Optimal panel of immunohistochemistry for the diagnosis of B-cell non-Hodgkin lymphoma using bone marrow biopsy: a tertiary care center study

Background@#Morphological diagnosis of non-Hodgkin lymphoma (NHL) is usually based on lymph node biopsy. Bone marrow biopsy (BMB) is important for staging, and morphology alone can be challenging for subtyping. Immunohistochemistry (IHC) allows a more precise diagnosis and characterization of NHL using monoclonal antibodies. However, there is a need for a minimal panel that can provide maximum information at an affordable cost. @*Methods@#All newly diagnosed cases of B-cell NHL with bone marrow infiltration between 2017 and 2019 were included. BMB was the primary procedure for diagnosing B-cell NHL. Subtyping of lymphomas was performed by immunophenotyping using a panel of monoclonal antibodies on IHC. The primary diagnostic panel of antibodies for B-cell NHL included CD19, CD20, CD79, CD5, CD23, CD10, Kappa, and Lambda. The extended panel of antibodies for further subtyping included CD30, CD45, CD56, Cyclin D1, BCL2, and BCL6. @*Results@#All cases of B-cell NHL were classified into the chronic lymphocytic leukemia (CLL) and non-CLL groups based on morphology and primary IHC panel. In the CLL group, the most significant findings were CD5 expression, CD23 expression, dim CD79 expression, and weak surface immunoglobulin (Ig) positivity. In the non-CLL group, they were CD5 expression, positive or negative CD23 expression, strong CD79 expression, and strong surface Ig expression. An extended panel was used for further subtyping of non-CLL cases, which comprised CD10, Cyclin D1, BCL2, and BCL6. @*Conclusion@#We propose a two-tier approach for immunophenotypic analysis of newly diagnosed B-cell NHL cases with a minimum primary panel including CD5, CD23, CD79, Kappa, and Lambda for differentiation into CLLon-CLL group and Kappa and Lambda for clonality assessment. An extended panel may be used wherever required for further subtyping of non-CLL.

Chordee without hypospadias: operative classification and its management

Developing countries. To propose a operative classification of Chordee without hypospadias [CWH] with its management. Tertiary referral centre; Retrospective study from January 2000 to January 2011. Total 26 patients were classified peroperatively into sixtypes [A: Cutaneous chordee[rightwards arrow] Degloving skin and dartos [1/26]; B: Fibrous chordee[rightwards arrow] chordectomy [4/26];C: Corporocavernosalchordee[rightwards arrow] Corporoplasty +/- Urethral mobilization [4/26]; D: Urethral tethering with Hypoplastic urethra[rightwards arrow]Urethral mobilization +/- urethral reconstruction because of hypoplastic urethra [14/26]; E: Congenital short urethra[rightwards arrow] excision of urethra from the meatus and urethroplasty [2/26]; and F: Complex chordee[rightwards arrow] Degloving +/- Corporoplasty +/- urethroplasty [1/26 patients].The follow-up over 6 months to 9 years were analyzed. SPSS soft ware version 17.0 for Windows. The mean age of surgery was 5.33 +/- ?0.11 years. The success rate defined on uroflowmetry and voiding cystourethrography was 65.6%. The coronal urethra-cutaneous fistula developed in 26.9% [7/26] [including 7.7% [3/26] of associated metal stenosis]. The urethral stricture developed in 3.8% [1/26]. CWH needs stepwise surgical management. The operative classification may help in better understanding and management of this difficult entity. Meticulous tissue handling and urethroplasty is needed for good and promising results

Primary hepatic tuberculosis: a rare but fatal clinical entity if undiagnosed

Hepatic tuberculosis particularly in the absence of military tuberculosis is rare. It can occur as a primary case or due to reactivation of an old tubercular focus. We report case of a 24 year old married female who died of primary hepatic tuberculosis. She had no evidence of tuberculosis elsewhere. Appropriate treatment initiated early can result in marked recovery whereas failure to recognize this entity can prove to be fatal.

