Bone marrow metastasis in nonhematological malignancies: A study from tertiary care center.

Introduction: Metastatic cancer presents a treatment challenge to clinicians, particularly for patients with bone marrow infiltration. For tumor staging, therapy selection, and prognosis risk stratification, the status of the bone marrow should be known for the presence or absence of metastasis. The study aimed to evaluate the hematological findings and comprehensive analysis of bone marrow in cases of nonhematological malignancies with bone marrow metastasis. Materials and Methods: This retrospective study comprised a record retrieval of the departmental archives for the past 6 years. A total of 331 patients with nonhematological malignancies were found, of whom 31.42% (104/331) showed bone marrow metastasis. An integrated clinical approach with bone marrow examination findings and immunohistochemistry whenever necessary was used to achieve a definitive diagnosis of bone marrow metastasis. Results: Among the study population, 31.42% (104/331) of patients had nonhematological malignancies that metastasized to the bone marrow. Most of the patients with bone marrow metastasis had anemia, which was found in 77.88% (81/104) of the cases. Leukoerythroblastic reaction was noted in 31.73% (33/104) of the cases, and thrombocytopenia was found in 25% (26/104) of the cases. The most common malignancy with bone marrow metastasis in adults was prostatic adenocarcinoma (28.1%) (9/32) and in pediatric cases, neuroblastoma (53.9%) (52/98). Conclusions: It is essential to diagnose nonhematological malignancies that have metastasized to the bone marrow since this necessitates tumor staging, therapy selection, and prognosis risk stratification. To conclude, not a single hematological parameter is predictive of bone marrow metastasis; however, unexplained anemia, a leukoerythroblastic blood picture, and thrombocytopenia in peripheral blood should raise suspicion for bone marrow metastasis in cases of nonhematological malignancies.

Résumé Introduction: Le cancer métastatique présente un défi de traitement pour les cliniciens, en particulier pour les patients présentant une infiltration de moelle osseuse. Pour la stadification tumorale, la sélection du traitement et la stratification du risque de pronostic, l'état de la moelle osseuse doit être connu pour la présence ou l'absence de métastases. L'étude visait à évaluer les résultats hématologiques et l'analyse complète de la moelle osseuse dans les cas de tumeurs malignes non hématologiques avec métastases de la moelle osseuse. Matériel et méthodes: Cette étude rétrospective comprenait une récupération des archives ministérielles des 6 dernières années. Un total de patients atteints de tumeurs malignes non hématologiques ont été trouvés, dont 31,42% (104/331) présentaient des osmétastases médullaires. Une approche clinique intégrée avec les résultats de l'examen de la moelle osseuse et l'immunohistochimie chaque fois que nécessairea été utilisé pour établir un diagnostic définitif de métastases médullaires. Résultats: Dans la population étudiée, 31,42 % (104/331) des patients présentaient des tumeurs malignes non hématologiques qui se métastasaient à la moelle osseuse. La plupart des patients atteints de métastases de la moelle osseuse présentaient une anémie, qui a été trouvée dans 77,88% (81/104) des cas. Une réaction leucoérythroblastique a été observée dans 31,73 % (33/104) des cas, et une thrombocytopénie a été observée dans 25 % (26/104) des cas. La tumeur maligne la plus fréquente associée aux métastases de la moelle osseuse chez l'adulte était l'adénocarcinome de la prostate (28,1 %) (9/32) et, chez les enfants, le neuroblastome (53,9 %) (52/98). Conclusions: Il est essentiel de diagnostiquer les tumeurs malignes non hématologiques qui ontmétastasé à la moelle osseuse car cela nécessite une stadification tumorale, une sélection thérapeutique et une stratification du risque de pronostic. Pour conclure, pas un seul paramètre hématologique n'est prédictif des métastases de la moelle osseuse; Cependant, une anémie inexpliquée, une image sanguine leucoérythroblastique et une thrombocytopénie dans le sang périphérique devraient faire suspecter des métastases de la moelle osseuse en cas de tumeurs malignes non hématologiques. Mots-clés: Aspiration de moelle osseuse, biopsie de la moelle osseuse, métastases de la moelle osseuse, résultats hématologiques, immunohistochimie, tumeurs malignes non hématologiques, frottis sanguin périphérique.

