Large atypical lipomatous tumour of the neck with mediastinal extension managed by transcervical excision.

Tumours of adipose tissue origin are relatively rare in the head and neck. Here, we report a case of an unfamiliar lipomatous lesion that involved the neck and mediastinum. A nil-comorbid man in his 40s presented with a slowly progressive anterior neck swelling of 3 years, which was diagnosed as lipoma by histopathological sampling. Computed tomography demonstrated the lesion to be involving parapharyngeal and retropharyngeal spaces with mediastinal extension. The lesion was removed by the transcervical approach. The final histology of the excised specimen, with immunohistochemistry for mouse double minute 2 (MDM2) and p16, suggested an atypical lipomatous tumour (ALT). This report accentuates the occurrence of this rare neoplasm in the neck, which often mimics lipoma clinically. Although radiology can demonstrate suggestive features, histology with MDM2 and/or p16 positivity can confirm the diagnosis of ALT as against the lipoma. A successful transcervical excision, despite the deeper extension of the lesion between the critical structures of the neck and mediastinum, demonstrates the non-infiltrating nature of the tumour.

Acute myocardial infarction in a young adult with hyperhomocysteinaemia secondary to tropical sprue.

Coronary heart disease and its complications remain the most common cause of morbidity and mortality throughout the world. In addition, its incidence among adults <45 years of age has also been steadily increasing in the past few decades. Besides the typical aetiology such as coronary artery abnormalities or autoimmune disorders, increasing rates can be attributed to escalating trends of obesity, type 2 diabetes mellitus, and illicit abuse of drugs such as cocaine and amphetamines in the younger population.1 Every cardiovascular event in a young adult must be thoroughly investigated as the aetiology is typically unconventional. Our case reports a young man who developed an acute inferior wall myocardial infarction (IWMI) in the setting of hyperhomocysteinaemia secondary to vitamin B12-folate deficiency itself due to tropical sprue.

Analysis of red blood cells from peripheral blood smear images for anemia detection: a methodological review.

Anemia is a blood disorder which is caused due to inadequate red blood cells and hemoglobin concentration. It occurs in all phases of life cycle but is more dominant in pregnant women and infants. According to the survey conducted by the World Health Organization (WHO) (McLean et al., Public Health Nutr 12(4):444-454, 2009), anemia affects 1.62 billion people constituting 24.8% of the population and is considered the world's second leading cause of illness. The Peripheral Blood Smear (PBS) examination plays an important role in evaluating hematological disorders. Anemia is diagnosed using PBS. Being the most powerful analytical tool, manual analysis approach is still in use even though it is tedious, prone to errors, time-consuming and requires qualified laboratorians. It is evident that there is a need for an inexpensive, automatic and robust technique to detect RBC disorders from PBS. Automation of PBS analysis is very active field of research that motivated many research groups to develop methods using image processing. In this paper, we present a review of the methods used to analyze the characteristics of RBC from PBS images using image processing techniques. We have categorized these methods into three groups based on approaches such as RBC segmentation, RBC classification and detection of anemia, and classification of anemia. The outcome of this review has been presented as a list of observations.

Choristomatous Endocervical Polyp with Heterologous Adipose Tissue.

Endocervical polyps are a common occurrence in the postmenopausal age group and many reports have described the presence of heterologous elements in the stroma of such polyps. The presence of mature adipose tissue in the stroma has been hypothesized to be arising from the perivascular fat or metaplastic transformation of the smooth muscle cells posttrauma. A 75-year-old female presented with spotting per vagina. Colposcopic examination revealed an endocervical polyp which was excised. Microscopic examination showed an ulcerated epithelium with metaplastic changes along with sheets of mature adipose tissue with focal S100 positivity conferring a diagnosis of choristomatous endocervical polyp with heterologous adipose tissue. The primary clinical concern of a malignant cause in this age group is alleviated by the diagnosis of this rare benign entity. Only three such cases have been reported in the English literature so far, and the present case accounts for the fourth such case.

Epidemiology, resistance characteristics, virulence determinants, and treatment outcomes of Staphylococcus aureus bone and joint infections: a one-year prospective study at a tertiary care hospital in India.

