBCL and Burkitt’s lymphoma. Indolent lymphoma was more common in females than males (37.5% vs. 10.5%). The classical B-symptoms were present in 32.6% (n = 14). The BM was hypercellular in 62.8% of cases (n = 27) and cellular in 14% (n = 6). The pattern of BM biopsy involvement was diffuse in 65.1% (n = 28), interstitial in 23.3% (n = 10), and nodular in 11.6% (n = 5). Diffuse involvement of marrow was more frequent than nodular in aggressive lymphomas compared to indolent ones. Conclusions: In patients with B-cell NHL, BM involvement is more common in the indolent disease. The pattern of diffuse marrow involvement is more common in our region

Glioblastoma Multiforme: Five-year Experience at a Tertiary Cancer Centre in North India

Background: Glioblastoma Multiforme (GBM) is one of the most common brain tumors. Despite multimodal treatment with surgery and chemoradiotherapy, survival outcome remains bleak. Many patients do not tolerate and complete such aggressive treatment. Our Center is the largest tertiary care referral hospital in the region; we report our findings about 5-year outcome in these patients. Methods: From January 2014 to December 2018, we conducted a retrospective observational study. We included patients with histopathologically proven diagnosis of GBM. Descriptive statistics of patient data was retrieved from patient files at Hospital Based Cancer Registry (HBCR) at our State Cancer Institute (SCI). All the data was recorded and analyzed using appropriate statistical methods. Results: 54 histopathologically proven cases of GBM were enrolled. Most patients were in the fifth and sixth decade of life, with a male to female ratio of 2:1. Headache was the most common presenting symptom in 23 (42.5%) patients followed by seizures in 13 (24%) patients. The average lesion size was 4.7 cm. Gross total excision was done in 12 (22%) patients, near total excision in 8 (15%) patients. 48 (89%) patients received radiation therapy concurrent with temozolomide. 4 (7.4%) patients had complete response with chemoradiotherapy. Median survival was 16 months. Patients who underwent Gross total excision or near total excision had a median survival of 15.9±3.56 months, whereas patients who underwent subtotal excision had a median survival of 8.29±4.14 months. Patients who completed trimodality therapy had better survival. Conclusion: Patients receiving trimodality therapy with gross total excision and adjuvant chemoradiation achieve best survival rates. Advanced age, poor performance score, larger tumor size, deep seated lesions, suboptimal tumor excision, and steroid dependency carry poor prognosis