ABSTRACT
Background: Carcinoma of gall bladder clinically mimics benign gall bladder diseases and often escapes detection untiladvanced stage. Careful attention to any evidence of wall thickening, thorough sampling and close examination of any deeplysituated glandular structures are critical.Aims: To study the clinicopathological pattern of gall bladder malignancies.Materials And Methods: This was a 4 year retrospective study and carried in Department of Pathology, Government MedicalCollege, Srinagar, Kashmir, between January 2015 and December 2018. Our study included 57 cases of gall bladder malignanciesincluding incidental detected cases.Results: During this four year study, a total of 57 patients were studied. Male to female ratio of 0.78:1 was seen. The age ofthe patients ranged from 27-85 years and peak age incidence was seen in sixth decade of life. The most common presentingsymptoms were pain abdomen followed by anorexia and dyspepsia. Grossly evident tumor was seen on initial pathologicexamination in 49 cases (85%) while 8 cases grossly presented no visible tumor (i.e. incidental gall bladder carcinomas havingonly mild wall thickening undetected by imaging).The most common tumor sites were in the body and the fundus of gallbladder.The most common histologic type was adenocarcinoma NOS in 47 cases followed by papillary adenocarcinoma in 2 cases,mucinous adenocarcinoma in 2 cases, primary squamous cell carcinoma in 3 cases, and a single case each of neuroendocrinetumor and adenosquamous carcinoma. Immunohistochemistry was done, wherever needed, for confirmation.Conclusion: GBC is not an uncommon clinical entity in Kashmir valley, unlike western countries. In spite of the advancedimaging techniques, early gall bladder carcinoma is not efficiently detected. Therefore, every gallbladder should be subjectedto routine histopathological examination because with identification of an early gallbladder carcinoma a curative resection maybe possible and these patients have a good long term survival.
ABSTRACT
Background: Pancytopenia refers to combination of anaemia, leukopenia and thrombocytopenia. It may be a manifestation of a wide variety of disorders, which primarily or secondarily affect the bone marrow. However, aetiology of pancytopenia varies from one geographical region to another. Bone marrow aspiration plays an important role in identifying the cause of pancytopenia. This study was carried to identify the causes of pancytopenia and to find out the bone marrow morphology in cases of pancytopenia.Methods: This study was conducted in the department of haematology in a tertiary care center in Kashmir valley for a period of 3 years. Inclusion criteria: cases with hemoglobin less than 10 gm/dl, total leucocyte count of less than 4000/mm3 and platelet count less than 100,000/mm3 were included in the study.Exclusion criteria: Patients receiving chemotherapy/radiotherapy were excluded from the study. Bone marrow aspiration (BMA) was performed from posterior iliac crest of the patients. Bone marrow aspiration smears were stained with Leishman stain for microscopy.Results: A total of 334 cases were studied during a period of 3 years. Age of patients ranged from 1 year to 85 years with mean of 43.59 years.180 cases were male, and 154 cases were female with male:female ratio of 1.2 :1. The commonest cause of pancytopenia was megaloblastic anemia seen in 103 cases (30.8%) followed by dual deficiency anemia seen in 69 cases (20.7%).37 cases (11%) were of acute leukaemia. Aplastic anemia was seen in 35 cases(10.5%). Other causes of pancytopenia were myelodysplastic syndrome, multiple myeloma, iron deficiency anemia and hypersplenism.Conclusions: Bone marrow aspiration in patients of pancytopenia helps in the identification of the underlying cause in most of the cases. BMA is helpful for understanding the disease process; and in planning further investigations and management of cytopenia patients.
ABSTRACT
Background: Plasma cell dyscrasia (PCD) is the term used to describe the disorders characterized by neoplastic proliferation of plasma cells with the abnormal production of immunoglobulins (Ig). Patients with multiple myeloma frequently have abnormal coagulation tests. Aim of the present study were to correlate prothrombin time (PT) and Activated Partial Thromboplastin time (aPTT) with Ig concentrations in patients with newly diagnosed with PCD and to compare PT and aPTT values in untreated and treated patients diagnosed with PCDMethods: This study was conducted in the department of clinical hematology of SKIMS, a tertiary care hospital in northern India from 2015 to 2016. Patients diagnosed with PCD were advised for coagulogram (PT, aPTT) as a base line investigation. A total of 72 patients were included in the study.Results: 37% of multiple myeloma cases (newly diagnosed) and 22% of light chain disease patients presented with prolonged PT whereas none of the patients in treated cases of PCD had prolonged PT. The mean Ig concentration was significantly higher in patients with prolonged PT and aPTT compared to that of patients with normal PT and aPTT values. In IgA myeloma, the mean immunoglobulin concentration was 3643 mg/dL with a mean PT and aPTT values of 18.8s and 36.6 (p value: 0.006). The mean free light chain concentration in kappa (k) light chain myeloma was 1727 mg/L with a mean PT value of 20.5 s, mean aPTT value of 37.4 s (p-value: 0.026).Conclusions: Patients with newly diagnosed myeloma presented with prolonged PT as compared to the treated cases. Also, mean Ig concentration was significantly higher in patients with prolonged PT and aPTT compared to that of patients with normal PT and aPTT values.