Budding yeast in a child with acute leukemia: Nothing CRYPT(O)IC about it

A 13-year-old girl child with B-cell precursor acute lymphoblastic leukemia presented with complaints of fever, fatigue and left-sided iliac mass of 20 days duration. Preliminary blood culture from the peripherally inserted central catheter (PICC) demonstrated the presence of budding yeast cells. This is a rare form of “Disseminated cryptococcosis”. Budding yeast cells emphasizes the significance of various differentials of yeast in positive blood cultures bottles, as identifying Cryptococcus from gram stain can be complicated. This manuscript also highlights the presence of crystalloid geometric appearance like “Buckminsterfullerene”, which is derived from the mucopolysaccharide capsule in Cryptococcus. These structures are rarely observed, and in this case, are exceptionally remarkable.

Massive blood transfusion.

Pediatricians in the hospital setting must frequently treat children who require massive transfusion (MT) in a variety of clinical situations ranging from major trauma to neonatal hyperbilirubinemia. After identifying the need for massive transfusion, the pediatrician must select the appropriate blood components. Different blood components have specific temperature, preservative, and time requirements for their storage. Changes, termed storage lesions, occur over time in blood components during storage; biochemical changes include decreased levels of 2,3-DPG, a decrease in pH, and an increase in supernatant potassium (K+) with a concurrent decrease in intracellular K+. These changes may affect the function and the viability of components. Additionally, physical changes such as deformation of the red cell membrane occur during storage. Knowledge of these storage lesions is necessary for the pediatrician to make the most appropriate decisions regarding the preparation and selection of components during MT. Serious complications of MT include hemostatic abnormalities, biochemical/metabolic abnormalities, hypothermia, mechanical injury and the effect of Rh incompatibility, each of which has a specific management response. Pediatricians need to be aware of the potential complications associated with massive transfusion, to take measures to prevent them when possible, to anticipate additional transfusion requirements, and to know how to manage them in the pediatric patient.

Relative efficacy of bone marrow trephine biopsy sections as compared to trephine imprints and aspiration smears in routine hematological practice.

The relative efficacy of trephine sections, trephine imprints and aspiration smears in yielding diagnostic and additional information was compared in 767 sets of bone marrow samples. Trephine sections were diagnostic in significantly more cases as compared to trephine imprints and aspiration smears (P < 0.001). Additional information was obtained in 326 trephine sections which was not available from trephine imprints and aspiration smears. Significantly more number of trephine sections provided diagnosis in case of dry tap/scanty material, for assessment of lymphoma-tumour infiltration, cellularity, Perl's reaction, megakaryocyte density and proliferating cell lines in myeloproliferative disorders. Fibrosis of bone marrow, pattern of bone marrow involvement and topographical alterations were appreciable only on trephine sections. The differential counts done on trephine imprints and aspiration smears correlated well and cytomorphological characterisation of immature cells (blasts and promyelocytes) could be done on these two preparations. Although trephine sections provide maximum information, all three preparations were found complementing each other and should be evaluated simultaneously for complete bone marrow interpretation.

Fibrinolytic activity in human malignant tumors.

We have studied fibrinolytic activity of 12 cases of infiltrating duct carcinoma of breast (7 metastatic and 5 non-metastatic) and ten cases of adenocarcinoma of gastrointestinal tract (5 each of metastatic and nonmetastatic), and compared with some of their normal tissue counterparts. Both metastatic and non-metastatic tumors of breast and gastrointestinal tract had significantly higher levels of fibrinolytic activity as compared to normal tissues. Though mean fibrinolytic activity (expressed as ug/ml of urokinase activity) of metastatic tumors of breast and gut had higher values as compared to non-metastatic counterparts, however it did not reach statistical significance.

An association of acute myeloid leukaemia and multiple myeloma: a case study.

A case of denovo presentation of acute myeloid leukaemia with multiple myeloma is reported in a 32 years old male. He presented with pancytopenia and aleukaemic leukaemia. Bone marrow examination revealed presence of acute myeloid leukaemia and sheets of plasma cells. Serum electrophoresis showed a M protein which was characterised to be Ig lambda with decrease in normal immunoglobulin levels.

A clinico-pathological study of six cases of hairy cell leukaemia.

Clinicopathological findings of six cases of Hairy cell leukaemia are presented. All the patients were males, the age ranged between 32-57 years. Complications of anaemia and neutropenia were common modes of presentation. Hepatomegaly and splenomegaly were present in all the cases whereas only 2 patients had lymphadenopathy. Severe pancytopenia was detected in 3 cases and circulating hairy cells were present in all the cases. Trephine biopsy done in all six patients was found to be diagnostic. Tartrate resistant acid phosphatase was detected in the hairy cells of 2 cases.

Correlation between morphological and cytochemical heterogeneity of acute promyelocytic leukemia (APL) and its association with myelodysplasia.

Sixty one cases of acute promyelocytic leukemia (M3) were diagnosed between Jan., 1985 and Dec., 1988. Morphologically 46 cases (75.4%) were characterised as typical M3 and 15 cases (24.6%) as M3 variant. Typical M3 cases had higher number of hypergranular promyelocytes and Auer rods (P less than 0.001). The cytochemical stains of myeloperoxidase, Sudan Block and Black and chloroacetate esterase were strongly positive in M3 typical and mild to moderately positive in M3 variant cases. Alpha-naphthyl acetate esterase positivity with fluoride inhibition was seen only in M3 variant cases (80%). The clinical and haematological parameters including marrow blast count were not significantly different in the two groups. This study has shown that M3 variant cases more frequently express heteregenous cytochemical patterns and myelodysplastic changes.

Pure red cell aplasia associated with essential thrombocythemia (a case report).

A rare case of erythroblastopenia associated with essential thrombocythemia (ET) is described. The patient had markedly elevated platelet count (5200 x 10(9)/1) and significant platelet dysfunction leading to extensive soft tissue and gastrointestinal hemorrhage. There was paucity of erythroid precursors in the bone marrow - a feature hitherto undescribed in ET. The thrombocytosis responded to well busulphan therapy but patient succumbed to fulminant infection consequent upon drug induced neutropenia.

Erythroleukaemic blast crisis in chronic granulocytic leukaemia.

A rare instance of erythroleukaemic blast crisis in chronic granulocytic leukaemia is described in a 22 years old male. A combination of morphology and a battery of cytochemical stains helped us to make this diagnosis.

Granular cell variant of acute lymphoblastic leukaemia.

A rare morphological variant of acute lymphoblastic leukaemia in a ten years old child is described. Ninety five percent of the lymphoblasts had significant number of course granules in the cytoplasm. Diagnostic and prognostic significance of this variant is discussed.