Primary central nervous system lymphoma: Comprehension of cell-of-origin subtypes

Primary central nervous system diffuse large B-cell lymphoma (PCNS-DLBCL) is an uncommon extranodal lymphoma that accounts for more than 95% of all the CNS lymphomas. Unlike its systemic/nodal counterpart, which is currently subtyped into cell-of origin (COO) subtypes, its feasibility and utility are largely debatable in PCNS-DLBCL. Objectives: To classify PCNS-DLBCL into COO-subtypes based on immunohistochemical algorithms by Hans and Choi and evaluate concordance between the two. A further aim is to investigate the clinicoradiological and histomorphological parameters of the subtypes thus obtained. Materials and Methods: As many as 143 cases of primary CNS lymphoma were evaluated by immunohistochemistry for CD10, BCL6, MUM1, GCET, and FOXP1 and based on which the said 143 cases were further classified into COO subtypes using Hans and Choi algorithms. Results: Mean age was 53.8 years with marginal male preponderance and predominantly centroblastic morphology (75.5%). CD 10 was positive in 8.9% of the cases, BCL6 in 58.6%, MUM1 in 89.9%, GCET in 32.9%, and FOXP1 in 79.5%. As much as 84.9% cases were of non-germinal center B-cell (GCB) subtype and 15.1% cases were of GCB subtype as determined based on Hans algorithm. Furthermore, 90.7% cases were of activated B-cell (ABC) subtype and 9.3% cases were of GCB subtype according to Choi algorithm. A 91.8% concordance was observed between Hans and Choi algorithms. Among the 6 discordant cases, 5 cases were subtyped as GCB by Hans and ABC by Choi and 1 case as ABC by Hans and GCB by Choi. Conclusion: Most of PCNS-DLBCLs are of non-GCB/ABC COO subtype, but inconsistences abound in the utility of IHC algorithms in PCNS-DLBCL COO subtypes.

An Empirical Study of the Nutritional Status of Severe Acute Malnourished (SAM) Children between Pre and Post Admission in Nutrition Rehabilitation Center (NRC)

The aim and objective of this research study was to compare the nutritional status of Severe Acute Malnourished (SAM) Children between Pre and Post admission in Nutrition Rehabilitation Center (NRC). The exploratory as well as descriptive research design was used. The nutritional status was checked by four test variables as Weight-kg, Height-cm, MUAC (Mid-Upper Arm Circumference). The sample size of this study was 211. The normality test was performed using One-Sample Kolmogorov-Smirnov Test. Since the data of four test variable was not normal, hence non-parametric test (Wilcoxon Signed Ranks Test) was used for the comparative study between pre and post condition. The findings concluded that there was a difference of the weight, height, MUAC, of the children in pre and post medical treatment in the NRC for the SAM children.

Pulmonary Artery Hypertension Masquerading as Hilar Mass

This is a case of a 68-year-old man who came with complaints of chronic dry refractory cough of 3-month duration. He is a known case of atrial septal defect (ASD). Chest radiograph done showed prominent convex pulmonary bay with right hilar mass. Contrast-enhanced computed tomography (CECT) thorax was done. The mass-like lesion was found to be an enlarged and dilated pulmonary artery. The refractory cough was due to compression of larger airways by pulmonary trunk.

IgG4 related sclerosing encapsulating peritonitis with cocoon formation: An unusual and undescribed presentation

IgG4-related sclerosing mesenteritis is a rare disease of mesentery of an unknown etiology which shows a constellation of histopathologic findings of lymphoplasmacytic inflammation with IgG4-positive plasma cells and marked fibrosis. This chronic inflammatory condition of mesentery forming an abdominal cocoon has never been described before to the best of our knowledge. Here, we report a patient with a history of subacute small bowel obstruction who was found to have an intra-abdominal encapsulating mass in the right iliac fossa and was finally diagnosed as IgG4-related sclerosing encapsulating peritonitis (abdominal cocoon) based on peroperative findings, histology and immunohistochemistry.

Paediatric type diffuse high grade gliomas in the WHO CNS5 classification: What the pathologist needs to know?

Pediatric-type of diffuse high-grade gliomas (HGG) are classified as a distinct group in the current fifth edition of WHO classification. This group of high-grade tumors is no more called as glioblastoma (GBM), which has been reserved for adult isocitrate dehydrogenase (IDH)-wild type HGG. These tumors are uncommon as compared to embryonal tumors and low-grade gliomas (LGG). Pediatric-type of diffuse HGG biologically differs from their adult counterparts in that they are therapeutically less sensitive to alkylating chemotherapies. They comprise a heterogeneous group of molecularly defined tumors – predominantly histone gene altered, less common receptor tyrosine kinase (RTK)-mediated, and syndrome-associated. This review provides an overview of these uncommon tumors and discusses the diagnostic approach of this heterogeneous group of tumors.

