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Background: Tuberculosis (TB) disrupts iron balance through systemic inflammation. Pulmonary tuberculosis (PTB) is linked to diverse anaemia types, necessitating intricate haematological and biochemical assessments for diagnosis. This study aims to describe the prevalence of anaemia of chronic disease (ACD), iron deficiency anaemia (IDA) among PTB patients and factors associated with these types of anaemia. Methods: A cross-sectional analysis was conducted from community-based cohort study involving sputum-positive PTB patients from 2018 to 2020 in urban Puducherry. Participants were enrolled from 10 primary health centres within 2 weeks of initiating anti-tubercular treatment (ATT). Blood samples were collected for assessing haematological and biochemical parameters. The sTfR/log ferritin ratio was used to distinguish between ACD and IDA. Data were captured using Epicollect5 and analysed using STATA V14. Result: Of the 176 PTB patients included, 63.07% (111/176) had anaemia, with ACD being the predominant type (84.6%, 94/111). The C-reactive protein (CRP) levels were higher among the anaemic group [40.77 (16.66-58.51) mg/dl vs 24.65 (14.23-47.26) mg/dl] and higher among the ACD as compared to IDA [46.9 (22.3-61.2) vs 20.8 (13.0-39.1) mg/dl]. Undernourished [adjusted prevalence ratio (APR) =3.43; confidence interval (CI): 1.21-9.69] and patients having low risk of dependence on tobacco [APR = 1.52; CI: 1.10-2.11] had higher risk of ACD. Female patients had higher risk of IDA [APR = 4.95, P < 0.01]. Conclusion: The largest proportion of the PTB participants with anaemia had ACD. Acute-phase reactant and inflammatory marker are increased among newly diagnosed new sputum smear-positive (NSP) PTB participants at the start of ATT. Addressing inflammation is needed for combating anaemia in PTB patients.

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.

Background: Advances in automated blood cell counting offer new possibilities to analyse leukocyte differentials by fluorescence RNA/DNA staining combined with scattered light intensity technologies. Aims and Objectives: The purpose of this study is to identify the scatterplot patterns in normal cell counts and various White Blood Cell (WBC) disorders and to assess their efficacy compared to a peripheral blood smear (PBS) in the diagnosis of WBC disorders. Materials and Methods: A three-phased descriptive study analysing a total of 933 EDTA blood samples. The total leucocyte count, differential leucocyte count, scatterplot patterns as obtained by automated cell counter and PBS were studied in 405 normal samples (Phase 1) and 415 samples with WBC abnormalities (Phase 2). In phase 3, the scatterplots of 113 abnormal flagged samples were analysed and provisional diagnosis made in each case which was then compared with the diagnosis on the PBS. Sensitivity, Specificity, Positive and Negative predictive values (PPV & NPV) were calculated. Results: A grid-based standard scatterplot of normal samples was generated as a reference plot in phase one. Based on the scatterplots obtained in known WBC abnormalities studied in phase two, the basic abnormal patterns specific to each of the individual abnormalities were discerned. The phase three study showed excellent correlation between scatterplots and PBS findings in neutrophilia, eosinophilia, lymphocytosis and leukopenia (sensitivity 92-100%, specificity 98-100%). Abnormalities suspected to be leukemia on the scatterplots had a relatively low sensitivity and PPV. Conclusion: WBC scatterplots can be used as a screening tool as it correlates well with various WBC disorders in the PBS.

Metaplastic breast carcinoma (MBC) is a rare malignant neoplasm of the breast which is highly aggressive and is known for its early recurrence and poor prognosis. Concurrent detection of a MBC and tuberculosis of the axillary lymph node is a rarity. To the best of our knowledge, there is no such case report in the literature. A 35-year-old premenopausal woman was diagnosed as a case of left carcinoma breast with a left axillary lymph node. Core-needle biopsy of the breast was suggestive of squamous cell carcinoma. The patient underwent modified radical mastectomy with a latissimus dorsi myocutaneous flap. The postoperative biopsy of the breast and axilla revealed MBC and tuberculous lymphadenitis of the axillary lymph node. The patient received antitubercular therapy and radiotherapy, followed by chemotherapy and had no recurrence on follow-up. This case report emphasizes that metaplastic carcinoma breast can coexist with tuberculous axillary lymphadenopathy.