Solitary superficial angiomyxoma of the ear pinna: a diagnostic dilemma with a review of literature.

Superficial angiomyxoma is an extremely rare subcutaneously placed myxoid soft tissue neoplasm. There are few case reports with fine needle aspiration cytological and histopathological findings available for this tumor because of its rarity. Here, we describe a case of superficial angiomyxoma in a 24-year-old girl who had a solitary left ear pinna mass without a Carney's complex at the time of presentation or at the end of two years of follow-up next to the surgical removal of the tumor. The clinical, cytomorphological, and histological findings, together with the immunohistochemical markers, in a case of superficial angiomyxoma are described in this rare case report for the first time in the English literature.

Study of Hemato-morphological Features in Neuroblastoma Infiltrating Marrow.

Objective Neuroblastoma typically affects children within the first 5 years of life and accounts for 10% of all pediatric malignancies. Neuroblastoma at onset may manifest as a localized or metastatic illness. The aim of this study was to identify hematomorphological features in neuroblastoma infiltrating marrow as well as to ascertain the prevalence of bone marrow infiltration in neuroblastoma. Materials and Methods This retrospective study included newly diagnosed 79 cases of neuroblastoma, which were referred for bone marrow examination for the staging of the disease. Medical records were retrieved to acquire hematomorphological findings of peripheral blood and bone marrow smears. Statistical Package for Social Sciences, IBM Inc., USA, version 21.0 was used to analyze the data. Results The interquartile age range of neuroblastoma cases was 24.0 to 72.0 months (median = 48 months) with a male to female ratio of 2.7:1. Also, 55.6% (44/79) of cases in the study population showed evidence of marrow infiltration. The bone marrow infiltration was significantly linked to thrombocytopenia ( p = 0.043) and nucleated red blood cells ( p = 0.003) in peripheral blood. The bone marrow smears of cases with infiltration showed a significant shift to the left in the myeloid series ( p = 0.001) and an increased number of erythroid cells ( p = 0.001). Conclusion For neuroblastoma patients, a diligent, exhaustive search for infiltrating cells in bone marrow is advised if thrombocytopenia or nucleated red blood cells are identified on a peripheral blood smear and bone marrow smears showed myeloid left shift with an increased number of erythroid cells.

Lower lip cysticercosis: An unusual case report.

Cysticercosis is a disease that occurs when humans are infected with Taenia solium larvae. The parasitic illness cysticercosis, which is common in impoverished nations, hardly ever affects the mouth. Oral cysticercosis is rare that might be challenging to diagnose clinically. This rare case report documents an oral cysticercosis case in a 38-year-old male patient who had an asymptomatic lesion in the buccal mucosa of his lower lip. A T. solium larva was identified on histopathological examination in a cystic cavity after an excisional biopsy.

Primary Pure Intrarenal Yolk Sac Tumor in 1.5-Year-Old Boy-A Rare Case Report.

Germ cell tumors primarily arise in gonads and extragonadal germ cell tumors, an uncommon entity, originates usually along the midline. Here, we report the fifth example of intrarenal pure yolk sac tumor in a 1.5-year-old boy who presented with abdominal pain and underwent excision of the mass for suspected Wilms tumor. On histopathology and immunohistochemistry, a diagnosis of a yolk sac tumor was rendered. Postoperative serum alpha-fetoprotein levels were 21 000 ng/dl. The purpose of this report is to emphasize the importance of suspecting a germ cell tumor as one of the differential diagnoses of a suspected case of Wilms tumor and the significance of evaluating serum alpha-fetoprotein levels preoperatively.

RUFY1 binds Arl8b and mediates endosome-to-TGN CI-M6PR retrieval for cargo sorting to lysosomes.