Recent advances in the diagnosis of immune mediated demyelinating neuropathies

Inflammatory neuropathies are a group of acquired neuropathies which could be due to autoimmune, infectious, paraneoplastic, or paraproteinemic etiology. The etiological diagnosis of inflammatory neuropathy is not simple, and often requires combination of clinical, electrophysiological, and histopathological findings to arrive at a precise diagnosis which is important for management of the disorder. Whereas there are comprehensive and sensitive panel of serological tests available for diagnosis of the infectious, paraneoplastic, paraproteinemic neuropathies, the diagnosis of immune-mediated demyelinating neuropathies remain a considerable challenge as there is both clinical and pathological overlap. Newer non-invasive methodologies such as high-resolution ultrasound, magnetic resonance imaging (MRI), and importantly, serological testing for antibodies are emerging, and it is essential for the practicing pathologist to be up-to-date with emerging modalities. In this review, we focus on the approach to diagnosis of immune-mediated demyelinating neuropathies.

Role of the pathologist in the diagnosis of autoimmune encephalitis

Autoimmune encephalitis is a group of non-infectious immune-mediated inflammatory disorders manifesting with epilepsy and encephalitis syndromes that are associated with autoantibodies in the serum and/or cerebrospinal fluid (CSF). Pathogenic autoantibodies have been discovered against intracellular onconeural antigens, surface neuronal, or synaptic antigens with distinctive pathogenesis that underlie differences in response to immunotherapy. The onconeural antigens incite cytotoxic T-cell-mediated neuronal destruction, whereas surface antigens trigger direct damage by autoantibodies via complement mediated pathways, and hence respond well to immunomodulatory therapy, in contrast to poor response in the former. Neuroimaging, electroencephalogram, and CSF findings being non-specific, detection of autoantibodies is essential for a confirmatory diagnosis. Detection methods available include tissue-based assay, cell-based assays, immunoblot, cell culture, flow cytometry, and enzyme-linked immunosorbent assays. In this review, we discuss the various testing modalities available for onconeural and cell surface antibodies, their sensitivity and specificity and the emerging role of the pathologist in the diagnosis of autoimmune encephalitis. Early diagnosis is crucial for instituting treatment and preventing morbidity and mortality.

A review of adult-type diffuse gliomas in the WHO CNS5 classification with special reference to Astrocytoma, IDH-mutant and Oligodendroglioma, IDH-mutant and 1p/19q codeleted

The fifth edition of the World Health Organization (WHO) Classification of Tumors of the Central Nervous System (WHO CNS5) features several changes in the classification, diagnostic criteria, nomenclature, and grading of diffuse gliomas. Adult-type diffuse gliomas are genetically defined and include astrocytoma, isocitrate dehydrogenase (IDH)-mutant, oligodendroglioma, IDH-mutant and 1p/19q codeleted, and glioblastoma, IDH-wildtype. This review briefly discusses two tumor types: astrocytoma, IDH-mutant, and oligodendroglioma, IDH-mutant and 1p/19q codeleted, with emphasis on relevant changes in their classification and defining molecular genetic alterations. A simplified approach to the diagnosis of these tumors is provided.

Non-granulomatous inflammatory lesions of CNS: Approach to diagnosis

Infections constitute an important and common category of diseases, particularly in less developed countries. Infections present with a broad spectrum of clinical and radiologic features dictated by the cell and tissue tropism and host response elicited, posing a considerable diagnostic challenge. Early diagnosis and treatment are crucial in preventing mortality and morbidity. Recourse is often made to biopsy for ascertaining the diagnosis, and hence the pathologist plays a vital role in patient management. Therefore, knowledge of the histopathologic changes is necessary to recognize the histological changes and guide the diagnostic workup and management. Each microbial agent elicits a distinctive pattern of inflammatory tissue response, which can serve as a clue to the etiological agent. Based on the causative organism, microbial, and host factors, the inflammatory response may be acute or chronic, necrotic or non-necrotic. The inflammation can be of varied patterns – lymphohistiocytic, granulomatous, inflammatory demyelinating, fibrosing, or showing minimal inflammation. The pattern of necrosis also differs based on the causative organism. Typically, pyogenic bacteria are associated with suppurative inflammation, tuberculosis with caseous granulomatous, and fungi with suppurative granulomatous inflammation. Viral infections are associated with lymphohistiocytic non-necrotizing inflammation and, based on cell tropism, can cause demyelination (e.g., JCV) and/or viral inclusions. Parasitic infections (protozoal or metazoal) display a broad spectrum of inflammatory changes that overlap with other types of infections. This review briefly describes pathological patterns and associated pathogens and provides an algorithmic approach based on pattern recognition that may be useful for the practicing pathologist.