Leukocytoclastic vasculitis (LCV) is a complex group of conditions which are characterized by vascular damage and neutrophilic infiltrates. LCV in children is usually considered as a part of connective tissue diseases, autoimmune disorders, and primary systemic vasculitis such as systemic lupus erythematosus (SLE) or Henoch–Schonlein purpura (HSP). We herein describe a 9-year-old child with fever, arthritis, diffuse abdominal pain, and palpable purpura over the lower limbs, who was initially diagnosed to have HSP based on the European League Against Rheumatism criteria. He also had thrombocytosis which was attributed to HSP. The skin biopsy showed LCV, providing corroborative evidence of HSP in this setting. Due to severe abdominal pain, prednisolone was prescribed, and resolution of symptoms occurred. There was no hepatosplenomegaly, anemia, polycythemia, or lymphadenopathy at this juncture. On follow-up, however, the thrombocytosis worsened (2000 × 109/L) with appearance of a palpable spleen. Further investigations revealed essential thrombocythemia (ET) as the etiology of LCV in this child. The learning point in this case report is the emphasis on consideration of inclusion of malignancies in the spectrum of LCV in children, besides the usual differential diagnosis such as HSP or SLE, especially when accompanied by worsening thrombocytosis. ET has not been reported in the constellation of malignancies described in association with LCV in the literature.

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.

CD34 and CD79a are markers of hematopoietic stem cell and B-lymphoid cells, respectively. The abnormal expression of these markers in megakaryocytes has been noticed in cases of myelodysplastic syndrome, inherited platelet disorders, and reactive erythrocytosis. As a routine practice, while studying post-induction chemotherapy marrows in acute leukemia, immunomarkers, positive in the initial diagnostic workup, were performed to look for the residual blasts. Interestingly, we noticed CD34 immunopositive megakaryocytes in four such cases. CD79a positive megakaryocytes were also seen in five other cases of post-induction acute lymphoblastic leukemia. All these megakaryocytes, which were regenerating and in clusters, showed both topographic and cytological features of dysmegakaryopoiesis. CD 34 and CD79a, which are often used to monitor residual disease in the post-chemotherapy bone marrow, show aberrant positivity in the megakaryocytes. This novel finding of regenerating megakaryocytes may be used as a feature of dysmegakaryopoiesis in megakaryocytes.

Introduction: The clinical use of blood with regard to cardiac surgeries should be justifiable as it is associated with significant transfusion requirements, and tends to put a great burden on the blood inventory. Storage of red blood cell (RBC) induces various biochemical, biomechanical, and immunological changes that affect red cell viability, deformability, oxygen-carrying capacity, microcirculatory flow, and hence cause various adverse outcomes related to transfusion. Aim of Study: We made an effort to investigate the patterns of usage of allogenic blood products and the effect of volume and storage age of transfused RBCs with morbidity and mortality after cardiac surgery. Methodology: This was a cross-sectional analytical study conducted from January 2016 to June 2017, including all patients undergoing elective open-heart cardiac surgery at a tertiary care hospital. Records were reviewed for the details of blood components issued such as date of collection, date of transfusion, date of expiry and number of units of blood components transfused, details of the surgery, demographic details, postoperative length of stay (PLOS), and complications. Results: A total of 75 patients were included in this study. The majority of the surgeries (60%) were done for rheumatic heart disease. The difference in the transfusion patterns of various blood products with respect to the types of surgery, age or gender was statistically not significant. There was an association between increased PLOS (considered to be >11 days which is the mean) and mean unit age of the transfused packed RBCs (pRBCs) and the difference was statistically significant using the Chi-square test. Conclusion: There is a wide variation in transfusion practices in patients undergoing cardiac surgery. There is no significant association between the number of pRBCs transfusions and postoperative neurological, pulmonary, and other complications when number of pRBCs units ≤4.

