Prognostic Information From Chemotherapy–Associated Changes In Bone Marrow Metastasis Of Neuroblastoma– A Case Report

Neuroblastoma is the most common extra–cranial solid tumour in children. Bone marrow examination is a part of diagnosis and staging workup of neuroblastoma. Chemotherapy forms mainstay of treatment and post–chemotherapy histological changes are an important indicator of prognosis. A 4–year–old male child came with complaints of fever and hepatomegaly. Investigations revealed a retroperitoneal neuroblastoma. Bone marrow was involved by neuroblasts (stage 4S). Platinum–based chemotherapy was started and post–induction phase bone marrow showed differentiation of neuroblasts to ganglion cells and schwannian stroma (tumour load <5%, minimal disease). The patient was lost to follow up thereafter. The patient returned after one year with the reappearance of neuroblasts (tumour load >20%, relapse) in the bone marrow. Use of immunohistochemical markers like chromogranin and S100 are helpful to map the tumour load and identify the tumour cells when they are sparse. Persistence / reappearance of neuroblasts post–chemotherapy or increasing tumour load indicate a relapse.

Intravascular Large B-cell Lymphoma – Morphological Diagnosis in the Molecular Era

Intravascular large B-cell lymphoma (IVLBCL) is a rare variant of diffuse large B-cell lymphoma, characterized by its unique morphology. Modern-day diagnostic methods like flow cytometry have limitations in accurate diagnosis of the disease making morphology the mainstay for its diagnosis and adequate management. Here, we present a case of IVLBCL with emphasis on diagnostic aids and adjuncts. A 63-year-old female presented with fever of unknown origin, seizers, hepatosplenomegaly, and peripheral cytopenias. Bone marrow aspirate shows a small number of atypical lymphoid cells. Flow cytometry done on the aspirate yielded 7% abnormal lymphoid cells; however, further, subclassification of this non-Hodgkin lymphoma was not aided by it. Bone marrow biopsy revealed the intrasinusoidal localization of the tumor cells, which were positive for CD20, BCL2, and Mum1 and along with flow cytometric expression of CD5 and lambda restriction of tumor cells; a diagnosis of IVLBCL was made. IVLBCL is a rare entity with protean clinical presentation which frequently leads to a delay in diagnosis. Modern diagnostic modalities like flow cytometry help in picking up even a small number of tumor cells; however, it is limited by failure to subcategorize the entity making morphology and immunohistochemistry as the backbone of its diagnostic workup.

Chronic myeloid leukemia with hyperdiploidy: A case report with review of literature.

Chronic myeloid leukemia (CML) is a common marrow stem cell neoplasm characterized by the presence of the Philadelphia (Ph) chromosome in more than 90% of patients. Studies have shown that CML can be associated with various other cytogenetic abnormalities. 5-10% of these cases can show complex translocations involving other chromosomes in addition to Ph chromosome. Here, we report a Ph-positive CML patient with a hyperdiploid karyotype who presented clinically in chronic phase but progressed to blast crisis in spite of treatment with Imatinib. This case highlights the significance of cytogenetic abnormalities on the prognosis in CML.