Arl8b, an Arf-like GTP-binding protein, regulates cargo trafficking and positioning of lysosomes. However, it is unknown whether Arl8b regulates lysosomal cargo sorting. Here, we report that Arl8b binds to the Rab4 and Rab14 interaction partner, RUN and FYVE domain-containing protein (RUFY) 1, a known regulator of cargo sorting from recycling endosomes. Arl8b determines RUFY1 endosomal localization through regulating its interaction with Rab14. RUFY1 depletion led to a delay in CI-M6PR retrieval from endosomes to the TGN, resulting in impaired delivery of newly synthesized hydrolases to lysosomes. We identified the dynein-dynactin complex as an RUFY1 interaction partner, and similar to a subset of activating dynein adaptors, the coiled-coil region of RUFY1 was required for interaction with dynein and the ability to mediate dynein-dependent organelle clustering. Our findings suggest that Arl8b and RUFY1 play a novel role on recycling endosomes, from where this machinery regulates endosomes to TGN retrieval of CI-M6PR and, consequently, lysosomal cargo sorting.

Prostate Tuberculosis Masquerading as Prostate Carcinoma: A Rare Case Report.

Genitourinary tuberculosis (GUTB), the second most frequent type of extrapulmonary tuberculosis (TB) in endemic regions, was initially described by Wildbolz in 1973. The prostate and epididymis are the first sites of male genital tuberculosis, followed by the seminal vesicles and the testicles. Here, we describe a case of a 65-year-old male who presented with obstructive lower urinary tract symptoms (LUTS) for the previous six weeks. The digital rectal examination revealed prostatic enlargement with a firm and nodular surface. A high prostate-specific antigen level (88 ng/ml) was found in serum analysis. There was a suspicion of prostate cancer on the basis of clinical, radiological, and serological examination. In view of the suspicion of carcinoma, a prostate biopsy was performed, which revealed the proliferation of prostatic glandular and stromal elements with interspersed granulomas, necrosis, and aggregates of mature lymphoid cells. The histopathology findings were indicative of benign prostatic hyperplasia with granulomatous prostatitis. Ziehl-Neelsen (ZN) stain was negative for acid-fast bacilli. The cartridge-based nucleic acid amplification test (CBNAAT) for Mycobacterium tuberculosis was ordered on the prostate biopsy tissue bits, which showed positive results. On the basis of histopathology and nucleic acid amplification test, the diagnosis of prostate tuberculosis was considered. There are no specific clinical and radiological findings related to prostate tuberculosis; hence, the diagnosis can be established only after histopathological examination and tissue-based cartridge-based nucleic acid amplification test. Clinicians should have a high index of suspicion for tuberculosis, especially in patients from endemic countries who present with symptoms of the lower urinary tract, especially if there is granulomatous inflammation coupled with necrosis.

Histological Spectrum of Post Covid Debridement Tissues: Salient Histomorphological Features With Respect to Identification Fungal Elements.

Background: Secondary bacterial and fungal infections in COVID patients have been documented during current pandemic. The present study provides detailed account of histomorphology of debridement tissue received for suspected fungal infections. The primary objective was to determine the morphological characteristics that must be recognized for the identification of fungal hyphae. Methods: The detailed histological examination of debridement tissue was performed. Demographic and clinical findings with treatment provided was recorded. Presence or absence of necrosis and lecocytoclasis was noted. Results: A total of 110 cases of debrided tissues were included in the study. Eosinophilic granular necrosis with lecocytoclasis was observed in 103cases; fungal elements were identified in 89.3% (92/103) of these. Eleven cases where necrosis was observed, strong suspicion of fungus was reported, 6 of them displayed fungus on KOH preparation, 3 on repeat biopsy. However, in 2 of these cases, neither KOH nor repeat biopsies identified the fungus. Mucor with aspergillus was observed in 7 cases and actinomyces in 3. In all these 10 cases dense fungal colonies were evident. In 7 cases careful observation revealed fruiting bodies of aspergillus. Cotton ball appearance of actinomyces was evident. Mucor infection in current disease was so rampant that aseptate ribbon like branching mucor hyphae were evident on H&E sections. Diabetes was significantly associated with fungal infection (97.2%; 70/72; P < .005). 90% [19/21] of the patients who were on room air and diagnosed with fungal infection were diabetic. Conclusions: Eosinophilic granular necrosis with the presence of neutrophilic debris in a case of suspected fungal disease suggests the presence of fungal elements. This warrants processing of the entire tissue deposited for examination, careful observation, application of fungal stains, and repeat biopsy if clinical suspicion is strong. Moreover, uncontrolled diabetes is more frequently associated with secondary fungal infection in COVID patients as compared to oxygen therapy.