Hidrops vesicular secundario a vólvulo: reporte de un caso / Gallbladder hydrops due to vesicular volvulus: a case report

Resumen Introducción: El vólvulo de vesícula biliar (VVB) es una causa extremadamente rara de colecistitis aguda. Aproximadamente 500 casos han sido reportados en la literatura mundial. Puede generar una obstrucción total del drenaje vesicular e isquemia con alto riesgo de progresar a perforación y peritonitis biliar. Caso clínico: Mujer de 90 años consultó por dolor hipogástrico de inicio súbito, asociado a masa abdominal palpable y dolorosa en flanco y fosa ilíaca derecha. Tomografía axial computada de abdomen y pelvis demostró una acentuada distensión de la vesícula biliar, ubicada por fuera de la fosa vesicular y con un punto sugerente de torsión. Fue sometida a laparotomía exploradora, desvolvulación seguida de colecistectomía, con evolución posoperatoria favorable. Discusión: Para el desarrollo de un VVB se requiere una "vesícula flotante", su cuadro clínico es inespecífico y muchas veces es confundido con una colecistitis aguda litiásica, su diagnóstico preoperatorio es difícil pese al estudio con imágenes. La intervención quirúrgica oportuna es el único tratamiento resolutivo, con excelentes resultados. Conclusión: La VVB es una patología rara, representa un desafío diagnóstico tanto para cirujanos como radiólogos.

Introduction: Gallbladder volvulus (GV) is an extremely rare cause of acute cholecystitis. Approximately 500 cases have been reported in world literature. It can lead to total obstruction of the gallbladder drainage and ischemia with a high risk of progressing to perforation and biliary peritonitis. Case report: 90-year-old woman consulted due to hypogastric pain of sudden onset, associated with painful palpable abdominal mass in the flank and right iliac fossa. Computed axial tomography of the abdomen and pelvis demonstrated an accentuated distention of the gallbladder, located outside the gallbladder fossa and with a point suggestive of torsion. She underwent exploratory laparotomy, devulvulation followed by cholecystectomy, with favorable postoperative evolution. Discussion: The development of GV requires a "floating gallbladder", its clinical picture is non-specific and is often confused with acute lithiasic cholecystitis. Its preoperative diagnosis is difficult despite the imaging study. Timely surgical intervention is the only resolutive treatment, with excellent results. Conclusion: GV is a rare pathology, it represents a diagnostic challenge for both surgeons and radiologists.

The paradigmatic shift in the clinical profile of dengue patients: a prospective observational study from a tertiary care center in north India

Background: Dengue a vector-borne viral disease transmitted by mosquito and has several complications causing fatalities and a bad impact on society. The paucity of studies in Uttar Pradesh and lack of epidemiological data necessitated to take up this prospective study. Thus, the current study looked into the causes of heavy prevalence, urban v/s rural ratio, gender difference, various complications to formulate a strategy to limit the severity of the disease by early diagnosis and rapid intervention. The fever caused by dengue is characterized by body ache, petechial rashes, myalgia, and nausea and vomiting. There can be varied manifestations of dengue involving the lung, pleura, peritoneum, pericardium, and complications of liver, kidney, brain, muscle, eye, and other organs. The disease is characterized by thrombocytopenia, dehydration, bleeding tendencies, shock, and multiorgan dysfunction. Current estimates reports about 40% (2.5-3 billion) of the world population are at risk. Purpose: The study is aimed at detecting clinical signs and symptoms of patients with dengue fever presenting to TMU teaching hospital between January 2019 to December 2019. Material and Methods: A prospective observational study was undertaken in serologically confirmed cases of dengue. The disease was analyzed for its clinical profile, required investigations were done and evaluated. Results: In the present study the clinical outcome was: 1) Dengue fever without warning sign was (29.46%). 2) Dengue fever with a warning sign (57.87%). 3) Severe dengue fever (12.12%). Mortality noted in the present study was 1.8%. Bleeding manifestations were noted in 8.2% of patients. Thrombocytopenia (<100,000) was noted in (85.85%) patients. Fever was the presenting complaint in the majority of the patients (99.3%). Fever was followed by myalgia (91.9%), headache (58.8%), arthralgia (28.2%). Conclusions: Patients of dengue presented with fever, headache, myalgia, nausea, vomiting. Bleeding manifestations were looked for. Lab findings like leucopenia and deranged liver function test were more than other studies.