Background: Indian Drugs and Cosmetics Act and Rules 1945 states that 1% or 4 units/month of any components prepared and stored should meet specific quality control parameter. Currently, our blood center relies on nonancillary tests such as prothrombin time (PT)/activated PT test for quality check of fresh frozen plasma (FFP). However, the guidelines advice to check the levels of labile coagulation factors, routinely. Aim: This study was conducted to establish coagulation factor assay and assess conditions such as collection, transportation, time of preparation, and storage conditions to assess the level of clotting factors FVIII and fibrinogen in FFP and to identify the association of the levels of clotting factors FVIII and fibrinogen in FFP with its mode of collection and storage. Materials and Methods: A cross-sectional study was carried out delimiting inclusion criteria as the FFP to be prepared from whole blood collected in-house or at outdoor blood collection drives blood with varying duration of storage within 12 months; the exclusion criteria on units that were discarded reasons due to leaking in bags found positive for transfusion transmitted infections. The sample size was calculated based on logistics, budget, and convenient sampling technique. Statistical analysis was carried out using software IBM PASW statistics (SPSS) version 19.0, and independent Student's one-way analysis of variance for levels of statistical significance was considered at P < 0.05 among the parameters such as clotting factors among the different blood groups. Results: There was no significant difference observed on different modes of collection between the levels of FVIII and fibrinogen. However, the difference between FVIII levels with different time-lapse of component processing was statistically significant (P = 0.002). However, regarding fibrinogen such a difference was not a significant difference. Conclusion: Heat-labile factors were maintained as per the DGHS criteria when FFP was prepared within 4 h and stored for 6 months.

Introduction: Information on incidence of various transfusion reactions could help in early recognition as well as management and could also help to institute adequate measures to make blood transfusion as safe as possible. The primary objective of the present study was to determine the frequency and types of adverse transfusion reactions in patients who required blood component transfusion. Methodology: This was a cross-sectional, observational study conducted over a period of 22 months from September 2014 to June 2016 in the Department of Transfusion Medicine, JIPMER. All patients admitted to the wards of various specialty departments who were transfused with blood components and reported to have transfusion reaction during or after transfusion of blood components were included in the study. Results: A total of 90,758 components were issued during the study period, and 137 transfusion reactions were reported which accounted for 0.15% of total transfusions. Febrile nonhemolytic transfusion reaction (46.7%) was the most common reaction followed by allergic reaction (31.3%). Among different blood components, packed red blood cells (82%) were most commonly associated with transfusion reactions. Conclusion: Transfusion reactions unless serious are grossly underreported either due to lack of attributing the adverse event to transfusion or because the milder reactions are usually managed and unreported as the staff are too often used to having them, especially in chronically transfused patients.

Objective: The frequency of bone marrow infiltration by Hodgkin lymphoma is low and varies from 3 to 18%. Hence there exists a dilemma whether bone marrow staging should be done only in the high risk cases. This study aims to study the clinicopathological features and the histomorphology of bone marrow infiltration by Hodgkin Lymphoma. Material and Method: Bone marrow aspirates and biopsies from cases of Hodgkin lymphoma diagnosed between 2007 and 2015 were studied. Immunohistochemistry with CD15 and CD30 were done in necessary cases. Bone marrow infiltration was correlated with various clinicopathological parameters. Results: Ten of the 81 cases (12.3%) studied showed infiltration by Hodgkin lymphoma in the bone marrow biopsy sections. All the aspirates were negative. Bone marrow in the involved cases showed Reed-Sternberg cells and/or mononuclear Hodgkin cells positive for CD30 in a polymorphous inflammatory background. Cases of lymphocyte depleted subtype (66%) and those with leucopenia/ thrombocytopenia (100%) were frequently associated with bone marrow infiltration. B-symptoms, anemia and mixed cellularity were the other risk factors. However none of these risk factors were noted in two out of the ten cases with bone marrow infiltration. Conclusion: As the role of bone marrow aspirate is minimal in the staging of Hodgkin lymphoma, bone marrow biopsy should be the method of choice. Immunohistochemistry helps in the doubtful cases. Bone marrow involvement was frequent but not confined to the high risk groups. Our findings suggest that bone marrow staging should not be restricted to the high risk cases alone.

