Side scatter versus CD45 flow cytometric plot can distinguish acute leukaemia subtypes.

BACKGROUND & OBJECTIVES: Flow cytometry is an important tool to diagnose acute leukaemia. Attempts are being made to find the minimal number of antibodies for correctly diagnosing acute leukaemia subtypes. The present study was designed to evaluate the analysis of side scatter (SSC) versus CD45 flow dot plot to distinguish acute myeloid leukaemia (AML) from acute lymphoblastic leukaemia (ALL), with minimal immunological markers. METHODS: One hundred consecutive cases of acute leukaemia were evaluated for blast cluster on SSC versus CD45 plots. The parameters studied included visual shape, CD45 and side scatter expression, continuity with residual granulocytes/lymphocytes/monocytes and ratio of maximum width to maximum height (w/h). The final diagnosis of ALL and AML and their subtypes was made by morphology, cytochemistry and immunophenotyping. Two sample Wilcoxon rank-sum (Mann Whitney) test and Kruskal-Wallis equality-of-populations rank tests were applied to elucidate the significance of the above ratios of blast cluster for diagnosis of ALL, AML and their subtypes. Receiver operating characteristic (ROC) curves were generated and the optimal cut-offs of the w/h ratio to distinguish between ALL and AML determined. RESULTS: Of the 100 cases, 57 of ALL and 43 cases of AML were diagnosed. The median w/h ratio of blast population was 3.8 for ALL and 1 for AML (P<0.001). ROC had area under curve of 0.9772.The optimal cut-off of the w/h ratio for distinction of ALL from AML was found to be 1.6. INTERPRETATION & CONCLUSIONS: Our findings suggest that if w/h ratio on SSC versus CD45 plot is less than 1.6, AML may be considered, and if it is more than 1.6, ALL may be diagnosed. Using morphometric analysis of the blast cluster on SSC versus CD45, it was possible to distinguish between ALL and AML, and their subtypes.

HPLC-DAD quantification of mangiferin, antioxidant potential and essential oil composition of the leaves of five varieties of Mangifera indica L. of North India.

Mangifera indica L. (Mango), native of tropical Asia, has enormous genetic diversity. Comparative phytochemical analysis of leaves of five varieties of Mangifera indica viz. Dashahri, Chausa, Langra, Lucknow Safeda and Gola grown in North India was carried out. Mangiferin content (using HPLC) was found to vary from 0.96 g to 3.00 g per 100 g of dry leaves. Essential oil composition (through GC-MS) showed the major components of all the five varieties to be caryophyllene (4.14-46.26%), humulene (3.19-30.45%), caryophyllene oxide (2.98-17.23%) and humulene epoxide 2 (1.56-4.73%). Results indicated that there was a direct relationship between total phenolic and flavonoid contents and DPPH radical scavenging activities. Our studies indicate that M. indica leaves, which are a form of biomass waste, could be used as an economical and renewable source of antidiabetic compound mangiferin as well as other biologically active phytoconstituents having nutraceutical as well as pharmaceutical applications.

When Clinico-Morphological and Molecular Studies Tell Different Stories: A Case of Myelodysplastic Syndrome.

Myelodysplastic syndromes (MDSs) are clonal hematopoietic stem cell disorders characterized by cytopenias, dysplasia in one or more of the major myeloid cell lines, ineffective hematopoiesis, with cellular marrow, and risk for leukemic transformation. We present a case of a 66-year-old male with a history of multiple packed red blood cell (PRBC) transfusions. Routine investigations, bone marrow aspiration, and biopsy were done. The clinical and morphological findings raised suspicion of MDS with isolated del (5q), so cytogenetics was done. When cytogenetics was done, there was a big mismatch in finding between clinical, morphological, and molecular findings which brought a major change in prognosis as well as treatment. It is, therefore, very essential to not rely only on the clinical and morphological findings to reach a diagnosis. Molecular findings play a pivotal role to come to a final conclusion.

Sertoli-Leydig Cell Tumor of Ovary: A Rare Case Report with Heterologous Elements and Focal Marked Anaplasia.

Sertoli-Leydig cell tumor (SLCT) of the ovary is an extremely uncommon neoplasm accounting for <0.5% of all primary ovarian neoplasms. These tumors belong to the category of sex cord-stromal tumors. The tumor has variable clinical and histopathological presentations complicating the diagnosis and therefore the treatment. The presence of heterologous elements is seen in one-fifth of these already rare neoplasms. Herein, we report a case of a 28-year-old female presenting with irregular menses, features of virilization, and abdominal pain. Histopathological examination revealed marked focal anaplasia in this tumor of, otherwise, intermediate differentiation along with the presence of heterologous elements. Reporting of such elements is imperative for adequate treatment and deciding follow-up.

Right atrial extension of a giant retroperitoneal leiomyosarcoma.

Leiyomyosarcoma of vascular origin is uncommonly seen but mostly occurring in the inferior vena cava. We report a case of young male who presented with giant retroperitoneal leiyomyosarcoma which extended into the right atrium along Inferior vena cava.

Neurilemmoma of lateral nasal wall.

Neurilemmoma is a benign tumour of nerve sheath origin that can arise from myelinated nerve. The Head and neck is the most frequent site involved and other sites are scalp, face, oral cavity, pharynx, larynx, trachea and ear. Neurilemmoma usually occur as solitary lesions and in association with NF type 2. Malignant transformation is very rare. We report a case of 18 year old male presented with complaint of nasal obstruction and swelling in right side of nose. We discuss the clinical presentation, histologic features, and therapeutic options for such a rare benign lesion.

Trichofolliculoma presenting as lobulated mass: a rare presentation.

Trichofolliculoma represents abortive differentiation of pluripotent skin cells toward hair follicles. We present a case of an adult female with lobulated mass involving the tip and dorsum of the nose for the last 15 years. The systemic and radiological examinations were noncontributory. The clinical diagnosis was thought to be dermoid cyst. The fine-needle aspiration cytology of the lobulated mass was performed, and the cytology smears showed anucleate squames admixed with sebaceous cells. The possibility of a benign skin adnexal lesion was suggested. The biopsy was done, and the final diagnosis of trichofolliculoma was made. The wide local excision of the mass was performed, and no recurrence was noted during the follow-up of 1 year.

Angioleiomyoma of the forearm.

Angioleiomyoma is a benign tumor of vascular smooth muscle origin. Although many factors have been implicated in its pathogenesis, presence of lipometaplasia suggests its hamartomatous nature. This tumor presents as a painful nodular mass in extremities. Thus angioleiomyoma should be considered as a differential diagnosis of any solitary painful mass of forearm. Herein we report a case of 37-years-old female presenting with a slow growing mass in the right forearm. Histopathological and immunohistochemical examination confirmed the diagnosis of angioleiomyoma.