Overt Clinical Hypereosinophilia in T- cell Non Hodgkin Lymphoma: A Case Report

The study describes a case of hyper-eosinophilia who was presented with overt manifestation of high eosinophil and detected to have underlying non Hodgkin lymphoma. The male patient was presented with profound weakness and multiple non itchy nodular skin lesion for 2 weeks. Biopsy from skin nodule showed deposits of abnormal lymphocytes. Lymph node biopsy showed effacement with mono nuclear abnormal cells which showed positivity for CD4 and 5, negative for cytokeratin and CD20. He was diagnosed to have T-NHL. [Fig. 3a, Fig. 3b] Bone marrow showed involvement by NHL cells. His diplopia and headache responded to intra-thecal methotrexate and possibly CNS involvement of disease was considered. Family opted out of allopathic treatment plan due to clinical progression. He later died of disease progression. This case illustrates the rare and interesting association of overt clinical hyper-eosinophilia and T NHL. The study suggests that cases with hyper eosinophilia should be evaluated thoroughly for T cell disease.

Disseminated Histoplasmosis in an Immunocompetent Patient from a Non Endemic Region, North India: Pointers to Potential Endemicity.

Progressive Disseminated Histoplasmosis (PDH) reported worldwide is yet a rare entity in India. Although, usually associated with an underlying immunocompromised state but few reports of this disease in non- immunocompetent individuals have been surfacing in last decade. We report PDH from Himalayan state of Uttarakhand North India in an agriculturist, non immunocompromised who responded well to treatment with no evidence of recurrence of the disease. Of late a number of cases are being reported from this region, an indication that this might be a hot spot of Histoplasma capsulatum.

three-year experience of medical thoracoscopy at a tertiary care center of himalayan region

Introduction: Medical thoracoscopy is a minimally invasive procedure for diagnosing and treating pleural diseases. Despite its proven role in diagnostic and therapeutic purposes, it is infrequently used, which could be because of cost of equipment and lack of training. We analyzed our initial 3 years record of thoracoscopy at Himalayan Institute of Medical Sciences, a tertiary care center in Himalayan region of north India

Materials and Methods: This cross-sectional study was to analyze our experience of medical thoracoscopy which was started in Jan 2011 at our center. All patients who underwent thoracoscopy during the period between Jan 2011 to Dec 2013 were included in the study. Thoracoscopy was performed for diagnosis of undiagnosed pleural effusions. Clinical, radiological, cytological and histopathological data of the patients were collected prospectively and analysed

Results: The diagnostic yield for a pleuroscopic pleural biopsy in our study was 87.23% [41/47]. Malignancy was diagnosed histopathologically in 70.2% [33/47] patients [both primary and metastatic pleural carcinoma] and tuberculosis in 10.6% [5/47]. There was no mortality related to procedure. Only three patients had minor complications like subcutaneous emphysema which was mild and resolved by second post-procedure day. Pain at intercostal drain site was observed in some patients

Conclusion: Thoracoscopy is an easy outpatient procedure and an excellent diagnostic tool for pleural effusion of uncertain etiology. It has low complication rate even in settings where the procedure is just started. It should be included in the armamentarium of tools for management of pleural effusion

CLINICO – HISTOPATHOLOGICAL SPECTRUM OF CUTANEOUS VASCULITIS: A RETROSPECTIVE STUDY OF 62 CASES

Context: Cutaneous Vasculitis is the inflammation of vessel walls which leads to hemorrhagic or ischemic events. The histopathological classification of cutaneous vasculitis depends on the vessel size and the dominant immune cell mediating the inflammation. Object: We studied the etiological factors and clinico-pathological spectrum of patients with cutaneous vasculitis at a tertiary referral centre of north India. Design: Skin biopsies of all patients with clinically suspected cutaneous vasculitis presenting over 5 years, between 2009-2014 were reviewed. Cutaneous vasculitis was classified on the basis of etiology (primary or secondary), on the basis of size of vessel wall as well as on the dominant inflammatory cell infiltrating the vessels. Results: Over 5 years, 62 / 103 patients evaluated for vasculitic syndromes had histologically proven vasculitis. Clinically, vasculitis was primary (77.4%) or secondary (22.5%) to drugs, infections, underlying connective tissue diseases and malignancy. Neutrophilic (n=30), lymphocytic (n=18), eosinophilic (n=10), and granulomatous (n=4) vasculitis were the major histopathological groups. Small vessel involvement was seen in 97% cases. Conclusion: Skin biopsy remains the gold standard for diagnosing cutaneous vasculitis. Small vessel vasculitis was the most common type of cutaneous vasculitis with the dominant cell type being neutrophilic. Eosinophilic infiltrate was exclusively associated with primary vasculitis.

