The urgency of Burkitt lymphoma diagnosis in fluid cytology-A tertiary care experience.

BACKGROUND: Burkitt lymphoma (BL) is an aggressive high-grade B-cell non-Hodgkin lymphoma commonly diagnosed in young age and is known to involve extra nodal sites. But the involvement of body fluids by BL is an uncommon presentation. Rapid diagnosis of BL is vital to prevent complications like tumour lysis syndrome. Cytological examination of body fluids continues to be an indispensable tool for rapid diagnosis of BL. OBJECTIVES: In this study, we aim to study the clinical, cytomorphological and immunophenotypic characteristics of BL involving serous effusions and other fluids. MATERIALS AND METHODS: In this retrospective study, 17 cases reported as BL in fluid cytology from 2016 to 2022 were collected and reviewed. We performed a comprehensive analysis of the clinical data, cytomorphological features, immunophenotyping data along with the haematological workup of these cases. We have also compared with the histopathological diagnosis for those cases where biopsy was available. RESULTS: BL more commonly involved ascitic fluid (52%), followed by pleural fluid (4 cases) and cerebrospinal fluid (CSF; 4 cases). Primary diagnosis of BL in fluid was done in 88% of the cases. Bone marrow involvement was noted in two cases. Cytological smears showed discrete monomorphous population of medium-sized atypical lymphoid cells with frequent apoptotic bodies. Classic cytoplasmic punched out vacuoles were observed in 88% of the cases. Immunophenotyping data was available for 12 cases in which tumour cells showed positivity for CD20 (100%), CD10 (4 of 7 cases), BCL6 (3 of 5 cases) and cMYC (7 of 7 cases-100%) and were negative for Terminal deoxynucleotidyl transferase (TdT) (11 of 11 cases). Mean Ki67 labelling index was 95%. Histopathological diagnosis was available for 9 cases, and there was 100% agreement between cytological and histopathological diagnosis in 7 cases. CONCLUSION: Precise diagnosis of BL can be rendered in body fluids by identification of classic cytomorphological features and by performing supportive ancillary tests in fluids for immunophenotyping.

Schwannoma of Nasopharynx-A Rare Case with A Complex Presentation.

Nasopharyngeal tumors are rare, and schwannomas originating from this location are extremely uncommon. Schwannomas are tumors arising from the Schwann cells of peripheral nerve sheath which are neuroectodermal in origin. These are benign, slow growing, well-encapsulated tumors and are mostly seen in the head and neck region. We present a rare case of schwannoma with nasopharynx as its epicenter in an elderly female patient who presented with complaints of hematemesis, bilateral nasal obstruction and stertorous breathing. Diagnostic nasal endoscopy revealed a smooth mucosa covered globular mass occupying bilateral choana. Contrast-enhanced computed tomography of Nose and paranasal sinuses revealed a homogenous mass occupying the entire nasopharynx extending into the nasal and oropharyngeal cavities. The patient underwent Trans-nasal Endoscopic excision under general anesthesia. Nasopharyngeal tumors have a wide range of presentation and a high index of clinical suspicion combined with imaging modalities is required for diagnosis and pre operative planning. Some tumors can cause life-threatening airway obstruction due to delayed presentation and should be managed efficiently and meticulously, with endoscopic excision being a viable approach for cases confined within the nasopharynx.

Malignant phyllodes tumor with liposarcomatous differentiation: Diagnosed on cytology.

Phyllodes tumor (PT) accounts for less than 1% of all primary tumors of the breast and 2% to 3% of all fibroepithelial lesions. We report a case of heterologous liposarcomatous elements in a malignant PT of the breast on Fine needle aspiration cytology (FNAC) and later confirmed by histopathological examination. A 58-years-old woman presented with a huge breast mass for which FNAC was done. Cytology showed features of malignant PT with a good representation of heterologous liposarcomatous areas. The cytological findings were in concordance with the histologic features. Malignant PT and its various heterologous elements of stroma can be diagnosed on FNA cytology when performed optimally. They can be vital for the preoperative assessment of patients suspected with malignancy to formulate the surgical plan accordingly.

Extending the critical aspects of the water access indicator using East Africa as an example.

The United Nations has declared 2005-2015 the Fresh Water Decade in which more people than ever before will gain access to water. Despite acknowledging that water quantity is important to health, so far only water quality is used in monitoring the Millennium Development Goals. This study examines the changes in national access figures when both water quality and quantity are taken into account to determine access. Using East Africa as an example shows that the number of people with access to water for the region decreased by 9% (7% urban and 10% rural). The largest difference in access is observed in Eritrea 25% (11% urban and 36% rural). Reduction is higher in rural areas. However, significant reduction in access is also observed in urban Ethiopia (14%). In conclusion, the indicators for access to water would be better articulated by adding water quantity to the indicator which currently only includes water quality, while the Demographic Health Survey and Multiple Indicator Cluster Survey routinely collects information on both aspects.

Improving the food environment in UK schools: policy opportunities and challenges.

Childhood obesity and nutrition are high on the UK policy agenda because of their association with chronic illnesses and related costs. In 2007, to improve children's nutrition, the Government introduced new standards for all school food sources, including products sold from vending machines. Our research explores the factors influencing schools' decisions and children's food choices in relation to vending machines. We conducted in-depth interviews with staff and pupils in one English Local Education Authority. We found that pupils made food decisions based on cost considerations, and convenience, and they strongly valued individual choice. Schools' decisions to provide vending were influenced predominantly by fiscal and structural constraints. Although unhappy with the current quality of school food, staff and pupils criticised initiatives to restrict unhealthy foods. It appears that achieving a healthier school environment is a long-term project involving multiple strategies of education and incentives, as well as regulation. These must involve parents as well as pupils and schools.