Study of serum lactate dehydrogenase level as diagnostic and prognostic indicator of megaloblastic anemia

Background: Megaloblastic anaemia is the hematologic manifestation of faulty proliferation of blood cell precursors. The present study was done to facilitate the diagnosis prior to performing any bone marrow aspirate by estimation of the value of serum LDH in the diagnosis of megaloblastic anaemia.Methods: The cases were selected from patients attended the OPD and admitted in Sanjay Gandhi Memorial Hospital & Gandhi Memorial Hospital, Shyam Shah Medical College, Rewa, Madhya Pradesh. Following investigations were then done to classify anaemia and to establish the diagnosis of megaloblastic anaemia like Haemoglobin estimation by cyanmethaemoglobin method, PCV, RBC count and absolute values, general blood picture, reticulocyte count, bone marrow examination and serum LDH estimation before and after treatment.Results: Of the 100 cases, 50 cases (50%) of the cases were microcytic hypochromic anaemia. 15 cases (15%) were normocytic normochromic anaemia; 35 cases (35%) were macrocytic anaemia on the basis of general blood picture and absolute values. The incidence of megaloblastic anaemia in Indian adults was 20%. Maximum number of cases (90%) of the cases had serum LDH level of more than 1000 U/L. Range of serum LDH level was 520 U/L to 4520 U/L. Thus, there was 2 to 20-fold of highest reference value (240 U/L at37 C) rise in serum LDH level in megaloblastic anaemia.Conclusions: Megaloblasatic anaemia is not uncommon in Indian adults and serum LDH levels provide an important means of diagnosis. It is a non-invasive procedure, safe, and does not require any expertise.

Massive amebic liver abscess--an unusual presentation.

A 40-year-old woman presented with a huge lump in the right half of the abdomen and irregular menses. Ultrasonography showed a cystic lump with septations, extending from the upper abdomen to the pelvis; the right ovary was not seen. On exploration, there was a large cyst arising from the right lobe of the liver; the aspirate was bilious. Since the cyst wall was adherent to retroperitoneal structures, complete excision was not possible. A roux-en-Y loop of jejunum was anastomosed to the cyst wall. Biopsy of the wall showed inflammatory granulation tissue with trophozoites of Entamoeba histolytica. She was treated with metronidazole, and recovered uneventfully.

Cytomorphological features, AgNOR counts and c-erb B-2 in carcinoma breast.

The present study was designed to evaluate the cytomorphological features (nuclear grade and smear pattern) and AgNOR counts in 60 cases of carcinoma breast. The smears were stained with May Gruenwald Giemsa (MGG) and Papanicolaou stains. Silver staining nucleolar organiser region (AgNOR) counts and c-erb B-2 immunostaining were also done in each case. The smear pattern was assessed and classified as 'typical', 'cluster predominant' or 'individual cell type', and the nuclei were graded as grade I, II or III. Smear pattern and nuclear grade were found to be related variables. A significant association was found between nuclear grade and AgNOR counts (p = 0.03). Also postmenopausal women had statistically significant higher nuclear grades and less cohesive cell clusters as compared to premenopausal women. Twenty-three carcinoma breast were positive for c-erb B-2, of these 14 were postmenopausal women.

Cytology. A valuable tool in prognostication of carcinoma breast.

Sixty consecutive cases of carcinoma breast diagnosed on fine needle aspiration cytology (FNAC) between July 1993 to June 1994 were studied prospectively. Nuclear grading was done on all cytologic smears, histologic grading was possible in only 22 cases. A good correlation was seen between nuclear grading on cytology and histology. Silver staining for nucleolar organizer region, and immunocytochemical staining for Ki-67 and C-erbB-2 could be done with ease on cytologic smears, providing necessary additional information on which to base the theraputic decisions.

Cytomorphology of some uncommon tumors of childhood and adolescence.

With the advent of newer adjuvant chemotherapeutic regimes resulting in dramatic improvement in survival, it is mandatory to obtain quick correct diagnosis, which is provided by fine needle aspiration cytology (FNAC). Cytology of childhood tumors was studied to find any distinguishing features, which would help in arriving at a diagnosis. Cytomorphology of 386 childhood and adolescent (0-19 years) tumors diagnosed between 1984 and 1993 were studied. Lipoma was the commonest benign tumor in 0-14 years age group. Fibroadenoma of the breast was the common benign tumor in adolescent (10-19 yrs) girls and pleomorphic adenoma in adolescent (15-19 yrs) boys. Wilms' tumor was the most frequent solid malignant tumor in preschool children and Hodgkin lymphoma, mixed cellularity in the school going age (5-19 yrs). Malignant tumors were more frequent (199). In addition, some rare malignancies like hepatoblastoma, meningioma, ganglioneuroblastoma, adrenocortical carcinoma, clear cell sarcoma kidney and malignant histiocytosis were diagnosed. The cytological features and the differential diagnoses are discussed. It is possible to diagnose these uncommon tumors if particular attention is paid to the distinguishing cytomorphological features in correlation with clinicoradiological findings and cytochemistry.

Immunoreactivity with S100 protein as an indicator of pregnancy.

The usefulness as a pregnancy marker, of immunoreactivity with S100 protein antiserum in endometrial curettings and fallopian tubes during pregnancy was assessed. Twenty six placental tissues of various gestational age, two hydatidiform moles and four fallopian tubes removed for ectopic pregnancy were stained with S100 protein polyclonal antiserum by immunoperoxidase technique. Strong immunostaining was found in glands within the decidua and epithelial cells of fallopian tubes during early pregnancy. However, no S100 protein could be demonstrated in the endometrium in various phases, endometrial carcinomas, decidual glands beyond 12 wk of gestation and normal fallopian tubes. The results indicate a relationship between S100 protein and early pregnancy. Positive immunoreactivity with S100 protein antiserum in the decidual glands and fallopian tube epithelium may help in confirmation of doubtful cases of pregnancy.

Cytologic diagnosis of tuberculous lymphadenitis in children by fine needle aspiration.

One hundred consecutively diagnosed cases of tuberculous lymphadenitis in children have been analysed retrospectively. All cases were stained by May Grunwald Giemsa for cytomorphology and Ziehl Neelsen stain for acidfast bacilli (AFB). In 52 cases the material was sufficient and AFB cultures were possible. A diagnosis of tuberculosis was made when smears showed epithelioid cell granulomas or AFB on either smears or culture. M. tuberculosis and atypical mucobacteria were cultured in 26 and 3 cases respectively. In 6 cases the diagnosis of tuberculosis would have been missed but for culture studies, the cytologic smears were necrotic and stains for AFB negative.

Histopathological study of xanthogranulomatous cholecystitis.

A total of 418 gallbladders removed surgically as chronic cholecystitis or carcinoma gallbladder were studied retrospectively for the presence of xanthogranulomas which were found in 45 (10.8%). The age of patients with xanthogranulomatous cholecystitis ranged from 15 to 80 yr with a mean of 45.3 indicating an early presentation of the disease in our population. The male to female ratio was 1:8. The gallbladder was invariably thickened and calculi of cholesterol or mixed type were present in all cases. Xanthogranulomatous foci appeared as yellowish nodules 2-15 mm in size, on the mucosal surface. In some gallbladders, the involvement was diffuse and these foci extended to the surrounding structures. Histologically, xanthogranulomas encompassed the full thickness of the gallbladder wall with variable extension into adjacent fat and connective tissue. This entity deserves distinct clinicopathological recognition, particularly because of a possible confusion with malignancy and the associated complications.