PURPOSE: The study was aimed to explore the differences between the Staphylococcus aureus osteosynthesis-associated infection (OAI) and non-implant related infections (NIRI) in terms of epidemiology, resistance characteristics, virulence determinants, treatment, risk factors, and outcome. METHODS: A prospective study was conducted from 2018 through 2019. The phenotypic and genotypic characterization of S. aureus, risk factors, treatment, and outcome were compared. RESULTS: A total of 60 patients were included. 50% had OAIs (70%) (p = .045). Overall, MRSA (OR 0.69; p = .020) and old age (OR 0.95; p = 0.035) were the important risk factors. Implanted patients presented with the features of chronic osteomyelitis (93.3%, p = 0.01). NIRI cases composed of only 66.7% of OM, and 55% of them were acute. OAI isolates were more frequently luk gene positives (50%) than isolates from the NIRI group (33.3%). Patients with OAI by luk positive isolates significantly had prolonged hospital stay (p = 0.043; OR-0.96, CI-0.91-1.0). Most of the NIRIs (60%) managed with antibiotics, but frequent surgical intervention (OR 10.68; p = .024) with prolonged systemic antibiotics (OR 1.07; p = .029) helped all OAIs to recover. Patients without implants were recovered in a higher number (83.3%). CONCLUSION: Our study highlighted that the differences exist between the OAI and NIRI, specifically in terms of clinical features, distribution of luk genes, treatment approach, and outcome. Risk factors for both types of infection remained the same.

Automated Decision Support System for Detection of Leukemia from Peripheral Blood Smear Images.

Peripheral blood smear analysis plays a vital role in diagnosing many diseases including cancer. Leukemia is a type of cancer which begins in bone marrow and results in increased number of white blood cells in peripheral blood. Unusual variations in appearance of white blood cells indicate leukemia. In this paper, an automated method for detection of leukemia using image processing approach is proposed. In the present study, 1159 images of different brightness levels and color shades were acquired from Leishman stained peripheral blood smears. SVM classifier was used for classification of white blood cells into normal and abnormal, and also for detection of leukemic WBCs from the abnormal class. Classification of the normal white blood cells into five sub-types was performed using NN classifier. Overall classification accuracy of 98.8% was obtained using the combination of NN and SVM.

Image Processing Approach for Detection of Leukocytes in Peripheral Blood Smears.

Peripheral blood smear analysis is a gold-standard method used in laboratories to diagnose many hematological disorders. Leukocyte analysis helps in monitoring and identifying health status of a person. Segmentation is an important step in the process of automation of analysis which would reduce the burden on hematologists and make the process simpler. The segmentation of leukocytes is a challenging task due to variations in appearance of cells across the slide. In the proposed study, an automated method to detect nuclei and to extract leukocytes from peripheral blood smear images with color and illumination variations is presented. Arithmetic and morphological operations are used for nuclei detection and active contours method is for leukocyte detection. The results demonstrate that the proposed method detects nuclei and leukocytes with Dice score of 0.97 and 0.96 respectively. The overall sensitivity of the method is around 96%.

Feature extraction using traditional image processing and convolutional neural network methods to classify white blood cells: a study.

White blood cells play a vital role in monitoring health condition of a person. Change in count and/or appearance of these cells indicate hematological disorders. Manual microscopic evaluation of white blood cells is the gold standard method, but the result depends on skill and experience of the hematologist. In this paper we present a comparative study of feature extraction using two approaches for classification of white blood cells. In the first approach, features were extracted using traditional image processing method and in the second approach we employed AlexNet which is a pre-trained convolutional neural network as feature generator. We used neural network for classification of WBCs. The results demonstrate that, classification result is slightly better for the features extracted using the convolutional neural network approach compared to traditional image processing approach. The average accuracy and sensitivity of 99% was obtained for classification of white blood cells. Hence, any one of these methods can be used for classification of WBCs depending availability of data and required resources.

Development of a Robust Algorithm for Detection of Nuclei and Classification of White Blood Cells in Peripheral Blood Smear Images.

