Spectrum of histopathologic diagnosis of lymph node biopsies: A descriptive study from a tertiary care center in South India over 5½ years.

Aims: Lymphadenopathy is a common clinical problem and biopsies undertaken to determine the cause of nodal enlargement may be neoplastic or nonneoplastic. The former are mainly lymphohematogenous malignancies and metastases while the causes of non-neoplastic lymphadenopathy are varied. This study was undertaken to determine the histopathological spectrum of lymphadenectomies. Materials and Methods: This was a descriptive crosssectional study wherein 1010 cases of histologically diagnosed peripheral lymph node biopsies in the Department of Pathology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry from January 2007 to June 2012 were reviewed. Surgical resection specimens with lymph node dissection were excluded from the study. Results: Neoplastic lesions were more common comprising 53% (535 cases) and included 32.1% (324 cases) of non-Hodgkin lymphoma, 12.4% (125 cases) of Hodgkin lymphoma and 8.5% (86 cases) of metastatic lesions. The non-neoplastic lesions were 47% (475 cases), which included 21.6% (218 cases) of non-specifi c reactive lymphoid hyperplasia, 6.8% (69 cases) of other reactive or specifi c lymphoid hyperplasia, 18% (182 cases) of tuberculous lymphadenitis, 0.6% (6 cases) of other granulomatous lesions. Conclusions: Lymph node biopsy plays an important role in establishing the cause of lymphadenopathy. Among the biopsied nodes, lymphomas were the most common (44.5%) followed by non-specifi c reactive hyperplasia (21.6%), tuberculous lymphadenitis (18%) and metastasis (8.5%).

Clinico-hematological profile of Chediak-Higashi syndrome: Experience from a tertiary care center in south India.

Introduction: Chediak-Higashi syndrome (CHS) is a rare autosomal recessive disorder characterized by partial ocular and cutaneous albinism, increased susceptibility to pyogenic infections, the presence of large lysosomal-like organelles in most granule-containing cells and a bleeding tendency. The abnormal granules are most readily seen in blood and marrow leukocytes, especially granulocytes; and in melanocytes. Other clinical features include silvery hair, photophobia, horizontal and rotatory nystagmus and hepatosplenomegaly. Materials and Methods: The clinico-hematological profile of a series of 5 cases of CHS encountered at JIPMER Hospital with diagnostic work-up done in the Department of Pathology over the last 6 years is presented. The diagnostic work-up included complete hemogram with peripheral smear, bone marrow examination, skin and liver biopsies. Results: The age of the patients ranged from 5 months to 3 years. All patients had silvery hair and partial albinism and presented with fever and recurrent chest infection. Two patients were stable. Three patients were in accelerated phase; of them, 1 patient with associated hemophagocytic syndrome had a rapidly fulminant course. Peripheral blood smear showed anomalously large granules in the leukocytes. Skin biopsy showed sparse, coarse melanin pigment in the epidermis, and liver biopsy done in 2 patients with accelerated phase showed portal lymphohistiocytic aggregates. Conclusions: The diagnostic hallmark of CHS is the occurrence of giant inclusion bodies (granules) in the peripheral leukocyte and their bone marrow precursors. The case series is being presented because of the rarity of CHS and varied spectrum of clinical and hematological presentation.

Effect of pregnancy induced hypertension on mothers and their babies.

OBJECTIVE: To study the hematological profile of mothers with pregnancy induced hypertension and their infants. METHODS: The effects of maternal hypertension on the hematological profile of neonates were studied in 50 cases comparing the values with that of infants born to normotensive mothers. RESULTS: There was higher number of preterm, Intra-Uterine Growth Restriction (IUGR) and Small for Gestational Age (SGA) babies among the infants of hypertensive mothers. There was a significantly higher incidence of thrombocytopenia and nucleated RBCs seen in these babies. Significant neutropenia was not documented and there was no increased incidence of bleeding when compared to controls. CONCLUSION: Although there were significant changes in the hematological profile of infants born to hypertensive mothers, there was no significant increase in neonatal morbidity as a result of these changes.

Role of bone marrow trephine biopsy in the diagnosis of marrow involvement in Hodgkin's disease.

Bone marrow involvement in Hodgkin's disease alters the stage and hence the prognosis and treatment modality. Seventy-six patients of biopsy proven Hodgkin's disease in whom a bone marrow aspiration and biopsy were done simultaneously at the time of diagnosis were included in the study. Bone marrow involvement was seen in 14 (18%) cases. All 14 cases were diagnosed on biopsy. Only one aspirate was suspicious of involvement. Rest was either diluted (28%) or was normal (64%). Eleven patients were upstaged from stage I, II and III to stage IV. All patients had cytopenia of one or more cell line. Increased fibrosis, necrosis and a polymorphic cellular infiltrate were associated findings in the marrow. We wish to highlight the importance of bone marrow trephine biopsy over aspirate in staging even clinically early stage Hodgkin's disease.

Spontaneous tumour lysis syndrome associated with non-Hodgkin's lymphoma--a case report.

Spontaneous tumour lysis syndrome is characterized by hyperuricemia, hyperkalemia, hyperphosphatemia, metabolic acidosis and hypocalcemia, that occur even prior to the treatment of a neoplasm. This rare occurrence was encountered in a patient with non-Hodgkin's lymphoma (NHL), of follicular cell type. Conservative but intensive treatment led to complete resolution. Subsequent chemotherapy was well tolerated.

Plasma cell leukemia--a case report.

Plasma cell leukemia, occurring either de novo or in patients with long standing multiple myeloma, is the least common type of plasma cell dyscrasia. Histogenetically plasma cell leukemia is derived from terminally differentiated B cells. It is diagnosed by presence of absolute plasma cell count >2000/cm or >20% circulating plasma cells. Two cases of plasma-cell leukemia are reported here. Clinical spectrum and course of the disease, are discussed. Both cases (of primary plasma cell leukemia) had abrupt onset of disease, poor response to therapy and short survival time. Both presented with fatiguability and weakness. Evidence of organomegaly and radiological and hematological evidence of plasma cell leukemia, with thrombocytopenia and evidence of visceral involvement with leukemic cells, was seen in one case.

A study of fibroepithelial tumours of the breast.

Cytological parameters were studied in 18 fibroepithelial tumours of the breast including 8 benign phyllodes, 1 malignant phyllodes, and 9 fibroadenomas between 1999 to 2001. Cytology smears were studied without knowledge of previous cytodiagnosis by 3 different observers. Histopathologic parameters were studied in 18 fibroepithelial tumours by 3 observers. Cyto-histological correlation was carried out. Cytological criteria by Chinoy et al (1999) were utilized to give revised cytodiagnosis. Initial cytodiagnosis and revised cytodiagnosis were correlated with histopathological diagnosis. 8/9 cases of fibroadenoma (88%) studied were correctly diagnosed on FNAC after semiquantitative team approach as opposite to 44% initial cytodiagnosis. Cytological distinction between benign phyllodes and fibroadenoma was improved after semiquantitative approach to various parameters. Diagnosis of malignant phyllodes posed no problems in cytodiagnosis. Present study supports the role of FNAC in distinguishing benign from malignant phyllodes and distinguishing fibroadenoma from phyllodes tumour. The latter being a rare fibroepithelial tumour, its study is interesting.