Hematological Alterations Induced by Imidacloprid and Ameliorative Effect of Withania somnifera in Female Albino Wistar Rats

Present study was aimed to evaluate the effect of oral administration of imidacloprid on weekly body weights and hematological parameters in female rats and also to determine the protective role of Withania somnifera against imidacloprid induced toxicity. Forty eight (48) female albino Wistar rats were divided into four (4) groups of twelve (12) animals each. Group 1 served as control, groups 2 was given with imidacloprid at the rate of 30 mg/kg b.wt/day, group 3 was maintained as Withania somnifera (WS) control (1g/ kg feed) and group 4 was treated with both imidacloprid + Withania somnifera (dose as above). The experiment was carried out for a period of 30 days and the test compound was administered daily by oral gavage. Blood samples were collected on 15th and 30th day for hematological analysis. A significant (P < 0.05) reduction in weekly body weights were observed in group 2. Hematology revealed a significant (P < 0.05) decrease in TEC, Hb, PCV, MCV, MCH and MCHC and increase (P < 0.05) in TLC in group 2. The DLC revealed a significant (P < 0.05) increase in neutrophil count and significant (P < 0.05) decrease in lymphocyte count in group 2. Administration of Withania somnifera along with imidacloprid brought moderate protection in all the above parameters

Cross-country transport and isolation and identification of Streptococcus pneumoniae by use of alternate sources of blood supplemented media among laboratories in India

Background: The isolation of S. pneumoniae (Sp) depends on specimen integrity / transport, media and expertise. The non-availability of sheep blood agar poses a challenge in identification of colonial morphology and identification in India. Methods: Laboratories processed swabs containing either pure Sp or Sp in mixed cultures with a second (confounding) bacterium shipped across the country in cold conditions. Duplicate set of swabs was shipped back to the central laboratory to assess the impact of shipping on culture viability. The identical swab was cultured on sheep, human blood and one additional agar plate used in the laboratory. Results: 46/60(77%) of cultures containing only Sp were correctly identified. In specimens where Sp was present in mixed culture, the proportion of isolates in which Sp was correctly identified varied, with most variability attributed to the particular confounding organism rather than the media. There was no discernible impact of temperature-controlled (4-6°C) transport on the isolation of Sp from culture swabs. Conclusions: The study clearly elucidates the ability of laboratories for isolation of S. pneumoniae on human blood agar in resource limited settings. The results highlight the difficulties inherent in correctly identifying pathogens in mixed cultures in needs improvement using standardized tests across the study centers. The study also reaffirms the ability to transport biological specimens over long geographical distances without loss.

Period prevalence of hypertension and risk factors in an urban slum of Maharashtra

Background: One in three adults worldwide has high blood pressure and proportion increases with age. Detecting high blood pressure is easy. Hence a study for prevalence of hypertension was conducted in an urban slum of Pune, Maharashtra.Methods: The study was conducted in an urban slum field practice area exclusively under the community medicine department of a tertiary care hospital during the period of February 2014- July 2014. Overall 1043 people fulfilling the inclusion and exclusion criteria were interviewed, and anthropometric measurements were taken, followed by blood pressure readings and awareness of own hypertensive status. Data was compiled, edited, classified, and analyzed. The prevalence of hypertensive patients was obtained and physical and behavioral risk factors were analyzed for association.Results: The prevalence of hypertension in adults above 18 years of age was 25.6% with mean age of hypertensive patients was 48.58±15.75 yrs. Hypertension was significantly associated with age, habit of adding extra salt to cooked food, family history, BMI and consumption of smokeless form of tobacco among the study participants. Hypertension was not significantly associated with gender and religion of the participants. Of the 267 hypertensives, 40.82% were aware of their hypertensive status and amongst those aware 61.46% were on anti-hypertensives.Conclusions: Hypertension is a public health problem affecting slum population as well. It is significantly associated with risk factors, which are modifiable. The awareness of hypertensive status is low, the under treatment is lower. The population in slum, with its poor literacy, low awareness and income levels provides an opportunity to make an intervention necessary as well as challenging.

