C-Window Peaks on CE-HPLC are Extremely Rare in Northern India, and Only Infrequently Represent HbC.

Hemoglobin C (HbC, HBB:c.19G > A) is a structural variant that has been reported rarely from India. This was a retrospective review of all high performance liquid chromatography (HPLCs) submitted over a 14 year period to a tertiary care center in North India with an aim of finding hemoglobins that elute in the C-window. Of the 32,364 HPLCs screened, 6 cases showed peaks in the C-window. Of these 6 cases, only two cases contained hemoglobin C. These was one case each of HbC/ß thalassemia and compound heterozygosity for HbC and HbD. There were 4 cases which showed very similar red cell indices and chromatograms with multiple peaks eluting in D-window, C-window and an additional peak with a retention time of 4.74 min. These four cases were compound heterozygous for an α chain variant HbQ-India and a ß-chain variant HbD.

Bilateral seminomas coexisting with adenomatoid tumor: An unusual occurrence.

Coexistence of bilateral seminomas and adenomatoid tumor is rare. We encountered an interesting case of bilateral testicular seminomas along with a paratesticular nodule which was diagnosed as an adenomatoid tumor on histology. Although seminomas and adenomatoid tumor are frequent neoplasms, bilaterality and their coexistence have been rarely described and can pose diagnostic difficulties. Herein, we describe a case of a 53-year-old man who presented with bilateral testicular swellings which were diagnosed as bilateral seminomas with an adenomatoid tumor in the left paratesticular region on histopathology. The pathological findings of these coexistent tumors and the utility of immunohistochemistry in establishing a correct diagnosis in such scenarios are discussed.

Comparison of the characteristics of two hemoglobin variants, Hb D-Iran and Hb E, eluting in the Hb A2 window.

BACKGROUND: Cation exchange-high performance liquid chromatography (CE-HPLC) is most commonly used to evaluate hemoglobin (Hb) variants, which elute in the Hb A2 window. This study aimed to assess prevalence of an uncommon Hb variant, Hb D-Iran, and compare its red cell parameters and peak characteristics with those of Hb E that commonly elutes in the Hb A2 window. METHODS: Generally, we assess abnormal Hb using CE-HPLC as the primary technique along with alkaline and acid electrophoresis. All cases with Hb A2 window >9%, as assessed by CE-HPLCs during 2009-2013, were selected. RESULTS: Twenty-nine cases with Hb D-Iran variant were identified-25 heterozygous, 2 homozygous, 1 compound heterozygous Hb D-Iran/ß-thalassemia, and 1 Hb D-Iran/Hb D-Punjab. Overall prevalence of Hb D-Iran was 0.23%. Compared to patients with Hb E, those with Hb D-Iran had significantly higher Hb (12.1 vs. 11.3 g/dL, P=0.03), MCV (82.4 vs. 76.4 fL, P=0.0044), MCH (27.9 vs. 25.45 pg, P =0.0006), and MCHC (33.9 vs. 33.3 g/dL, P=0.0005). Amount of abnormal Hb (40.7 vs. 26.4%, P=0.0001) was significantly higher while retention time (3.56 vs. 3.70 min, P=0.0001) was significantly lower in Hb D-Iran than in Hb E. CONCLUSION: Hb D-Iran peak can be easily missed if area and retention time of the Hb A2 window are not carefully analyzed. To distinguish between variants, careful analysis of peak area and retention time is sufficient in most cases and may be further confirmed by the second technique-alkaline electrophoresis.

A Case Presenting with Splenic Infarct Diagnosed as Primary Bone Marrow CD5 Positive DLBCL: A Clinicopathological Correlation.

