Role of Immunohistochemistry in Diagnosis and Subtyping of Acute Leukemia using Selected IHC Markers in a Resource Limited Setting

Introduction: In resource limited settings where geneticstudies and flow cytometry were not routinely done oravailable, morphology is primarily used for diagnosis andsubtyping of acute leukemias with use of ancillary tests likecytochemistry and immunohistochemistry in selected casesfor a more accurate and definitive diagnosis. This study wasdone to assess the role of immunohistochemistry in diagnosisand subtyping of acute leukemias in resource poor settingusing selected IHC markers and to find diagnostic accuracy ofmorphologic diagnosis.Material and methods: The study was done on 45 selectedcases of acute leukemia. Immunohistochemistry was doneon all cases for typing and confirmation of diagnosis aftermorphological examination of peripheral blood smears andall three bone marrow preparations.A limited panel of IHCmarkers were used including Anti MPO, Anti CD3, AntiCD20, Anti CD22, Anti TdT, Anti CD117, Anti CD15 andAnti CD68(KP1) for immunohistochemistry.Results: The accuracy of morphological diagnosis in casesof AML and ALL in the study was 84.09% and 82.22%respectively. By intercalating immunohistochemical studieswith morphological examination almost all cases of acuteleukemia can be diagnosed and subclassified, and diagnosticaccuracy is increased as compared to morphologicalexamination alone.Conclusion: Though morphology remains thegold standard for paraffin embedded bone marrowtrephines,immunohistochemical staining has became anintegral part of diagnostic workup in cases of hematologicmalignancies in limited resource settings.

Aspiration vs nonaspiration technique of cytodiagnosis--a critical evaluation in 160 cases.

The two sampling techniques were studied in 160 randomly selected cases of superficial swellings in various sites of the body. They were sampled by fine needle aspiration (FNA) and by non-aspiration (NA) (a needle without application of aspiration pressure). Cell samples were cytologically assessed and critically evaluated using five objective parameters. Contamination with blood was more in lymphnode, thyroid and liver lesions in aspiration smears than NA smears and values were statistically significant. Similarly when compared for the degree of cellular trauma and cellular degeneration statistically significant better results were obtained by nonaspiration technique for lymphnode lesions. Regarding amount of cellular material obtained by FNA, statistical significant better results were found for breast lesions only. Statistically significant better maintenance of architecture was observed only for thyroid lesions by NA technique. Better average scores were observed by NA technique for lymphnode and thyroid only. Categorizing all the smears obtained by FNA & NA on the basis of their scores according to predetermined criteria, greater number of diagnostically adequate specimens were obtained by FNA than by NA but the number of diagnostically superior specimens obtained by NA technique was found to be more than that by FNA. The difference was found to be statistically significant. However the number of inadequate smears was also more by NA technique than by FNA technique.

Hidden cases of leprosy (in prison)

Leprosy survey conducted in eight prisons in seven districts of Bihar State revealed a prevalence of 13.3 per 1000 which was 12 times more than the recorded prevalence of leprosy in the State. Thus this finding supports the view that prisons could form a hyperendemic pocket for leprosy. Regular NLEP services need to be extended to the inmates of the prisons.