Comparative Analysis of the Distribution of Various Subtypes of Lymphoid Malignancies in Uttarakhand with other Regions in India.

Lymphoid malignancies (LM) form an umbrella term comprising both Hodgkin Disease (HD) and Non Hodgkin Lymphoma (NHL). A number of studies conducted in India and worldwide suggests that the disease exhibits similar pattern with contrasting regional variations. Examining regional variations is important as it may provide an insight to the etiological factor and pathogenesis of the disease. Aim: The aim of our study was to investigate the current pattern of lymphoid malignancies both HD and NHL in Uttarakhand and subsequently compare the results with other regions. Materials and Methods: We analyzed 116 cases of Lymphoid Malignancies that were reviewed over a period of 18 months. Both HD and NHL were diagnosed morphologically and then Immunohistochemistry (IHC) using CD3, CD15, CD20, CD30, and CD45 was employed to further subtype disease according to current WHO classification. Results: The lymphoid malignancies were further subdivided into HD and NHL. Nodular Sclerosis (NS) was the dominant subtype of HD in Uttarakhand (48.78%) and was comparable with results from other regions. Statistical analysis regarding distribution of various subtypes of HD in Uttarakhand and its comparison with three distinct geographical regions also showed p value < 0.241832 which was not statistically significant. However, amongst NHL Diffuse Large B cell Lymphoma (DLBCL) (54.66%) was the commonest subtype. Besides, a significant number of cases of Anaplastic Large Cell Lymphoma (12%) were also observed. Furthermore, statistical analysis showed that the distribution of various subtypes of NHL in Uttarakhand when compared to three distinct geographical regions was statistically significant (P value < 0.002808). Conclusion: Geographic differences in the incidence and histologic subtypes of Lymphomas do exist.

Crianças com linfadenopatia cervical significativa: análise clínico-patológica e papel da aspiração por agulha fina no contexto indiano / Children with significant cervical lymphadenopathy: clinicopathological analysis and role of fine-needle aspiration in Indian setup

OBJETIVO: Estudar o perfil clínico-patológico de crianças indianas com linfadenopatia cervical e o papel da citologia aspirativa por agulha fina com ênfase especial na tuberculose como causa. MÉTODOS: Foram incluídas 89 crianças com faixa etária de 10 meses a 12 anos, admitidas em nosso hospital de abril de 2004 a março de 2005. Todos os pacientes foram submetidos a completa avaliação clínica e investigativa em relação à linfadenopatia cervical. Medidas de desfecho incluíram estado clínico e a capacidade de testes convencionais em categorizar tipos diferentes de linfadenopatia e sua utilidade no diagnóstico de linfadenite tuberculosa. A variabilidade interobservador foi analisada através do teste de kappa, tendo boa concordância. RESULTADOS: A hiperplasia reativa foi o tipo mais comum de linfadenite, seguida da granulomatosa. Os linfonodos do triângulo posterior unilateral foram o grupo afetado com maior freqüência no grupo de linfadenopatia cervical tuberculosa. A aspiração por agulha fina, seguida da coloração de Ziehl-Neelsen, histopatologia e cultura em associação, obteve sucesso em realizar o diagnóstico em 85,7 por cento dos casos de etiologia tuberculosa. CONCLUSÕES: A aspiração por agulha fina é uma ferramenta diagnóstica valiosa no tratamento de crianças com apresentação clínica de linfonodos cervicais aumentados. A técnica reduz a necessidade de procedimentos mais invasivos e dispendiosos, principalmente em países em desenvolvimento.Cultura e histopatologia, entretanto, devem ser consideradas em casos nos quais a citologia aspirativa por agulha fina não é diagnóstica.

OBJECTIVE: To study the clinicopathological profile of children from India with cervical lymphadenopathy and the role of fine-needle aspiration cytology with special emphasis on tuberculosis as a cause. METHODS: A total of 89 children in the age group of 10 months to 12 years, presenting to our hospital from April 2004 to March 2005, were included. All the patients underwent thorough clinical and investigational assessment vis-à-vis cervical lymphadenopathy. Outcome measurements included clinical status and ability of conventional tests to categorize different types of lymphadenopathy and their utility in diagnosing tubercular lymphadenitis. Interobserver variability was analyzed measuring kappa test and was found to be in agreement. RESULTS: Reactive hyperplasia was the most common type of lymphadenitis, followed by granulomatous involvement. Unilateral posterior triangle lymph nodes were the most commonly affected in the tubercular cervical lymphadenopathy group. Fine-needle aspiration followed by Ziehl-Neelsen staining, histopathology and culture in combination were able to perform the diagnosis in 85.7 percent of cases affected with tubercular etiology. CONCLUSIONS: Fine-needle aspiration is a valuable diagnostic tool in the management of children with the clinical presentation of enlarged cervical lymph nodes. The technique reduces the need for more invasive and costly procedures, especially in a Third World country. Culture and histopathology, however, should be considered in cases where repeated fine-needle aspiration cytology is non-diagnostic.

Applications of flow cytometry to hematopoietic stem cell transplantation

Applications of flow cytometry to clinical and experimental hematopoietic stem cell transplantation (HSCT) are discussed in this review covering the following topics: diagnosis and classification of lymphohematologic disorders, quantitation of hematopoietic progenitors in the graft, lymphohematopoietic reconstitution following HSCT and animal models of human HSCT. At the end, the utilization of flow cytometry in clinical HSCT by Brazilian transplant centers is briefly reviewed.

