Cutaneous metastasis in a case of Wilm's tumor diagnosed on cytology - A rare case report.

A 12-year-old male child presented with complaints of a slow growing swelling in the right parasternal region noticed since one month. On examination, the lump was 2 × 2 cm firm, mobile nontender located in the subcutaneous plane which was also confirmed radiologically. Fine needle aspiration cytology was attempted showed small to medium sized monotonous round cell morphology, nuclear molding and mitotic figures were frequent. Few cells exhibiting rosettoid arrangement. No definite epithelial or mesenchymal component was evident. No glio-fibrillary matrix or lymphoglandular bodies were evident in the smears. Based on morphology, a small round cell tumor was considered with possibilities of Wilm's tumor and Ewing's family of tumor. Based on morphological differentials ICC was requested, tumor cells were positive for strong nuclear WT1 staining while CK and FLI1 were negative. The cytomorphology along with the ICC confirmed the diagnosis of metastatic wilm's tumor. Seven years back, patient had a history of nephrectomy, which on histopathology was reported as triphasic Wilms tumor with favorable histology. Generally Wilm's tumor recurs within 2 years of diagnosis. Late recurrence in Wilm's tumor is rare with only a handful of case reports. Common sites for metastasis include lung, liver, contralateral kidney. Cutaneous metastasis is very uncommon, early detection of which with helps in therapeutic and prognostic decisions. The interesting aspect of this article is cytological detection of cutaneous metastasis of late recurrence Wilm's tumor, which is extremely rare to occur.

Pooled nucleic acid testing strategy for monitoring HIV-1 treatment in resource limited settings.

BACKGROUND: Virological monitoring (VM) and drug resistance (DR) analysis are crucial for effective HIV management. Due to the high cost of commercial assays, VM and DR analysis is not performed in resource-limited-settings. OBJECTIVE: The objective of this study is to develop a pooling based algorithm for the combined identification of virologic treatment failure (VTF) by nucleic acid testing (NAT) and DR by sequencing - NAT+DR assay. STUDY DESIGN: We enrolled 559 participants on first-line therapy and analyzed for VTF. The virologically suppressed participants were followed-up to see the VTF prevalence (>1000 copies/mL) and DR by the NAT+DR pooling. Each pool comprising 5 plasma samples were amplified by targeting reverse transcriptase gene, if found positive, the pool was deconvoluted and samples were individually tested for HIV RNA and DR. Assay characteristics of NAT+DR assay were calculated in comparison with commercial assay. RESULTS: Of 559 participants, 67 had VTF at baseline and were excluded. Of the remaining 478 participants, 325 returned for follow-up and NAT+DR assay was performed for them. Of 65 pools tested, 13 pools were positive. On deconvolution 14 individuals were found to have VTF. Sensitivity, specificity, positive predictive value and negative predictive value was 100%, relative efficiency was 59% and 87% & 85% cost was saved for identifying VTF and combined identification of VTF and DR, respectively. CONCLUSIONS: Pooled NAT+DR assay is likely a good strategy to drastically reduce the cost and sustainability of the VM and can thereby facilitate the scale-up of successful HIV treatment programs, and reduce unnecessary switching to second-line drugs in resource-limited-settings.