Introduction: Acute Febrile Illness (AFI) is common in the tropics and caused by diverse pathogens. Dengue, malaria, enteric fever and scrub typhus are few common causes of AFI in India. Peripheral blood smear and complete blood counts are important investigations carried out in the investigation of acute febrile illness. Cell abnormalities in AFI produce unique scatterplot diagrams which may aid in diagnosis. Aim: To differentiate the scatter plot patterns of normal blood samples from those in AFI and to assess whether the abnormal scatter plot patterns (if they exist in AFI) can be used for predicting the common acute febrile illness. Materials and Methods: The descriptive study was conducted in JIPMER for a period of two months on EDTA blood samples of patients reported for complete blood count and peripheral blood smear examination in the haematology laboratory. Consecutive blood samples of patients with acute febrile illness were collected for a two month period and analysed for scatterplot patterns. Controls included samples with normal counts, scatterplots and no history of fever. A total of 323 samples of AFI and 100 control samples were assessed. AFI and control samples were processed in SysmexXT2000i haematological analyser and simultaneous serological and culture investigation was carried out to detect the nature of AFI. Sensitivity and specificity were calculated based on differences between AFI and control blood samples. Results: Out of 323 AFI samples, 158 were bacterial, 2 were of enteric fever, 18 were fungal, 17 were viral, 9 were mycobacterial, 5 were malarial, 1 was helminth, 1 was rickettsial while 139 were serology and culture negative. Negative y-axis monocyte deviation was a common sensitive finding in bacterial (sensitivity0.87), fungal (sensitivity-0.88) and viral aetiology (sensitivity0.82) while neutrophilic leukocytosis was sensitive in bacterial (sensitivity-0.79), fungal (sensitivity-0.78) and mycobacterial aetiology (sensitivity-0.78). Lymphopenia was also found in fungi (sensitivity-0.78). Malaria showed splitting of eosinophils (specificity-0.98), RBC granularity increase (specificity-0.99) and increased neutrophil-eosinophil merge (specificity-0.83). Other common findings included monocytosis, left shift of neutrophils and presence of blue areas in RBC region. Conclusion: Scatterplot patterns obtained from a complete blood count can give a clue in the diagnosis of the aetiologies of acute febrile illnesses.

Composite lymphoma is a rare tumor composed of two or more distinct lymphomas in the same topographic site or tissue. Several combinations of B-cell non-Hodgkin lymphoma (NHL), T-cell NHL, and Hodgkin lymphoma can occur with different prognoses and treatments. The coexistence of a B-cell NHL and a T-cell NHL is unusual. The exact etiology of composite lymphoma is unknown; however, few mechanisms have been proposed to explain its pathogenesis. The chemotherapeutic protocols are heterogeneous but are essentially targeted against the high-grade component. Most of the cases show worse outcome with a median survival of 12 months. In this article, we report a case of composite lymphoma which was initially diagnosed as diffuse large B-cell lymphoma, and the presence of CD3-positive atypical cells in the bone marrow urged us to re-evaluate the lymph node biopsy following which a focus of Alk-1-positive anaplastic large cell lymphoma was identified.

To evaluate the in vivo antitumor activity of cleistanthin B in Ehrlich's ascites carcinoma (EAC) and Dalton's ascites lymphoma (DAL) cell lines induced malignant ascites mouse models and DAL cell line induced solid tumor mouse model. All animals were injected with 2 × 106 EAC/DAL cells i.p./s.c. to induce malignant ascites and solid tumor and treated with 5-fluorouracil (5-FU) 20 mg/kg or cleistanthin B for 10 days. Cleistanthin B was given at three doses viz. 25, 50 and 100 mg/kg. The percentage increase in life span and the overall survival in malignant ascites animals and the tumor volume in solid tumor animals were measured. The haematological parameters were assessed in all animals before and 2 weeks after the treatment. Cleistanthin B 50 mg/kg and 5-FU significantly prolonged the life span (>25%) of malignant ascites tumor bearing animals. The overall survival was significantly improved by both. Only cleistanthin B 50 mg/kg significantly reduced the elevated WBC counts in EAC tumor bearing animals. Both 5-FU and cleistanthin B 50 mg/kg reversed the malignancy induced increase in neutrophils and platelet counts and decrease in lymphocyte counts but not to the normal range. Only 5-FU significantly reduced the solid tumor volume. None of the three doses of cleistanthin B was effective against the solid tumor. Cleistanthin B has antitumor activity against EAC and DAL tumor mice but it is not as effective as 5-FU. At 50 mg/kg dose cleistanthin B exerts significant antitumor activity compared to 25 and 100 mg/kg dose. Its effect on WBC count is higher and advantageous when compared to 5-FU. But cleistanthin B in the doses used is not effective against solid tumor.

With an increase in the use of high dose chemotherapeutic regimens, higher cure rates and longer survival periods of cancer patients, the incidence of secondary malignancies are increasing. Therapy related Myeloid Neoplasm (t-MN) is a second malignancy after chemotherapy/radiotherapy given for a prior malignancy. Of the various t-MN Acute Promyelocytic Leukaemia (APML) as a complication of chemo-radiotherapy is very rare. We report a rare case of therapy related APML in a breast cancer survivor.

