Correlation of Day 8 Steroid Response with Bone Marrow Status Measured on Days 14 and 35, in Patients with Acute Lymphoblastic Leukemia Being Treated with BFM Protocol.

Berlin-Frankfurt-Munster (BFM) protocol is commonly used in India for treatment of acute lymphoblastic leukemia (ALL). The present study was conducted to correlate day 8 steroid response with bone marrow status (by morphology and flow cytometry) at day 14 and day 35 of treatment. It was a prospective study which included all newly diagnosed ALL patients who visited hospital between March 2013 and February 2015 i.e. 2 years. On 8th day, the number of lymphoblasts was counted in the peripheral blood. Based on the number of blasts patients were classified as good steroid responders and poor steroid responders. Following pre-induction steroids patients were given induction therapy. During this phase on day 14 and day 35 bone marrow (BM) aspiration study was done. Later day 8 steroid response, Day 14 BM status and day 35 BM status were correlated. Results showed that there was a statistically significant correlation between day 8 steroid response and day 14 BM status (both by morphology and flow cytometry). There was no statistically significant correlation between day 8 steroid response and day 35 BM status (both by morphology and flow cytometry). There was no statistically significant correlation between day 14 and day 35 BM status (both by morphology and flow cytometry). Sensitivity and specificity of morphological evaluation of BM was much lower compared to minimal residual disease assessment by flow cytometry. There is a need to incorporate flow cytometry in risk stratification of patients who are being treated with BFM 2002 protocol.

Osteonevus of Nanta Presenting as Nodule over Left Eyebrow.

Osteonevus of Nanta is a rare histopathological finding in which there is an ectopic bone formation in intradermal nevus. Very few cases have been reported so far in the literature. We present a case of osteonevus of Nanta, which occurred as a nodule over the left eyebrow in a 52-year-old female patient. Simple excision proved to be curative in the present case.

Xanthogranulomatous osteomyelitis presenting as swelling in right tibia.

Xanthogranulomatous osteomyelitis is a very rare form of chronic osteomyelitis which presents like a bone tumor. Three cases of xanthogranulomatous osteomyelitis have been described previously in the literature. We present a case of xanthogranulomatous osteomyelitis occurring in the distal part of tibia. This case presented as swelling in a 13-year-old boy. Simple curettage proved to be curative in the present case.

Pigmented trichoblastoma with sebaceous hyperplasia.

Trichoblastoma is a rare benign trichogenic tumour with epithelial and mesenchymal components recapitulating the germinal hair bulb and associated mesenchyme. A 50- year- old male patient presented with slowly enlarging circumscribed solid nodule measuring 4x3x4.5 cm over the tip of the nose. Microscopy of tumour revealed nodular tumour spanning the entire dermis with collection of mesenchymal cells resembling follicular papilla. Areas of pigmentation and sebaceous hyperplasia were noted. There is a need for differentiation of this tumor which is benign, from other pigmented tumors having basaloid arrangement of cells such as basal cell carcinoma.