De novo CD5+ Diffuse large B cell lymphoma (DLBCL) is a rare and aggressive subtype of DLBCL. It is a distinct clinicopathologic entity with complex molecular profile and poor prognosis. A 59 year old female presented with pyrexia of unknown origin since 1 month. On examination, there was severe pallor, hepatosplenomegaly and no palpable lymphadenopathy. Complete blood count revealed bicytopenia with normal total leucocyte count. Liver and renal function tests were normal. Ultrasonography abdomen revealed splenic enlargement with two focal lesions attributed to either splenic abscess or infarcts. Patient was being managed as splenic infarct but continued to have bicytopenia. Further investigation showed elevated serum ferritin, triglycerides and LDH. With a clinical suspicion of infection and haemophagocytic lymphohistiocytosis bone marrow aspiration (BMA) and biopsy (BMBx) was done. BMA showed extensive haemophagocytosis and ~7.4 % large lymphoma-like cells. On this basis PET-CT was suggested which showed enlarged spleen with diffuse uptake. BMBx showed nodular and intrasinusoidal collection of abnormal lymphoid cells. On immunohistochemistry, these cells were positive for CD20, CD5, MUM1, BCL-2, BCL-6 and negative for CD3, CD10 and CD23. CD34 highlighted focal intrasinusoidal pattern. The complete clinicopathological profile suggested the diagnosis of de novo CD5+ DLBCL, with primary hepatosplenic pattern of involvement. CD5+ DLBCL presenting as splenic infarct is very rare. This case was unusual as the diagnosis of a primary aggressive lymphoma with haemophagocytosis was established in a patient who presented with fever and splenic infarct without lymphadenopathy. This indicates the importance of good morphological assessment of a bone marrow aspirate and biopsy to make a correct diagnosis.

Hepatocellular carcinoma arising in a testicular teratoma: a distinct and unrecognized secondary somatic malignancy.

We report an interesting case of testicular germ cell tumor with distinct seminomatous and teratomatous components. A rare development of secondary somatic malignancy in the form of hepatocellular carcinoma was observed. Immunohistochemically, hepatocellular cancer was positive for cytokeratin, hepatocyte paraffin-1 (HepPar-1), α-fetoprotein, glypican-3 (GPC-3), octamer-binding transcription factor 3/4 (Oct3/4), and Ki-67. In addition, adenocarcinoma and rhabdomyoblastic differentiation were also evident. Placental alkaline phosphatase (PLAP), Sal-like 4, and Oct3/4 were positive in seminoma. To the best of our knowledge, we have not found any such report of secondary development of hepatocellular carcinoma in a testicular teratoma. We believe that it is a rare, distinct phenomenon in germ cell tumors and deserves recognition.

Correlation of p63 protein expression with histological grade of meningiomas: an immunohistochemical study.

Prediction of tumor behavior in meningiomas based on morphological features alone remains difficult. Several immunohistochemical biomarkers have been proposed to assist conventional methods. However, no single immunohistochemical marker can unequivocally discriminate between benign and aggressive meningiomas. There is only 1 study available in the literature that correlates p63 expression with overall histological grade of the meningioma. The present study is undertaken to assess the correlation between p63 expression and histological grade of meningiomas. For this purpose, the authors studied and analyzed the immunohistochemical expression of p63 in 85 cases of meningioma, including WHO grade I (63), grade II (11), and grade III (11) cases. Correlation between histological grade and nuclear immunoreactivity to p63 antibody was performed. Furthermore, expression of p63 protein was correlated with short clinical follow-up and Ki-67 proliferation index. Among 85 patients analyzed, there were 61 women (71.7 %) and 24 men (28.2%) between 7 and 75 years old. Expression of p63 protein was found in 34.9% of grade I cases, but in grade II and III, 63.6% of cases each were immunoreactive. Correlation between histological grade and p63 immunoreactivity was significant (P = .02). p63-positive grade I meningiomas did not show elevated Ki-67 index. The present study contradicts earlier reports because there are a considerable number of grade I meningiomas that express p63. Although p63 expression is significantly associated with higher histological grade of meningiomas, it may not be considered as a sole biomarker to assess aggressive behavior of the tumor.