Glycemic status in exclusively breast fed low birth weight babies In first 72 hours of life in a teriary care hospital

Background: Neonatal hypoglycaemia, a common metabolic problem, often goes unnoticed owing to lack of specific symptoms. It can lead to considerable mortality and morbidity with long term neurological sequelae. Adequate breast feeding play an important role in maintaining normal glucose levels. So, this study is done to assess the incidence of hypoglycaemia in exclusively breast fed low birth weight babies, both term and preterm neonates and evaluate the impact of early breast feeding on glycaemic status upto 72 hours of life.Methods: This study was conducted over 12 month period involving 236 AGA (Appropriate for gestational age), SGA (Small for gestational age) babies with birth weight between 1.6-2.49 kg. Blood glucose values were measured at birth, 3h, 6h, 12h, 24h, 48h and 72h of life after delivery which was independent of feeding time. Hypoglycaemia was assessed against age of onset, gestational age, sex of baby, mode of delivery and time of initiation of breast feeding.Results: Total 56 episodes of hypoglycaemia were recorded in 52 babies of which 46 (27%) were term SGA babies and 6(8%) were preterm AGA babies (p=0.00148). The incidence of hypoglycaemia was found to be 22%, highest during the first 24 hours of life (93%) and delayed breast feeding is the most commonly noted risk factor (p=0.00024).Conclusions: Low birth babies are more prone to develop hypoglycaemia especially in first 24 hours of life with delayed introduction of breast feeding being one of the common risk factors and asymptomatic hypoglycaemia can be managed with frequent breast feeding without any formula feeds.

Association Of Typhoid Fever With Hepatitis A And Hepatitis E Viral Infections: A South Indian Perspective

Introduction: Endemic, enteric infectious agents continue to wreak havoc on the health of communities in our country. The present study was undertaken with the aim of elucidating the association of typhoid fever with Hepatitis A(HAV) and Hepatitis E (HEV) viral infections as there is a paucity of data regarding the prevalence of concurrent infections with these pathogens from our region. Materials and Methods: Of the serum specimens received during February – March 2018, 100 samples were routinely tested by Widal tube agglutination method. The same specimens were analysed for the presence of HAVand HEV IgM antibodies by ELISA. Results: The prevalence of typhoid, HAV and HEV in the study population was 3 %, 1% and 3% respectively while co-infection with typhoid and HEVwas found in 1% of cases. Conclusions: There is a need to conduct similar studies but on a larger scale to correctly estimate the burden of co-infections with common enteric pathogens.

Duodenal gangliocytic paraganglioma: A rare cause for gastrointestinal polyp

Duodenal gangliocytic paragangliomas are rare neoplasms often arising in the duodenum in close proximity to the ampulla of Vater. These neoplasms are considered to have a benign behavior with lymph node metastases being a rare phenomenon and distant metastases even more so. Although a standardized treatment has not been determined, a margin-free tumor resection seems to be the best treatment modality. We report herein the case of a 36-year-old female who presented with abdominal pain and was found to have a polyp in the second part of duodenum which was excised endoscopically. Histopathology and immunohistochemistry revealed characteristic features of this rare tumor.

Assessment Of Powered (MICRO Debrider) Instruments In Endoscopic Sinus Surgery

Background: Endoscopic Sinus Surgery (ESS) is the surgical practice of alternative for Sinonasal Polyposis (SP). Blood loss throughout Endoscopic Sinus Surgery be able to stop the flow of surgical procedure. The normal instruments grip and rip diseased tissues along with regular tissues causing amplified intra operative bleeding important to decreased visibility and therefore less accurate surgery. Microdebriders be extensively worn now a day in Endoscopic Sinus Surgery. This study is made to assess the advantages of microdebrider in Endoscopic Sinus Surgery in terms of blood loss throughout surgery, visibility of the field during surgery, duration of surgery and post operative healing. Methods: This is a potential study done in GEMS hospital, Srikakulam, over a period of October 2017 to September 2018. Patients who were diagnosed as sinonasal polyposis and underwent endoscopic sinus surgical procedure with microdebrider were taken into study and the outcome were documented and analyzed in terms of blood loss during surgery, visibility throughout surgery, time interval of surgery and post operative healing. Results: Out of 30 patients, majority of the patients had an average blood loss of 180 ml and preoperative visibility of grade 2 and standard duration of surgery of 60 minutes. the majority of the patients had grade Apost operative healing Conclusions: The use of microdebrider leads to contented surgical procedure and decreased rate of intra-operative complications and likely instrument in the practical endoscopic sinus surgery for the management of sinonasal polyposis