Immature Platelet Fraction: Its Clinical Utility in Thrombocytopenia Patients.

Objectives Etiology of thrombocytopenia is multifactorial and its pathogenesis should be distinguished for appropriate management. Newly formed immature platelets are called reticulated platelets (RPs) and can be estimated in peripheral blood using automated hematology analyzers, which express them as immature platelet fraction (IPF). In the present study we intend to assess and establish the clinical utility of IPF in differentiating the two major causes of thrombocytopenia-decreased production and increased destruction of platelets-along with determining its significance in monitoring patients with thrombocytopenia. Materials and Methods Sixty-one cases of thrombocytopenia and 101 healthy controls with normal platelet count were included in the study. IPF and all the other usual blood cell parameters were measured using a fully automated hematology analyzer. Based on the pathogenesis of thrombocytopenia, the cases were divided into groups and the difference in IPF value between the groups was evaluated. Results The reference range of IPF among healthy controls was estimated to be 0.7 to 5.7%. The mean IPF was significantly higher in patients with increased peripheral destruction of platelets (13.4%) as compared to patients with decreased production of platelets (4.6%). The optimal cutoff value of IPF for differentiating patients with increased peripheral destruction of platelets from patients with decreased production of platelets was 5.95% with a sensitivity of 88% and specificity of 75.9%. Conclusion Measurement of IPF is useful for detecting evidence of increased platelet production and helps in the initial evaluation of thrombocytopenia patients. It is a novel diagnostic method which can be used to differentiate patients with thrombocytopenia due to increased destruction of platelets from patients with thrombocytopenia due to bone marrow failure/suppression.

Validation and Modification of the Masood Scoring Index for the Diagnosis of Atypical Breast Lesions.

INTRODUCTION: Cytological diagnosis of borderline breast lesions remains challenging, and interobserver variability exists in their interpretation. The Masood scoring index (MSI) has been proposed to help in the subgrouping of breast lesions using objective criteria. AIM: The aim of the present study was to assess the interobserver variability in the scoring of breast lesions according to MSI and to see the utility of a modified scheme for discriminating benign and atypical lesions. STUDY DESIGN: Papanicolaou-stained smears (100 cases) that underwent fine needle aspiration for a palpable breast lump were independently evaluated by 2 observers, and the cases were categorized as per MSI. Percent agreement beyond chance score between both observers was calculated. Sensitivity analysis was performed by comparing the scores using models containing different parameters of MSI. RESULTS: The agreement amongst the 2 observers for scores was found to be 0.88 and it was 69% for category-wise diagnosis. Sensitivity analysis showed that the model with only 3 cytological parameters (cell arrangement, pleomorphism, and nucleoli) had similar discrimination ability in the classification of breast disease as benign or atypical as the standard MSI model. CONCLUSION: Further simplified models of MSI should be tested for improved diagnostic accuracy and wider acceptability.

Central nervous system filariasis masquerading as a glioma: case report.

Filariasis, an endemic zoonosis in the Southeast Asia region, has been reported to affect various organs as well as the central nervous system (CNS). Inflammatory reactions mimicking those from neoplastic lesions clinically and radiologically have been reported in the breast and urinary bladder. To date, a CNS manifestation of filarial infestation has been reported in the form of meningoencephalitis. The authors here present an interesting case of a young man presenting in status epilepticus, which on radiological evaluation appeared to be a glioma. However, postoperative histopathological examination changed the provisional diagnosis to a filarial infection of the CNS mimicking a primary CNS neoplasm.

Cytological findings of odontogenic myxofibroma: A diagnostic dilemma.

Odontogenic myxofibroma represents a rare slow-growing benign neoplasm, which usually occurs in the second and third decades of life and rarely in children or adults over 50 years of age. Myxomas in general represent from 2.3% to 17.7% of all odontogenic tumors, and myxofibromas represent a small number of all myxomas. Limited evidence is present in literature regarding the cytological diagnosis of odontogenic myxoma/myxofibroma. We hereby report the cytomorphological features of a histologically confirmed case of odontogenic myxofibroma and the pitfalls of the cytological diagnosis. A painless jaw swelling in a young boy was aspirated. Scanty mucoid material was obtained. Cytology Smears were moderately cellular and showed a population comprising predominantly of singly scattered plump to fusiform cells with bipolar cytoplasmic processes showing mild to moderate atypia embedded within dense myxoid matrix and another population of cells arranged in clusters. Case was interpreted as low grade mesenchymal tumor. Subsequent biopsy confirmed it as odontogenic myxofibroma arising in a odontogenic keratocyst. Precise interpretation of intraosseous jaw lesions FNAC may not always be possible, but an attempt should be made to broadly classify the lesion as an inflammatory lesion, cystic lesion, giant cell lesion, fibro-osseous lesion or as an odontogenic tumor. If dual population of odontogenic epithelium and mesenchymal cells embedded in myxoid matrix are identified in such aspirates, a possibility of myxoid odontogenic tumor may be suggested. Triple correlation of cytological, clinical and radiological findings can guide the surgeon for taking appropriate therapeutic decisions.