Osteolytic lesions of hand and feet: a seven-year experience from a tertiary referral centre of North India

There are 106 bones in hands and feet but their lesions are not commonly reported. This was a retrospective study of all osteolytic lesions involving bones of the hands or feet presenting to the only tertiary referral centre of the north Indian state of Uttarakhand during the 7-year period from January 2006 to December 2012. A compilation of the various demographic, clinical, radiological and histopathological findings was made. Of the 52 lesions encountered in the 7-year record, 75% were asymptomatic. 20 (38.4%) were benign tumours, 20 (38.4%) tumour-like lesions, 9 (17.3%) inflammatory and post traumatic lesions and only 3 (5.7%) were malignant lesions. Giant cell tumour was the most common benign tumour, aneurysmal bone cyst the most common tumour-like lesion and non-specific osteomyelitis was the most common inflammatory and post-traumatic pathology. All phalangeal lesions were non-malignant and 62% were either giant cell tumours or giant cell reactions. Giant cell reaction was confined to upper limb bones; metatarsals were afflicted exclusively with giant cell tumours (n=3) while malignant lesions affected the metacarpals in two and carpal bones in one instance. Aneurysmal bone cysts were seen exclusively in the tarsal (n=4) and carpal bones (n=2), a very rare finding. More cases need to be studied to define patterns of lesions of hands and feet. The definitive diagnosis is essential as many patients with osteolytic lesions may not require surgical intervention.

Lesions of Tongue : A Five Year Experience.

Context: Tongue lesions are quite common and affect both genders and all age groups. However, very few studies concentrate on the histopathological spectrum of tongue lesions, usually including them as a part of oral cavity lesions. No such study has been published from the newly formed state of Uttarakhand. Aim: A retrospective review of histopathology of various types of tongue lesions in different age groups of both genders, amongst cases reported in the department of pathology. Methods and Materials: Study included a total of 121 cases of tongue lesions reported in the histopathology section over a duration of five years, from July 2004 to June 2009. Result: In this study, the most common lesions were malignant (58.7%), followed by benign lesions (33%) and pre-malignant lesions (8.3%). The most common site for tongue lesions was base of tongue (52.8%). Common age groups affected were 41- 50 years (27.2%) and 51-60 years (28.0%). The most common clinical presentation was growth and induration. Overall males were affected more than females; with Male:Female ratio of 3.3:1. Conclusions: The commonest tongue lesion in this study was moderately differentiated squamous cell carcinoma among the malignant lesions whereas chronic inflammation was the commonest out of non-malignant lesions. Tongue may show some less common tumours like schwannoma and hemangioma etc.

Ultrastructure in resolving a diagnosis of poorly differentiated clear cell sarcoma of soft parts in an adolescent male.

Clear cell sarcoma of soft parts is a rare tumor in children and it requires a high index of suspicion for accurate diagnosis. Early diagnosis leads to radical surgical excision and limits the aggressive behavior of this tumor. We report a case of a 12-year-old boy with a recurrent soft-tissue tumor in the scalp, misdiagnosed on three occasions as epitheloid sarcoma owing to the poorly differentiated appearance of cells. In spite of focal S-100 expression, this tumor was not recognized as a tumor of melanocytic origin till melanosomes were demonstrated on electron microscopy (EM). Detection of melanosomes on electron microscopy helped in clinching the histology diagnosis, reiterating the definite role of EM in diagnosing these tumors. Failure to accurately diagnose this tumor resulted in institution of preoperative chemotherapy, delayed surgical excision, tumor progression and death of patient within a year and half of presentation.