Introduction: Nodal Peripheral T-Cell Lymphomas (NPTCL) are a rare and heterogeneous group of lymphomas seen to occur more often in Asian, including South Indian population. They have an overall poor prognosis. Aim: To document the varied spectrum of clinico-radiological, histopathological and follow-up parameters of NPTCL. Materials and Methods: This descriptive cohort study involved clinical, histopathological and haematological workup of NPTCL cases diagnosed from January 2008 to June 2013 in JIPMER, Puducherry, India. The cases were diagnosed as per World Health Organisation (WHO) 2008 classification. Results: NPTCL accounted for 25% of all Non-Hodgkin Lymphomas (80 cases). Peripheral T-cell Lymphoma-not otherwise specified (PTCL-NOS), Anaplastic Large Cell Lymphoma, ALK-positive (ALCL, ALK+), Anaplastic large cell lymphoma, ALK-negative (ALCL, ALK-) and Angioimmunoblastic Lymphoma (AITL) contributed to 51%, 29%, 10% and 10% of the cases respectively. A majority of patients (68%) had generalised lymphadenopathy, 26% had hepatosplenomegaly and 38% had marrow infiltration. Histomorphology showed wide variation within and in between the subgroups. Overall, necrosis, fibrosis and high mitosis were more common in ALCL while increased vascularity was seen prominently in AITL. At least 70% of the cases in each entity had advanced stage of disease. Conclusion: There is a three-fold increase in incidence of NPTCL lymphomas in JIPMER compared to WHO (2008). Most patients presented with advanced stage and in sixth decade, except ALCL. There was wide histomorphological variability among these cases. Awareness of the entity and its histopathological heterogeneity would be worthwhile in arriving at a conclusive diagnosis.

Introduction: Biliary Atresia (BA) and Neonatal Hepatitis (NH) are common causes of Neonatal Cholestasis (NC). There is a high degree of overlap between clinical and other investigational characteristics of BA and NH. Aim: To study the histopathological features of liver biopsies in cases of NC syndromes and to apply a histopathological scoring system in differentiating BA from other causes of NC. Materials and Methods: This study included 51 cases of NC (BA=25, NH=26) from Jan 2010 to June 2014. A scoring system, devised by Lee WS and Looi LM was applied to all the cases. Clinical, biochemical, Hepatobiliary scan (HIDA scan) and Peroperative Cholangiogram (POC) details of all the patients were collected. Results: Liver biopsy showed moderate to marked bile ductular proliferation in 24 (96%), bile plugging in 13 (52%), portal expansion in >50% of portal tracts in 19 (76%) and moderate/ severe lymphocytic infiltration in 15 (60%) cases of BA. Diffuse giant cell transformation and hepatocytic swelling were present in 19 (73%) and 22 (85%), respectively of NH. Score of ≥7 was helpful in differentiating BA from NH with 92% sensitivity and 96% specificity. Non-excretion of dye in the HIDA scan had 91% sensitivity and 65% specificity for the score of ≥7 which favoured the diagnosis of BA. POC was taken as the gold standard. Conclusion: A detailed histomorphology of liver biopsy along with a Lee and Looi score of ≥7 was helpful in differentiating BA from NH.

Introduction: Primary extranodal lymphoma (pENL) refers to group of disorders arising from tissues other than lymph nodes and even from sites, which normally do not contain lymphoid tissue. This study was undertaken to ascertain the prevalence, anatomical distribution, and histological subtypes of extranodal non-Hodgkin lymphoma (NHL) from a tertiary care institute in Southern India. Materials and Methods: This was a cross-sectional study conducted in the Department of Pathology over a period of 3-years. Detailed clinical history, routine complete blood count, microbiological status was obtained from the medical records. Hamatoxylin and eosin slides were reviewed and immunohistochemistry was performed using a panel of antibodies depending on the morphology. All cases were classified based upon morphologic and immunophenotypic criteria according to World Health Organization 2008 classification. Results: Primary extranodal NHL constituting 22.6% (68/300) of all NHL and the majority of patients were from higher age group with peak incidence seen in fourth to fifth decade of life. In the pediatric population, the most common site is ileo-caecal region (42.8%) and the most common morphology is lymphoblastic lymphoma (42.8%). Similarly in the adult population head and neck was the most common site constituting 36% and diffuse large B-cell lymphoma is the most common morphological subtype comprising 54% of all extranodal lymphomas. Conclusion: Although the reported incidence of pENL is low in India compared to other parts of the world, the possibility of pENL should always be kept in mind even though it arises in an extranodal site.

