RESUMO
Background: For diagnosis of haematological disorders there are three modalities to examine bone marrow, bone marrow aspiration cytology (BMA), bone marrow imprint (BMI) and bone marrow biopsy (BMB). BMA gives cytological picture; BMI also gives cytological picture but cells are less in number and BMB gives cytological as well as architectural picture. BMA alone may not be sufficient to reach diagnosis therefore the present study was undertaken to compare the above modalities. The study was conducted with the aim to perform cytomorphological evaluation of bone marrow in various haematological disorders with special reference to leukaemia and lymphoma and to compare bone marrow aspiration smears with bone marrow trephine biopsy.Methods: The present study was conducted in department of pathology, LLRM Medical College, Meerut inpatients attending the outpatient department and in-patient department of pediatrics and medicine of SVBP Hospital attached to LLRM Medical College, Meerut, over a period of one year i.e. from March 2018 to May 2019. A detailed clinical history, physical examination and laboratory examination of all the cases was done.Results: Out of 50 cases, maximum number of cases were of anemia 26/50 (52%) followed by leukemia 17/50 (34%), lymphoma 5/50 (10%), multiple myeloma 1/50 (2%), myelofibrosis 1/50 (2%), leishmaniasis 1/50 (2%) and idiopathic thrombocytopenic purpura 1/50(2%). BMA smears were compared with biopsy and concordance and discordance was established. The overall diagnostic accuracy of aspiration was 94%.Conclusions: Bone marrow examination is a safe, quick easy and cost-effective procedure with very less patient discomfort. BMA shows better cellular details when compared to BMI and BMB. BMB is diagnostic investigation in dry tap cases like aplastic anemia, myelofibrosis, myelodysplastic syndrome and metastatic tumors. In present study, concordance between BMA and BMB was seen in majority of the cases and diagnostic accuracy was 94% study concludes that bone marrow aspiration cytology and trephine biopsy complement each other and should be performed simultaneously for complete bone marrow work up and evaluation.
RESUMO
Cholangiocarcinoma are malefic tumours of bile duct. Signet ring cell carcinoma (SRCC) is rare entity. Several risk factors have been attributed to its ethology, the main overriding link between two being chronic inflammation of the bile system. Cholecystectomy has also been a proposed risk factor. This study was undertaken in Department of Pathology at LLRM Medical College, Meerut. A 49 years old female, operated for cholecystectomy 1.5 year back in same hospital, now presented with chief complains of jaundice and abdominal discomfort. The blood chemistry revealed increased total bilirubin (13.7 mg/dl), Alkaline phosphatase (877.6 IU/L), Carbohydrate Antigen (CA) 199(184 U/ml) and Carcinoembryonic antigen (CEA) (14.5 ng/ml). Computed Tomography (CT) showed a stricture in mid Common bile duct (CBD). Excision of stricture was done using retrocholic hepatico-jejunostomy. Tissue was submitted for histopathology. Histopathological assessment showed SRCC. The patient failed to turn up for further management but returned back after a span of time presenting with gross ascites and pallor ultimately leading to death within 12 weeks of diagnosis. This was the first case of SRCC to arise in a patient who had a previous history of cholecystectomy. Whether there is some connecting link between the two is still not clear. Further studies are warranted in this direction to establish cholecystectomy as an etiological factor for cholangiocarcinoma.