Malignant Melanoma in the Groin Masquerading as a Vascular Tumour: A Rare Cytodiagnosis.

Malignant melanoma (MM) is an aggressive cutaneous neoplasm tending to metastasise anywhere within the body. It frequently metastasises to the draining lymph nodes. A distinct presentation of MM occurs when metastatic lesions appear in the regional lymph nodes, while the primary tumour remains clinically undetected. Fine needle aspiration cytology (FNAC) is highly sensitive, rapid, and cost-effective. The utility of the FNAC procedure is well established in the patient's diagnostic workup. However, the Indian data on the cytodiagnosis and cytomorphology of metastatic MM are very scarce. We submit a clinicopathological profile of a rare case in a 68-year-old male, where FNAC from an inguinal mass led to the diagnosis of metastatic MM, which mimicked clinically as a vascular tumour. The present case highlights MM's unusual clinical presentation and cytomorphological details through FNAC.

Coexistence of Monoclonal Gammopathy and Hemolysis in Chronic Lymphocytic Leukemia: Unveiling a Rare Case.

In B-cell malignancies, there is a periodic presence of monoclonal gammopathies. In a notable multitude of cases with chronic lymphocytic leukemia (CLL), a cluster of antigen-inciting B-cells sometimes shows the presence of monoclonal gammopathy and autoimmune hemolysis simultaneously. The detection of monoclonal proteins or light chains in urine and/or serum is significantly increased in cases of CLL and can be identified using highly sensitive laboratory methods, such as serum protein electrophoresis. Hemolysis in these patients can be detected by the direct Coombs test (DCT). Several scientific research data indicate that the findings of hemolysis and the presence of monoclonal proteins have an adverse impact on the survival of patients. Nevertheless, there is no perspicuous proof to indicate the prognostic importance of hemolysis and monoclonal gammopathy in patients with CLL, even though monoclonal proteins and hemolysis in CLL generally occur at prevalences of 60%-80% and 5%-10%, respectively, very few cases have been reported in the literature. Owing to the peculiarity, we report a case of CLL diagnosed in 2023. The 66-year-old woman had developed the progressive disease along with the existence of monoclonal gammopathy and hemolysis. Although the manifestation of both findings could be due to the use of highly sensitive methods, it may also be attributable to an autoimmune process or progression from similar or distinct B-cell clones.

Cytodiagnosis of Basal Cell Adenoma of Parotid Gland: A Rare Case Report.

Basal cell adenoma is a rare benign neoplastic lesion of the parotid gland, therefore it is rarely diagnosed in preoperative work-up by fine needle aspiration cytology. This distinctive entity being regarded as one of the scarce salivary neoplasms is predominantly perceived in the female population, but is uncommon in young adults. It is extremely challenging to diagnose basaloid tumors predominantly basal cell adenoma of the salivary gland on cytopathology. Therefore present case report describes the fine needle aspiration cytology diagnosis of basal cell adenoma in the left parotid gland in a 40-year-old female. The case report also describes the cytomorphological characters, the cytological differential diagnoses and immunohistochemistry of basal cell adenoma.

Navigating uncertain illness trajectories for young children with serious infectious illness: a modified grounded theory study.

BACKGROUND: Infectious illness is the biggest cause of death in children due to a physical illness, particularly in children under five years. If mortality is to be reduced for this group of children, it is important to understand factors affecting their pathways to hospital. The aim of this study was to retrospectively identify organisational and environmental factors, and individual child, family, and professional factors affecting timing of admission to hospital for children under five years of age with a serious infectious illness (SII). METHODS: An explanatory modified grounded theory design was used in collaboration with parents. Two stages of data collection were conducted: Stage 1, interviews with 22 parents whose child had recently been hospitalised with a SII and 14 health professionals (HPs) involved in their pre-admission trajectories; Stage 2, focus groups with 18 parents and 16 HPs with past experience of SII in young children. Constant comparative analysis generated the explanatory theory. RESULTS: The core category was 'navigating uncertain illness trajectories for young children with serious infectious illness'. Uncertainty was prevalent throughout the parents' and HPs' stories about their experiences of navigating social rules and overburdened health services for these children. The complexity of and lack of continuity within services, family lives, social expectations and hierarchies provided the context and conditions for children's, often complex, illness trajectories. Parents reported powerlessness and perceived criticism leading to delayed help-seeking. Importantly, parents and professionals missed symptoms of serious illness. Risk averse services were found to refer more children to emergency departments. CONCLUSIONS: Parents and professionals have difficulties recognising signs of SII in young children and can feel socially constrained from seeking help. The increased burden on services has made it more difficult for professionals to spot the seriously ill child.

A systematic review of the organizational, environmental, professional and child and family factors influencing the timing of admission to hospital for children with serious infectious illness.

BACKGROUND: Infection, particularly in the first 5 years of life, is a major cause of childhood deaths globally, many deaths from infections such as pneumonia and meningococcal disease are avoidable, if treated in time. Some factors that contribute to morbidity and mortality can be modified. These include organisational and environmental factors as well as those related to the child, family or professional. OBJECTIVE: Examine what organizational and environmental factors and individual child, family and professional factors affect timing of admission to hospital for children with a serious infectious illness. DESIGN: Systematic review. DATA SOURCES: Key search terms were identified and used to search CINAHL Plus, Medline, ASSIA, Web of Science, The Cochrane Library, Joanna Briggs Institute Database of Systematic Review. STUDY APPRAISAL METHODS: Primary research (e.g. quantitative, qualitative and mixed methods studies) and literature reviews (e.g., systematic, scoping and narrative) were included if participants included or were restricted to children under 5 years of age with serious infectious illnesses, included parents and/or first contact health care professionals in primary care, urgent and emergency care and where the research had been conducted in OECD high income countries. The Mixed Methods Appraisal Tool was used to review the methodological quality of the studies. MAIN FINDINGS: Thirty-six papers were selected for full text review; 12 studies fitted the inclusion criteria. Factors influencing the timing of admission to hospital included the variability in children's illness trajectories and pathways to hospital, parental recognition of symptoms and clinicians non-recognition of illness severity, parental help-seeking behaviour and clinician responses, access to services, use and non-use of 'gut feeling' by clinicians, and sub-optimal management within primary, secondary and tertiary services. CONCLUSIONS: The pathways taken by children with a serious infectious illness to hospital are complex and influenced by a variety of potentially modifiable individual, organisational, environmental and contextual factors. Supportive, accessible, respectful services that provide continuity, clear communication, advice and safety-netting are important as is improved training for clinicians and a mandate to attend to 'gut feeling'. IMPLICATIONS: Relatively simple interventions such as improved communication have the potential to improve the quality of care and reduce morbidity and mortality in children with a serious infectious illness.