Gelatinous marrow transformation (GMT) or serous atrophy of bone marrow (BM) is a rare disease characterised by focal marrow hypoplasia, fat atrophy, and accumulation of extracellular mucopolysaccharides abundant in hyaluronic acid. This study reviews 11 cases of GMT from South India. Clinical and haematological parameters, BM aspirate, and biopsies of all patients diagnosed with GMT over a period of 7 years were studied. GMT was diagnosed in BM biopsy based on characteristic morphological appearance and was confirmed by alcian blue positive staining pattern at pH levels of 2.5 and 0.5. Eleven patients were diagnosed with GMT. All were males within the age range of 15 to 50 years. The underlying clinical diagnosis was human immunodeficiency virus positivity in 5 cases, 2 with coexistent disseminated tuberculosis, 1 with cryptococcal meningitis, and 1 with oral candidiasis; disseminated tuberculosis in 1 case; pyrexia of unknown origin in 2 cases; Hodgkin's lymphoma in 1 case; acute lymphoblastic lymphoma with maintenance chemotherapy in 1 case; and alcoholic pancreatitis in 1 case. BM aspirates showed gelatinous metachromatic seromucinous material in 3 cases. BM biopsies were hypocellular in 7 and normocellular in 4 cases and showed focal GMT in 5 and diffuse GMT in 6 cases. Reactive changes were seen in 4 cases and haemophagocytosis in addition to GMT in 1 case. GMT is a relatively uncommon condition and an indicator of severe illness. It should be differentiated from myelonecrosis, amyloidosis, and marrow oedema. A high index of suspicion is required to diagnose this condition.

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

Plasma cell leukemia (PCL) is a rare lymphoproliferative disorder characterized by a malignant proliferation of plasma cells (PC) in blood and marrow. Cutaneous involvement is very rare in PCL. We present the case of a 45-year-old lady who presented with multiple hemorrhagic nodules and plaques in the skin. Her total leucocyte count was 2,00,200/cmm with 85% abnormal plasmacytoid cells in peripheral smear. Biopsy of the skin lesions revealed diffuse infiltration by plasma cells with 'choked' blood vessels. A diagnosis of plasma cell leukemia with cutaneous involvement was made. On the second day of admission, the patient expired probably because of intracranial bleed due to thrombocytopenia. Post-mortem bone marrow and liver biopsy also showed diffuse infiltration by plasma cells. Monoclonality of the cells was proven by demonstrating the production of only kappa light chains.

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.

Introduction: Hemophagocytic lymphohistiocytosis (HLH) is a rare syndrome of immune dysregulation. It is characterized by hypercytokinemia and macrophage activation resulting in fever, cytopenia, splenomegaly and hyperferritinemia leading to fatal outcomes if untreated. Aim: To study clinical profile, diagnostic and etiological workup, treatment and prognosis of hemophagocytic lymphohistiocytosis patients. Materials and Methods: We report retrospective analysis of 8 cases of adult and adolescent HLH admitted over a period of 2 years at JIPMER, a tertiary care centre in South India. Results: Mean age of patients was 27 year (range 13 to 57 years) and 3 were adolescents. Median duration of symptoms was 10 days (5-60 days). Common presenting symptoms were fever, jaundice, abdominal pain, rash and seizures. Physical findings included pallor, icterus, splenomegaly, hepatomegaly and lymphadenopathy. Laboratory findings were variable cytopenia with pancytopenia in 65% cases, hyperferritinemia (100%), hypertriglyceridimia (75%) and elevated serum bilirubin (62.5%) and liver enzymes (87.5%). Underlying cause could be detected in only 6 patients with one each of dengue fever, lymphoma, tuberculosis, EBV infection, scrub typhus and juvenile idiopathic arthritis. Median overall survival at the end of 1.5 years was 62%. Conclusion: Low threshold for suspicion, adequate evaluation and timely treatment can improve outcome in patients of HLH.

