Cytogenetic and cytokine profile in elderly patients with cytopenia.

In the elderly with cytopenia, the diagnosis of myelodysplastic syndrome (MDS) may be missed. Cytokine levels contribute to the pathology of MDS. Hence, the objectives were to evaluate cytogenetic profile as a prognostic indicator in risk stratification and cytokine levels as a screening tool in patients with cytopenia for diagnosis. Over 2 years (2016-2018), 150 elderly patients were screened. MDS diagnosis was confirmed by morphology. Interleukin-2 (IL-2) and IL-6 levels were assessed in 50 patients, and karyotyping was performed in 20 confirmed cases of MDS. Age-matched healthy controls were used for comparison of cytokine levels. Among 150 patients, 88.6% had anemia, including nutritional anemia (51.2%). MDS diagnosis was confirmed in 35 patients. In 15 patients, unexplained cytopenia (UC) was present. Karyotyping in 20 MDS patients was normal in 15 (75%) patients and revealed a complex karyotype in four (20%) patients and double chromosomal abnormality in one (5%) patient. The Revised International Prognostic Scoring System (IPSS-R) scored 91% in the low-risk group and 9% (n = 3) in the high-risk group; the latter three developed acute myeloid leukemia (AML) and two of them had a 7q deletion. Among the 15 cases of UC, one patient died from refractory anemia. No significant difference in levels of IL-2 and IL-6 were found between MDS and UC patients when compared with healthy controls, as well as between different risk groups and karyotypes. A significant difference in IL-2 levels was found in MDS patients with disease progression and with stable disease. On the basis of the findings, it is suggested that IL-2 levels will help in predicting disease progression.

Paraneoplastic multicentric reticulohistiocytosis: a clinicopathologic challenge.

Multicentric Reticulohistiocytosis (MRH) is a rare, systemic non-Langerhans cell histiocytosis (non-LCH) with prominent joint and skin manifestations. It is mostly self limiting. However, 15-30% of the cases are associated with malignancy and carry a poor prognosis. We report the case of a 42-year-old man who presented with multiple reddish-brown papules that on biopsy showed aggregates of oncocytic histiocytes with several multinucleate giant cells. Immunostains were positive for CD 68, CD 45 and were negative for S-100, CD1a. An impression of multicentric reticulohistiocytosis (MRH) was made, with the recommendation to screen for malignancy. Electron microscopy of the skin lesions showed features consistent with non-Langerhans cell histiocytosis. The patient was later diagnosed with acute myeloid leukemia at a follow-up visit several months later. Thus, it appears prudent to screen and follow-up adults with MRH, to identify an underlying malignant condition.

Cytological features of lobular carcinoma of breast: how important are the intracytoplasmic lumina?

Lobular carcinoma is the most common pitfall in the cytodiagnosis of breast lesions. Of the cytological features described intracytoplasmic lumina are stressed by many authors as an important diagnostic feature. The present study aims at evaluating the importance of intracytoplasmic lumina in the cytodiagnosis of lobular carcinoma along with other cytological features. Fine needle aspirates from 11 cases of histologically proven classical lobular carcinomas of breast were reviewed. It was observed that the low cellularity, dispersed dyscohesive small cells, mild pleomorphism, nuclear moulding and Indian filing were the most important cytologic features which aid in the diagnosis of lobular carcinoma where as intracytoplasmic lumina were of little significance.

Clinical profile and cervical cytomorphology in symptomatic postmenopausal women.

The atrophic changes in menopause reflected in cytology is known, but relevance of other features in menopausal management is relatively unknown. One hundred postmenopausal patients who presented with symptoms related to urogenital atrophy were studied (September 1999 - March 2000). Adequacy, density of inflammation with numerical scoring, specific pathogens and predominant cell type were assessed in each smear and correlated with presenting symptoms and duration of menopause. The most common presenting urinary symptom was dysuria followed by frequency and UTI. Smears of all patients showed inflammation, varying in intensity, irrespective of the presenting symptoms with a high incidence of candidiasis (12%). Three patients who had ASCUS on smears had carcinoma on follow up. Six patients who opted for HRT were followed up with cytology. Cytology in postmenopause can be used other than to assess hormonal status, to screen for malignancy, pathogens in inflammation and to monitor hormone replacement therapy.