Massive diffuse intraperitoneal multicystic mass in an infant

An 18-month-old boy was referred for painless progressively increasing abdominal distension, poor oral intake, and lethargy since 1 year. There was no history of fever, hematurea, or intestinal obstruction. The child was pale and had a pulse rate of 150 beats/min. The child had mild respiratory distress due to huge abdominal distension. The abdomen was tense and nontender. There was no evidence of intraperitoneal free fluid or any definitive lump. The hemogram showed anemia, other blood biochemistry test results were normal. Ultrasonography of the abdomen suggested the possibility of encysted ascites. A 64-slice contrast-enhanced computed tomography of abdomen showed diffuse intraperitoneal multicystic mass, composed of variable sizes and wall thickness cysts [Figure 1]. The definitive organ of origin could not be identified. Bowel loops were displaced upward by the mass. Diagnostic laparoscopy showed a pale, soft, extremely friable mass composed of cysts of variable sizes arising from the dome of the bladder. The cysts were noncommunicating and had no fluid. The mass was loosely adhered to the bowel, liver, and peritoneum. The rest of the abdominal organs were normal. Complementary cystoscopy was performed to rule out intraluminal extension of tumor, which was normal

Megaesophagus in the pediatric age group: a diagnostic dilemma

A 5-year-old boy weighing 8 kg presented with recurrent pulmonary infections, occasional nonbilious vomiting, intermittent cough, and failure to thrive since birth. On physical examination, vital signs were normal, but on auscultation left-sided fine crackles were found. The child was anemic, other blood biochemistry levels were within the normal range. A chest X-ray and computed tomography [CT] revealed bronchiectasis localized to the left hemithorax and a radiolucent air column within a distended esophagus. Other causes of chronic pulmonary diseases, such as cystic fibrosis, congenital immune deficiencies and primary ciliary dyskinesia were excluded. A barium swallow demonstrated a dilated esophagus with an air-fluid level and sudden narrowing at the distal end [Figure 1]. Esophageal manometry showed uncoordinated, low-amplitude peristalsis of the esophageal body and the lower sphincter pressure was normal

Isolated tuberculous splenic abscess in an immunocompetent individual

Tuberculosis (TB) of the spleen is an extremely rare clinical entity particularly among immunocompetent persons. We report a case of isolated tuberculous abscess of spleen in a 13- years- old boy. No primary focus of infection was detected in lungs or any other organ. The patient was treated by splenectomy after a therapeutic failure with standard antituberculous medication.

Oral cysticercosis-a rare presentation

Cysticercosis is a condition that occurs when man is infected with larvae of Taenia solium. Oral cysticercosis is a rare event, and it represents difficulty in clinical diagnosis. A case of oral cysticercosis in 11 year old girl is presented which complained of painless swelling for 6 months. A FNAC was performed which revealed bluish pink fibrillary material and interspersed nuclei and fragments of wall of larvae. Patient was treated with antihelminthic.

Chronic abdominal pain in a child

A 6-year-old boy presented to our out patients department with recurrent lower abdominal pain. Pain was started 2 years before intermittently, but it worsened over the past 6 months. Pain aggravated after eating meals. Patient's parent also gave a history of episodes of abdominal distension and constipation. Other symptoms, as well as his past history and family history, were otherwise unremarkable. Physical examination revealed a slightly distended abdomen. There was a huge intra-abdominal mass occupying the center of the abdomen. It was a single mass, freely mobile, firm in consistency, smooth surfaced with well defined margins, and nonballotable. Routine blood tests, including renal function and urine analysis, were normal. Computed tomography of the abdomen and pelvis revealed a huge heterogeneous mass extending from epigastrium to pelvis [Figure 1]. The entire small bowel loop was displaced laterally by the mass. There was no lymphadenopathy, and invasion of mass into the adjacent organ