Peripheral Blood Smear analysis plays a vital role in diagnosis of many diseases such as leukemia, anemia, malaria, lymphoma and infections. Unusual variations in color, shape and size of blood cells indicate abnormal condition. We used a total of 117 images from Leishman stained peripheral blood smears acquired at a magnification of 100X. In this paper we present a robust image processing algorithm for detection of nuclei and classification of white blood cells based on features of the nuclei. We used novel image enhancement method to manage illumination variations and TissueQuant method to manage color variations for the detection of nuclei. Dice similarity coefficient of 0.95 was obtained for nucleus detection. We also compared the proposed method with a state-of-the-art method and the proposed method was found to be better. Shape and texture features of the detected nuclei were used for classifying white blood cells. We considered classification of WBCs using two approaches such as 5-class and cell-by-cell approaches using neural network and hybrid-classifier respectively. We compared the results of both the approaches for classification of white blood cells. Cell-by-cell approach offered 1.4% higher sensitivity in comparison with the 5-class approach. We obtained an accuracy of 100% for lymphocyte and basophil detection. Hence, we conclude that lymphocytes and basophils can be accurately detected even when the analysis is limited to the features of nuclei whereas, accurate detection of other types of WBCs will require analysis of the cytoplasm too.

Mucoepidermoid Carcinoma of Salivary Gland: Limitations and Pitfalls on FNA.

Mucoepidermoid Carcinoma (MEC) is the most common malignant neoplasm of salivary gland origin. However, its morphologic heterogeneity poses difficulty in interpretation. In the present series we discuss the morphologic features of MEC, limitations and pitfalls in its diagnosis on Fine Needle Aspiration Cytology (FNAC). Fourteen cases of suspected MEC were evaluated cytologically followed by histopathological examination for confirmation. A definite cytological diagnosis was rendered in nine cases; three of the remaining five were underdiagnosed as abscess, pleomorphic adenoma and mucus cyst. Of the remaining two cases, one case each of sebaceous carcinoma and sialadenitis was mislabeled as MEC on cytology. A satisfactory aspirate composed of intermediate cells, mucin secreting cells and squamous cells in a mucinous background may not be obtained in all cases of low grade MEC. High grade MEC can be classified as squamous cell carcinoma. Hence, awareness of confounding factors with clinicopathologic correlation and judicious use of frozen section can help in minimizing errors.

Bladder Adenocarcinoma: A Persisting Diagnostic Dilemma.

Primary urinary Bladder Adenocarcinoma (PBA) is an uncommon neoplasm and can cause diagnostic difficulties due to histologic similarities with adenocarcinomas of adjacent structures like Gastrointestinal Tract (GIT) and prostate, since involvement of the bladder by metastasis or direct spread can occur. Seven cases of bladder adenocarcinomas were diagnosed during a period of four years in a tertiary care hospital. Patient's age ranged from 26-78 years with a male predilection. Three cases were signet ring type adenocarcinomas, two cases were subtyped as enteric variant, one as mucinous variant and one as adenocarcinoma Not Otherwise Specified (NOS) variant. One case showed urachal involvement. Common site of involvement was the base and posterior wall of the bladder. Three cases had prior history of GIT malignancy. No morphologic difference was identified to differentiate primary from secondary adenocarcinomas. Bladder adenocarcinoma is rare tumours. Primary and secondary adenocarcinomas cannot be distinguished from each other on morphologic grounds. Ancillary studies may have limited role in distinguishing between the two. Hence, clinical correlation has a major role in their evaluation.

Multiple Drugs Causing Severe Anemia in Infective Endocarditis.

Ceftriaxone and linezolid are commonly used antibiotics in infective endocarditis. Here we present a rare case of severe anemia caused by both the drugs via different mechanisms. Drugs have shown significant contribution in inducing anemia via hemolysis and bone marrow suppression in an infective endocarditis patient.

Haemolytic anaemia--PNH type II cells presenting a diagnostic dilemma.

A 28-year-old man presented with a history of intermittent haematuria over the past 10 years usually following fever episodes and requiring blood transfusions during the episodes. History of any thrombotic complications, chest pain or erectile dysfunction was not forthcoming. Examination revealed severe pallor with mild icterus and mild splenomegaly. His blood picture showed pancytopenia with elevated reticulocytes and indirect hyperbilirubinaemia. Indirect Coombs test was positive but direct was negative, serum lactate dehydrogenase was elevated and agglutinins were found to be of IgG type. Bone marrow showed a hypercellular marrow with myeloid and megakaryocytes suppressed. Donath-Landsteiner antibodies were found to be negative ruling out paroxysmal cold haemoglobinuria. Flow cytometry was performed with a suspicion of paroxysmal nocturnal haemoglobinuria (PNH) and was shown to be partially negative for CD59 but positive for CD55, a pattern consistent with type II PNH.