Linfoadenopatías periféricas: diferencias entre enfermedades benignas y neoplásicas / Peripheral lymphadenopathy: distinction between benign and malignant disorders

Durante dos años, desdemarzo de 1994 a marzo de 1996, se hizo un estudio prospectivo y longitudinal en158 lactantes, niños y adolescentes que consultaron por una o más linfoadenopatías periféricas. El objetivo fue señalar diferencias entre linfoadenopatías benignas y neoplásicas. Los tres grupos diagnósticos y el número de pacientes fueronlos siguientes: linfoadenopatías benignas 130, linfoadenopatías neoplásicas 20 y otros diagnósticos 8. En base a la anamnesis y el examen físico se establecieron diferencias significativas, valor de P<-0.05, a favor de linfoadenopatías para: fiebre, infección de las vías aéreas superiores, consistencia de goma, dolor y flogosis. Las diferencias significativas a favor de linfoadenopatías neoplásicas fueron: descenso de peso, ganglios de mayor tamaño, adhesión a planos subyacentes, asociación de dos o más grupos ganglionares, adhesión o maraña de ganglios, consistencia leñosa y localización cervical inferior-supraclavicular. Se hallópuerta de entrada vinculada a patología infecciosa local o regional en 68 por ciento de las adenopatías inespecíficas y en todos los casos, excepto en uno, de enfermedad por aranazo de gato. Diez pacientes con linfomas se presentaron asintomáticos, 6 tenían tres o más meses de evolucón. Síndrome de la vena cava superior o síndrome mediastinal, dolor óseo, epistaxis, disnea, petequias, derrame pericárdico y derrame pleural, se registraron exclusivamente en las neoplasias. Linfoadenopatías de localización cervical inferior-supraclavicular solas o asociadas a otros grupos ganglionares hubo en 25 pacientes, de los cuales el 52 por ciento tuvo cáncer y el 20 por ciento otras enfermedades serias o progresivas. Las radiografías de tórax mostraron severo compromiso hiliar y/o mediastinal en 9 de 16 pacientes con linfomas, 7 de ellos con adenopatías de localización cervical inferior-supraclavicular. Se hicieron 32 biopsias ganglionares a 31 pacientes, con las mismas se obtuvo un alto rendimiento terapéutico que fue del 59 por ciento. Conclusiones: en los pacientes sintomáticos es posible establecer diferencias entre linfoadenopatías benignas y neoplásicas, útiles para solicitar en forma precoz la biopsia ganglionar por escisión, cuando se sospeche enfermedad maligna oenfermedades serias o progresivas. En los casos con linfoadeonopatías y asintomáticos, recomendamos la biopsia precoz si se se comprueba crecimiento rápido y sin flogosis, en cinco a seis semanas....

Reticulosis medular histiocítica / Histiocytic medullary reticulosis

La Reticulosis Medular Histiocítica constituye una neoplasia maligna generalmente fatal en un período corto de tiempo. Los histiocitos atípicos invaden hueso, médula ósea, higado, bazo, intestino, meninges, piel agregando nosotros laringe, localización no referida en la bibliografia consultada. Las lesiones cutáneas constituyen el 10-13% del compromiso general; consisten en tumores queratósicos ulcerados, distribuidos en tronco y miembros. Los métodos inmunohistoquimicos (lisozima, alfa, antitripsina, S-100) son actualmente otro elemento importante de diagnóstico, siendo como en nuestro caso positivos tanto en laringe como piel. La evolución es mala, falleciendo en poco tiempo por sobreinfecciones o bien hemorragias. Nuestra paciente respondió satisfactoriamente a la quimioterapia instituida, en un período de dos años de control.

An Immunohistochemical Study of Proliferative Disorders of Histiocytes

ln an attempt to clarify the dual origin histiocytes and to reclassify histiocytic proliferative disorders according to their immunohistochemical properties, normal histiocytes and histiocytes in selected proliferative disorders were stained using the peroxidase-antiperoxidase method for lysozyme, 1-antichymotrypsin and for S-100 protein. The proliferated histocytes of cosinophilic granutoma and Letterer-siwe disease were strongly immunoreactive for S-100 protein. In histiocytic medullary reticulosis (HMR) and in histiocytic lymphoma, all three markers were found within the tumor cells. ln fibrous histiocytoma and in juvenile xanthogranuloma, only a few weakly immunoreactive cells for S-100 protein were observed. lnflammatory malignant fibrous histiocytoma(MFH) (Xanthosarcoma) and xanthoma were immunoreactive for 1-antichymotrypsin and lysozyme respectively. ln MFH of the storiform -pleomorphic type and in atypical fibroxanthoma, stains using all of the histiocytic markers were negative. These results suggest that eosinophilic granuloma. Letterer-Siew disease, fibroxanthoma and juvenile xanthogranloma are proliferative disorder of T-zone histiocytes; HMR and histiocytic lymphoma are those of pluripotential stem cells capable of dual histiocytic differentiation; xanthoma and xanthosarcoma are monocytic proliferative disease; and MFH of the storiform-pleomorphic type and atypical fibroxanthoma are not true histiocytic diseases.