Bone marrow involvement as a rare manifestation of relapsed choroidal melanoma

Choroidal Melanoma is the most common primary intra-ocular malignancy. Incidence of primary choroidal melanoma is about 6 cases per 1 million population. It disseminates hematogenously. The most common site of metastasis is liver. Metastatic melanoma involving the bone marrow is rare, occurring in 5% of patients with disseminated disease. However, Choroid melanoma with bone marrow involvement is very rare. Only a few case reports are published in literature.  Authors present a case of bone marrow metastasis from choroid melanoma in 55 years old female who has been treated for primary choroidal melanoma by enucleation of left eye three years back. In the evaluation of symptomatic anemia, features suggestive of bone marrow infiltration by choroidal melanoma were observed on bone marrow aspiration and biopsy. The diagnosis was confirmed by positivity of immune-histochemistry markers HMB-45 and Melana.

Expression of MUC5AC in normal gastric mucosa, intestinal metaplasia and gastric carcinoma by immunohistochemistry

Background: Carcinomas of the stomach are a heterogeneous group of lesions in terms of architecture, pattern of growth, cell differentiation, and histogenesis. Altered MUC5AC expression patterns have been reported previously in intestinal metaplasia as well as in gastric cancer. The aim of the study was to analyse the expression pattern of MUC5AC in normal, pre-neoplastic and neoplastic gastric epithelium.Methods: Formalin fixed paraffin embedded sections of sixty cases which include twenty cases of each normal gastric mucosa, intestinal metaplasia and gastric carcinoma were taken up for the study and subjected to immunohistochemistry using MUC5AC.Results: The intensity of MUC5AC immunostaining in normal gastric mucosa, intestinal metaplasia and gastric carcinoma was evaluated. Immunoreactivity was graded as 0 (negative), ± (trace positive), + (positive) or ++ (strongly positive). Statistical analysis was performed with Chi-Square test and significant differences were noted between these 3 groups (p value <0.05).Conclusions: Authors concluded that MUC5AC expression rates might be good parameters in progression of intestinal metaplasia to gastric carcinoma and might be a good prognostic marker for gastric carcinoma as it is very well implicated in understanding of gastric carcinogenesis.

Study of expression of PTEN and Cyclin D1 in endometrium at a tertiary care centre

Background: To study the expression of PTEN (Phosphatase and Tensin homologue) and Cyclin D1 in normal, hyperplastic and neoplastic endometrium by immunohistochemistry and to corroborate the interrelationship between PTEN and Cyclin D1 in normal to neoplastic endometrial disorders including endometrial carcinoma.Methods: Formalin fixed paraffin embedded (FFPE) sections of spectrum of endometrium in fifty different cases were taken from secretory phase to endometrial carcinoma and subjected to Immunohistochemistry using PTEN and Cyclin D1 .Results: Immunoreactivity was regarded as positive when brown staining was localized in the nuclei or cytoplasm. The intensity of nuclear staining was graded from 0 to 3+ and the extent was semi quantitatively estimated. If less than 10% of cells were positive a score of 0 was given, 11 % to 30% cell positivity was scored as 1+, 31% to 60 % positivity was scored as 2+ and more than 60% positive cells was labelled as 3+. Statistical analysis was performed with Chi-Square test and significant differences were noted between these 3 groups (p value < 0.05).Conclusions: The present study supports that an inverse correlation exists in the expression of PTEN and Cyclin D1 in normal, hyperplastic and neoplastic endometrium. The decreased PTEN expression is a marker of the earliest endometrial premalignant lesions, and we propose that use of PTEN immunostaining may be informative in identifying premalignant lesions that are likely to progress to carcinoma. Cyclin D1 expression in endometrial glands increases progressively in intensity and extent from normal endometrium to hyperplasia to carcinoma.

Evaluation of pancytopenia on bone marrow aspiration- study at a tertiary care center in Kashmir valley, India

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.

Bone marrow profile in hematological disorders: an experience from a tertiary care centre

Background: Bone marrow aspiration and trephine biopsy are two most important techniques which are complementary for diagnosing both neoplastic and non- neoplastic haematological diseases. The present study was conducted in the department of pathology to compare the role of bone marrow aspirate and trephine biopsy for diagnosing the haematological diseases.Methods: The study was conducted in the department of pathology government medical college Srinagar over a period of 2 years from Feb 2016 to Jan 2018. The study was one-year retrospective and one year prospective. Bone marrow aspiration was done in 626 cases out of which biosy was done in 300 cases.Results: Out of the selected 300 cases were both aspiration and trephine biopsy were available, diagnostic material on bone marrow aspirate was adequate in 288 cases. 12 cases were aparticulate. Biopsy was inadequate in 8 cases. Overall megaloblastic anaemia (26.6%) was most common followed by dual deficiency anemia. Multiple myeloma was the most common neoplastic pathology (13%) followed by followed by acute leukaemia’s (6%) and Chronic lymphoproliferative disorders (CLPDS) (5%). 1 case each of visceral leishmaniasis and malarial parasite were also noted. 4 cases (1.3%) of granulomatous pathology and 2 cases (0.6%) of Hodgkins lymphoma were diagnosed exclusively on bone marrow biopsy.Conclusions: Bone marrow aspiration and biopsy are complimentary to each other in diagnosing hematological disorders with biopsy being gold standard in the assessment of cellularity, pattern, extent of tumor infiltration and focal infiltration. It is more helpful in diagnosing granulomatous pathology and metastatic deposits of tumors eliciting fibrotic response.

Correlation of prothrombin time and activated partial thromboplastin time with serum immunoglobulins in newly diagnosed patients with plasma cell dyscrasias: an experience from tertiary care centre

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.

Intensive care management of organophosphorus poisoning patients: an experience from tertiary care centre

Background: Organophosphate (OP) insectide poisoning results from occupational, accidental and intentional exposure. The mortality rate of OP poisoning is high. Early diagnosis and appropriate treatment is often lifesaving.Methods: This study 揑ntensive care management of organophosphorous poisoning in Govt. medical college Srinagar (Sgr) hospital was a prospective one and was conducted over a period of two. All the patients with a provisional diagnosis of Organophosphorous poisoning who reported to the medical casualty and intensive care unit of SMHS hospital Sgr were included in this study.Results: Out of a total of 1258 Organophosphorous poisoning cases, males were (34.5%) and females were (65.5%). Suicidal mode of poisoning was most common in our patients and constituted 63.20%. Out of 254 Organophosphorous poisoned patients admitted in ICU, 184 survived and 70 expired. Therefore, mortality rate for Organophosphorous poisoned patients who needed mechanical ventilation was 27.55.Conclusions: OP poisoning is a serious problem in Kashmir Valley. Efforts should be directed towards rapid diagnosis and management of this condition. Additionally, close intensive monitoring of these patients for early recognition of respiratory failure which is one of the serious complication of OP poisoning with intensive care support will help in decreasing the mortality rate in these patients.