Leukemic Pleural Effusion In Aml-M0: Unusual Presentation

Extramedullary disease in AML-M0 is a rare occurrence. It is even rarer to encounter breathlessness as primary presenting complaint secondary to a leukemic pleural effusion. Leukemic pleural effusion occurs rarely in acute myeloid leukemia (AML) with minimal differentiation. Patients with AML usually present with weakness, hemorrhage, and recurrent infections. The highest incidence of extramedullary leukemic manifestation is seen in monocytic AML. Here, we report the case of an 18-year-old male who presented withbreathlessness and vocal cord palsy. Examination and investigation established diagnosis of an acute myeloid leukemia M0 with leukemic pleural effusion

Morphological Typing of Lymphomas with Immunohistochemistry.

Lymphoid malignancies (LM) are a heterogeneous group of disorders that are broadly divided into Hodgkin disease (HD) and Non-Hodgkin Lymphoma (NHL). Diagnosing lymphoid malignancies based on morphology in conjunction with immunohistochemistry (IHC) forms the basis of WHO classification and this has prognostic implications.With this background this study was designed thus including all the lymphoid malignancies both NHL and HD. Materials and Methods: This study was conducted at a tertiary centre in Uttarakhand and included a total of 116 cases of lymphoid malignancies. Of these 41 cases were of Hodgkin disease and 75 cases were of NHL. These cases were initially diagnosed on morphology employing Hematoxylin and Eosin (H&E) and special stains like Reticulin. Subsequently, a preliminary panel of monoclonal antibodies using CD3, CD15, CD20, CD30, and CD45 were employed. All the cases were then classified using WHO classification. Results: HD- Of the 41 cases of Hodgkin’s disease the commonest subtype was Nodular Sclerosis seen in 26 cases (48.78%). Reed Sternberg in reactive milieu is diagnostic of Hodgkin disease. In all cases except one Reed Sternberg cells exhibited positivity for both CD15 and CD30. NHL – Of the 75 cases of NHL an initial classification based on morphology was done. All the cases were classified according to International Working Formulation initially. Subsequently, IHC was employed using CD3, CD15, CD20 and CD45. The disease was then classified according to WHO classification and broadly divided into B or T cell types. B cell expression was seen in 60 cases (80%) and T cell expression in 15 cases (20%). The commonest B cell subtype was Diffuse Large B cell Lymphoma (26.4%).

Ewing’s Sarcoma of Zygomatic Bone.

Ewing’s sarcoma is an uncommon malignancy usually arising from the skeletal system particularly pelvic bones and long bones of lower extremities and mostly affecting children and young adults. Its occurrence in the maxillofacial region with soft tissue involvement is struck with rarity. It carries a poor prognosis due to its uncontrolled potential for metastatic spread; therefore an early and integrated treatment approach must be adopted to improve patient’s long term survival.

Ectopic Thyroid Tissue Co-Existing with a Eutopic Thyroid.

Ectopic thyroid tissue, a developmental defect of thyroid gland, is met with rarity in day to day clinical practice. The diagnosis of ectopic thyroid demands a meticulous clinical examination and use of different imaging modalities. We are here reporting a case which presented as an anterior neck swelling, moving with deglutition, and also on and off dysphagia. After necessary investigations she underwent surgery and then the diagnosis of ectopic thyroid was made which was later confirmed with biopsy report which was suggestive of lymphocytic thyroiditis.

Primary Nasopharyngeal Tuberculosis.

Tuberculous infection of the upper respiratory tract is an uncommon clinical condition and in that nasopharyngeal involvement is struck with rarity per se. This condition is often prevalent in people of low socioeconomic strata living in endemic areas, especially in developing countries. It has a silent and indolent course and most commonly mimicks nasopharyngeal carcinoma in its clinical presentation. In absence of concurrent pulmonary involvement, it is often misdiagnosed or diagnosed only after the biopsy has been taken. Nevertheless, high index of suspicion is required on part of the clinician to diagnose this comparatively rare entity.

Comparative Analysis of the Distribution of Various Subtypes of Lymphoid Malignancies in Uttarakhand with other Regions in India.

Lymphoid malignancies (LM) form an umbrella term comprising both Hodgkin Disease (HD) and Non Hodgkin Lymphoma (NHL). A number of studies conducted in India and worldwide suggests that the disease exhibits similar pattern with contrasting regional variations. Examining regional variations is important as it may provide an insight to the etiological factor and pathogenesis of the disease. Aim: The aim of our study was to investigate the current pattern of lymphoid malignancies both HD and NHL in Uttarakhand and subsequently compare the results with other regions. Materials and Methods: We analyzed 116 cases of Lymphoid Malignancies that were reviewed over a period of 18 months. Both HD and NHL were diagnosed morphologically and then Immunohistochemistry (IHC) using CD3, CD15, CD20, CD30, and CD45 was employed to further subtype disease according to current WHO classification. Results: The lymphoid malignancies were further subdivided into HD and NHL. Nodular Sclerosis (NS) was the dominant subtype of HD in Uttarakhand (48.78%) and was comparable with results from other regions. Statistical analysis regarding distribution of various subtypes of HD in Uttarakhand and its comparison with three distinct geographical regions also showed p value < 0.241832 which was not statistically significant. However, amongst NHL Diffuse Large B cell Lymphoma (DLBCL) (54.66%) was the commonest subtype. Besides, a significant number of cases of Anaplastic Large Cell Lymphoma (12%) were also observed. Furthermore, statistical analysis showed that the distribution of various subtypes of NHL in Uttarakhand when compared to three distinct geographical regions was statistically significant (P value < 0.002808). Conclusion: Geographic differences in the incidence and histologic subtypes of Lymphomas do exist.

Tuberculous Otitis Media.

Considerable variation exists between the clinical presentation of tuberculous otitis media (TOM) seen nowadays and what was described earlier. Confusing clinical picture and subsequent delay in diagnosis of TOM permits it to progress unhindered and results in permanent disabling conditions like facial paralysis and profound hearing loss. Hence an early diagnosis of TOM and timely commencement of appropriate therapy remains a challenging task. A high index of suspicion is required on part of the clinician to diagnose this fabled entity.