Aims: Lymphadenopathy is a common clinical problem and biopsies undertaken to determine the cause of nodal enlargement may be neoplastic or non-neoplastic. The former are mainly lymphohematogenous malignancies and metastases while the causes of non-neoplastic lymphadenopathy are varied. This study was undertaken to determine the histopathological spectrum of lymphadenectomies. Materials and Methods: This was a descriptive cross-sectional study wherein 1010 cases of histologically diagnosed peripheral lymph node biopsies in the Department of Pathology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry from January 2007 to June 2012 were reviewed. Surgical resection specimens with lymph node dissection were excluded from the study. Results: Neoplastic lesions were more common comprising 53% (535 cases) and included 32.1% (324 cases) of non-Hodgkin lymphoma, 12.4% (125 cases) of Hodgkin lymphoma and 8.5% (86 cases) of metastatic lesions. The non-neoplastic lesions were 47% (475 cases), which included 21.6% (218 cases) of non-specific reactive lymphoid hyperplasia, 6.8% (69 cases) of other reactive or specific lymphoid hyperplasia, 18% (182 cases) of tuberculous lymphadenitis, 0.6% (6 cases) of other granulomatous lesions. Conclusions: Lymph node biopsy plays an important role in establishing the cause of lymphadenopathy. Among the biopsied nodes, lymphomas were the most common (44.5%) followed by non-specific reactive hyperplasia (21.6%), tuberculous lymphadenitis (18%) and metastasis (8.5%).

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.

Introduction Follicular lymphoma (FL) is an indolent chronic lymphoproliferative disorder of B-cells with variable clinical behaviour. It is the second most common subtype of Non-Hodgkin lymphoma in western countries but reported to have a lower incidence in Asia. Materials and methods Cases of FL diagnosed in the Department of Pathology of our Institute from January 2009 to June 2015 were included in the study. The clinicopathological parameters including staging, histological details and immunohistochemical markers CD20, CD10, Bcl2 and Ki67 were recorded in all the cases. Results Of the 497 cases of Non-Hodgkin Lymphoma reported during the study period, 36 (7.2%) cases were follicular lymphoma. The mean age was 50 years with male to female ratio of 3.2:1. Grade 1/ 2 was seen in 70% cases. 22 % cases had low grade with high proliferation index (Ki67 > 40%). Granulomatous response was seen in two cases. Diffuse large cell lymphoma component was present in four cases. Bone marrow involvement and peripheral blood spill was seen in 12 (37.5%) and six cases (18.8%) respectively. 72% cases were in stage 3 or 4. Conclusion Incidence of FL was lower in our study than other Indian studies. FL presented in the elderly, with male predominance and disseminated stage. Features of low grade with high proliferation index, granulomatous response, leukemic involvement and transformation to high grade lymphoma are highlighted in the study.

Introduction: Cerebral Venous Thrombosis (CVT) is a well known disease with diverse clinical presentation and causes. With advances in neuroimaging and changing lifestyles, the clinical profile and causes of CVT are changing. D-dimer has been studied in early diagnosis of CVT with variable results. This prospective study was carried out to assess the clinical profile of CVT and role of D-dimer in diagnosis of CVT. Aim: To study various aspects of CVT and role of D-dimer. Materials and Methods: The study period was September 2012 to July 2014 and included 80 imaging proven patients of CVT. We also included 39 controls for assessing D-dimer. Data was collected according to a preformed format. D-dimer was assessed by a rapid semi-quantitative latex agglutination assay. Discharged patients were followed up to six months. Results: Of the total 44 were women and 36 were men (F: M=1.2:1). The mean age of the patients was 29.5±9.68 years. Most common clinical features were headache 77 (96.25%), papilloedema (67.5%) and seizures 51 (63.75%). Pregnancy was the most common cause of CVT. Superior sagittal and transverse sinuses were the most common sinuses to be affected. The sensitivity and specificity of D-dimer for diagnosing CVT was 84.62% and 80% respectively. The risk factors for poor prognosis were altered sensorium, presence of sepsis, increased sinus involvement and deep sinus thrombosis. Conclusion: CVT affects both sexes equally. Puerperium still contributes to majority of the cases. Iron deficiency anaemia needs to be evaluated as a contributing factor for incidence of CVT. D-dimer is not useful in puerperal female with CVT. Positive D-dimer will strengthen the suspicion of CVT in patients with acute headache followed by a neurological deficit.

