Intravascular papillary endothelial hyperplasia: Olanzapine-induced vascular proliferation?

Intravascular papillary endothelial hyperplasia (Masson's tumor) is a reactive vascular lesion of obscure etiopathogenesis, often seen in the head and neck. Its presentation as a scalp swelling, however, is extremely uncommon. We describe the first report in an adult, being treated for bipolar illness. A young male presented with a right frontotemporal scalp swelling since 3 weeks. He was also being treated for bipolar illness with olanzapine. Examination revealed a soft, non-pulsatile swelling. After inconclusive aspiration results, a complete excision was performed. Histopathology revealed proliferating endothelial cells arranged as papillary fronds confined to vessel lumina, devoid of atypia, accompanied by thrombosed vessels facilitating a diagnosis of Masson's tumor. The patient is free of recurrence five months after surgery. Further studies on a possible effect of olanzapine on vascular proliferation in experimental in vivo and in vitro models would definitely aid in elucidating clinical relevance, if any.

Erythrophagocytosis in a patient with B-cell acute lymphoblastic leukemia with t(12;21) (p13.2; q22.1); ETV6-RUNX1: Case report and review of the literature

Erythrophagocytosis (EP) is extremely rare in de novo acute lymphoblastic leukemia (ALL). We document a rare case, which in addition, showed extensive blast vacuolization. A detailed literature review has also been incorporated with the aim of unraveling the prognostic import of our morphological observations if any. A five-year-old male presented with fever and progressive pallor for 1 month. He had hepatosplenomegaly and bicytopenia. Peripheral smear examination showed 43% blasts. Nuclear and cytoplasmic vacuolations were seen in 75% blasts and EP in 4% blasts. The blasts showed block positivity on periodic acid-Schiff (PAS) stain. Marrow aspirate smears showed 58% blasts displaying a similar morphology. Flow cytometry showed features of a common acute lymphoblastic leukemia antigen (CALLA) positive B-cell ALL with aberrant, dim CD 33 expression in 53.4% of the gated blasts. Fluorescence in situ hybridization showed translocation (12; 21) (p13;q22). The patient responded well to standard induction therapy. To conclude, EP is rarely seen in de novo ALL and is associated with a favorable translocation, t(12;21).

Sickle cell disease presenting in the third trimester of pregnancy: Delayed detection heralding a public health problem?

We report the case of a 22-year-old primigravida detected as having sickle cell disease (SCD), initially presenting in the third trimester (30th week) of pregnancy. The patient came to our center with a complaint of severe lower limb pain. The peripheral smear showed marked anisopoikilocytosis, numerous leptocytes, sickle cells, and target cells. High-performance liquid chromatography corroborated the diagnosis of SCD, showing a significant peak in the sickle window. The patient was conservatively managed and delivered a healthy baby through normal vaginal delivery. Delayed presentation of SCD in the third trimester of pregnancy is unusual. This report aims to bring attention to the possible causes of such a lag in detection. We also suggest measures to refine the antenatal healthcare screening at multiple levels, with regard to the detection of sickle cell hemoglobinopathy.

Composite pleomorphic xanthoastrocytoma-ganglioglioma; assessing and addressing the dilemma of differential expression of neuronal markers: Case report with diagnostic perspective

We report the case of a 5-year-old male child presenting with seizures for 4 months. Magnetic resonance imaging (MRI) revealed a cortical-based solid cystic lesion in the right parietal lobe. Histopathological examination showed a tumour comprised of spindled glial fibrillary acid protein (GFAP) positive neoplastic cells interspersed with bizarre pleomorphic cells showing nuclear pseudoinclusions and intermingled dysplastic ganglion cells variably immunopositive for synaptophysin, chromogranin, Neu-N and immunonegative for neuron filament protein (NFP). This report highlights the occurrence of the rare composite pleomorphic xanthoastrocytoma-ganglioglioma and the vagaries of immunohistochemical analysis in highlighting neuronal differentiation in such a case setting. In addition, to the best of our knowledge this is the youngest patient till date to present with this entity.

The clinical spectrum of neurocysticercosis in the Uttaranchal region.

OBJECTIVES: To study the clinical and radiological spectrum of neurocysticercosis in the Uttaranchal region. METHODS: A total of 592 patients of neurocysticercosis attending various health camps, medical outdoor and indoor department were studied for their clinical and radiological presentation. RESULTS: Out of the total 15,000 patients screened, 592 patients (3.94%) were found to be suffering from neurocysticercosis. Majority of them were in the age group of 21-30 years. Most of them presented with generalized seizures (62.5%), others had headache (37.5%), focal seizures (20.8%), localizing neurological signs (16.6%), meningitis (4.1%), and dementia (1.3%). Radiologically, parenchymal lesions were most prevalent (81%). However, interventricular lesions were also not very uncommon (32%). Most of them had single lesions (53.5%), 26.7% had multiple lesions and 0.7% had midline shift. Significantly, large number of patients were vegetarians (39%); only 17.6% were pork eaters while the remaining 82.4% never had pork in their meals. CONCLUSION: We believe that such high percentage is at least a rough indicator of high incidence and prevalence of neurocysticercosis in the Uttaranchal region. They had wide range of clinical and radiological presentation. Small number of pork eaters and a significant number of vegetarians suggest other modes of transmission and needs further evaluation.

Value of DOPEG estimation in CSF in depression.

3,4-Dihydroxyphenyl ethylene glycol (DOPEG), a metabolite of noradrenaline (NA), was estimated in CSF of 30 patients of depression diagnosed by the criteria of American Psychiatric Association in DSM-III; and compared with levels in 10 non-depressed individuals who served as controls. Mean DOPEG levels in CSF in the patient group (801.37 +/- 28.09 micrograms/l) were significantly higher (P less than 0.01) than those in the control group (724.3 +/- 34.62 micrograms/l). Formation of excessive amount of this particular metabolite suggests an excessive intraneuronal deamination of NA, partially accounting for the overall decline in the availability of NA in the noradrenergic neurons in patients of depression.