Introduction: Chediak-Higashi syndrome (CHS) is a rare autosomal recessive disorder characterized by partial ocular and cutaneous albinism, increased susceptibility to pyogenic infections, the presence of large lysosomal-like organelles in most granule-containing cells and a bleeding tendency. The abnormal granules are most readily seen in blood and marrow leukocytes, especially granulocytes; and in melanocytes. Other clinical features include silvery hair, photophobia, horizontal and rotatory nystagmus and hepatosplenomegaly. Materials and Methods: The clinico-hematological profile of a series of 5 cases of CHS encountered at JIPMER Hospital with diagnostic work-up done in the Department of Pathology over the last 6 years is presented. The diagnostic work-up included complete hemogram with peripheral smear, bone marrow examination, skin and liver biopsies. Results: The age of the patients ranged from 5 months to 3 years. All patients had silvery hair and partial albinism and presented with fever and recurrent chest infection. Two patients were stable. Three patients were in accelerated phase; of them, 1 patient with associated hemophagocytic syndrome had a rapidly fulminant course. Peripheral blood smear showed anomalously large granules in the leukocytes. Skin biopsy showed sparse, coarse melanin pigment in the epidermis, and liver biopsy done in 2 patients with accelerated phase showed portal lymphohistiocytic aggregates. Conclusions: The diagnostic hallmark of CHS is the occurrence of giant inclusion bodies (granules) in the peripheral leukocyte and their bone marrow precursors. The case series is being presented because of the rarity of CHS and varied spectrum of clinical and hematological presentation.

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.

Genital seborrheic keratosis (SK) is a rare entity, which can be easily misdiagnosed as genital warts. Dermoscopy is a useful tool to make diagnosis of SK in such cases. We report a 50-year-old woman with a large polypoidal growth on the external genitalia. Dermoscopic examination showed fissures and ridges, cerebriform appearance, and comedo-like openings consistent with SK. The histopathology confirmed the diagnosis of SK.

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.

Backgorund: Angiogenesis is associated with growth, dissemination and metastasis of tumours. Measurement of Microvascular Density (MVD) is a quantitative method of assessment of angiogenesis and would give a proportional co relate of the angiogenic process in tumours. The aim of this study is to measure the MVD by using CD34 staining in various phases of Chronic Myeloid Leukemia (CML) and type of CML (Granulocytic/Granulocytic Megakaryocytic) (G/GM) and to co-relate micro vascular densities with the grade of fibrosis. Materials and Methods: Bone marrow biopsy specimens of 30 CML patients and 20 non-CML (controls) cases that required bone marrow biopsy were subjected to CD34 staining and H&E staining. The mean MVD in CD34 slides was assessed by selecting hot spots and MVD was measured in these fields in high power (40 x magnification) and the mean MVD was calculated by taking the average of four hot spots per field. Grade of fibrosis and phase of CML, type (G/GM) were assessed in H&E slides. The controls were matched with respect to age and gender. Results: Among 30 patients with CML, 21 were in chronic phase, five in accelerated and four in blast crisis. A normal distribution was obtained for MVD of both CML cases and controls using tests for normality. Comparison of mean MVD between CML and controls by student t-test showed a significant increase in MVD of CML cases (p = 0.00026). However, no significant difference in MVD between the three phases viz, Chronic, accelerated and blast crisis phase (p = 0.302) was obtained by using one way ANOVA. Comparison of Grade of fibrosis with MVD using independent t-test showed no significant difference in MVD between low (Grade1&2) and high grade (Grade 3&4) (p = 0.805). No significant difference in MVD was obtained between G and GM types of CML using independent t-test (p =0.381). Conclusion: The study shows that there is a significant increase in MVD in CML cases than controls but no significant difference in MVD could be demonstrated between different phases of CML, histological types of CML and grades of fibrosis in CML.

Silicosis is an occupational lung disease caused by inhalation of crystalline silica. People working in occupations like sandblasting, surface drilling, tunneling, silica flour milling, ceramic making, and so forth are predisposed to develop silicosis. Crystalline forms of silica are more fibrogenic than the amorphous forms, highlighting the importance of the physical form in pathogenesis. Lung biopsy is rarely performed for the diagnosis of silicosis as it can easily be detected by occupational history and radiological features. Patients with silicosis can develop complications like tuberculosis, lung cancer, progressive massive fibrosis, cor pulmonale, broncholithiasis, or tracheobronchial compression by lymph nodes. Pleural involvement in silicosis is rare. Spontaneous pneumothorax is a pleural complication that can develop in such patients. Usually in silicosis pneumothorax is unilateral. We hereby report the lung biopsy findings and discuss the mechanism of pneumothorax development in a case of chronic silicosis who, later on died during the course of the disease.

Epidermal nevus syndromes are rare conditions, characterized by different types of keratinocytic or organoid epidermal nevi in association with ocular, neurological, and skeletal manifestations. We present a case of late onset epidermal nevus with hypertrichosis and hemihypertrophy of face. Genetic analysis did not reveal presence of FGFR3 or PIK3CA mutations. The patient has features that cannot be categorized into the present well-known syndromes.