Hematological and other Laboratory Parameter Changes in COVID-19 Patients.

BACKGROUND: World Health Organization (WHO) declared Coronavirus disease of 2019 (COVID-19) as a pandemic in March 2020. The disease showed a wide range of severity ranging from being asymptomatic to causing high mortality. Various laboratory parameters were investigated, which could be used as biomarkers to determine the severity of the disease. The objective of the present study was to analyze hematological, coagulation, and immunological markers in mild, moderate, severe, and critical cases of COVID-19 patients and their relation to the outcome. MATERIALS AND METHODS: A retrospective observational study of 1,000 COVID-19-positive hospitalized patients was conducted. Cases were classified into mild, moderate, severe, and critical groups using WHO guidelines. Along with demographic data, hematological, coagulation, and inflammatory parameters were analyzed and correlated with severity and survival. RESULT: Out of the total 1,000 cases, there were 510 cases in mild, 232 in moderate, 201 in severe, and 57 in the critical category. Increase in total white blood cell count, absolute neutrophil count (ANC), neutrophil lymphocyte ratio (NLR), platelet lymphocyte ratio (PLR), and inflammatory parameters like C-reactive protein (CRP), serum ferritin, lactate dehydrogenase (LDH), interleukin-6 (IL-6), and decrease in absolute lymphocyte count (ALC) showed significant difference with disease severity and survival. CONCLUSION: These are important biomarkers to predict the prognosis and outcome of COVID-19 patients. As these markers are easily available, they could be used to categorize the patients at an early stage for optimum management.

Eosinophilic meningitis due to A. Cantonensis revealed at autopsy.

Parasitic infection of the central nervous system could be fatal, and its incidence is rising due to increasing worldwide travel. Amongst the various nematodes, Angiostrongylus contonensis is the commonest and causes eosinophilic meningitis. It is a zoonotic disease produced due to the ingestion of raw or undercooked snails or slugs. Most cases of angiostrongyliasis are mild and self-limiting, but death can occur in severe cases lacking timely and proper treatment. Very few autopsy cases of A. cantonensis are reported. We present the case of a 32-year-old mentally challenged orphan male with eosinophilic meningitis at autopsy.

Disseminated epithelial cancers-An autopsy analysis.

BACKGROUND: Cancer is one of the leading causes of death due to noncommunicable diseases worldwide. Despite increasing public awareness and availability of sophisticated imaging techniques, some cancers evade clinical diagnosis and/or are incidentally encountered at autopsies, often with dissemination. AIMS: The present study evaluated the disseminated epithelial cancers at autopsy. MATERIALS AND METHODS: This is a retrospective observational 5-year autopsy analysis of disseminated epithelial cancers performed at a tertiary-care hospital. The cases were categorized as (1) clinically diagnosed malignancy, known primary; (2) clinically diagnosed malignancy, unknown primary; and (3) clinically undiagnosed malignancy. STATISTICAL ANALYSIS: Nil. RESULTS: Dissemination was identified in 66 (57.9%) of the 114 patients with epithelial malignancies. There were 29 patients (43.9%) in category 1, 26 patients (39.4%) in category 2, and 11 patients (16.7%) in category 3, majority of whom were women (38 patients, 57.6%). When all categories were considered together, lung and colorectal carcinomas were the commonest cancers seen in 13 (19.7%) and 8 (12.1%) patients, respectively, in both men and women. Majority of the patients (43 cases, 65.2%) had symptoms produced by metastases, which were the sole manifestations in 13 patients (19.7%). Lungs and liver were the common metastatic sites. CONCLUSIONS: Cancerous dissemination continues to be a major cause of morbidity and mortality even after considerable improvements in the surgical or nonsurgical treatment modalities. An autopsy study can provide important clinical insights in retrospect.

Solitary Plasmacytoma with Amyloid - An Unusual Dural-Based Lesion.

Solitary plasmacytoma of the dura without systemic involvement are extremely rare lesions, with <15 cases reported in the literature. Among these, ours is the second case to show the presence of amyloid. Fifty-year-old male had presented with headache, sudden onset right-sided weakness, and vomiting. Magnetic resonance imaging revealed an extra-axial mass in the left fronto-parietal region measuring 10 cm × 8.7 cm × 3.9 cm, suggestive of meningioma. The left fronto-parietal craniotomy was performed and multiple tissue bits aggregating to 10 cm × 8.5 cm × 2 cm along with thinned out membrane-like bit of calvarium was sent for pathologic examination. H and E stained sections showed sheets of plasmacytoid cells along with amyloid, which showed apple-green birefringence on Congo red staining. On immunohistochemistry, tumor cells were positive for CD38, CD138, showed kappa light chain restriction and were negative for CD45, CD34. Hence, it was diagnosed as a plasma cell neoplasm. Further work-up with whole-body positron-emission tomography scan revealed no systemic involvement. Dural-based lesions can mimic meningioma radiographically as well as intraoperatively. Histopathological examination unveils the diagnosis, to guide appropriate therapeutic regimens.

Angiocentric Glioma: Report of a Rare Case Presenting with Psychosis.

Angiocentric glioma (AG), first described in 2005, was included as a distinct entity in the 2007 World Health Organization Classification of Tumors of the Central Nervous System. It is a very rare cerebrocortical tumor mainly affecting children and young adults with a history of intractable partial seizures. The histopathological features of this entity are perivascular arrangement of monomorphic, bipolar spindled cells with subpial aggregation of tumor cells and variable neuroparenchymal colonization. Of uncertain histogenesis, this is a stable/slowly growing tumor. Prognosis following total surgical resection is favorable. We describe an AG in a 16-year-old, intellectually disabled, male patient, with psychosis. This is a rare presentation with only one such case in literature. Patient's symptoms ameliorated following surgery.

Intrathyroidal multiloculated proliferating thymic cyst.

Ectopic thymic tissue in neck is not uncommon; however, ectopic thymic cysts in neck are rare and intrathyroidal thymic cyst is still rarer. Multilocular proliferating thymic cyst is a rare entity and very few cases are described in mediastinum. We present the first case of a 73-year-old male with an intrathyroidal multilocular proliferating thymic cyst mimicking thyroid malignancy radiologically.

AML M7 Misdiagnosed as ALL.

Hematogones, which are normal precursors of B lymphocytes in the bone marrow, may be mistaken for blast cells on flow cytometry and histology when their numbers increase. We report such a case in a 16 months old male who was unsuccessfully treated for a pre-B cell ALL on the basis of flow cytometry of the bone marrow which showed a substantial population of CD19 and CD10 expressing 'blast' cells. A diagnosis of AML M7 was made on a subsequent bone marrow biopsy in which the blast cells expressed CD61 and Factor VIII, while they were negative for CD10 and CD20. Also present were a few CD10 and CD20 expressing small lymphoid cells, which were interpreted as hematogones. This report reiterates the problem of mistaking hematogones for 'blast' cells on flow cytometry, especially in the marrow of very young children where hematogones are often prominent.

Wilms' tumor with right heart extension: report of a post-chemotherapeutic fatality.

Wilms' tumor (WT) has a strong propensity to invade the vasculature in the form of tumor-thrombus, into the renal veins, and inferior vena cava and even into the right atrium. This cavo-atrial propagation does not alter the prognosis and pre-operative chemotherapy produces shrinkage to the extent of even disappearance of caval or atrial extensions. We present a case of sudden death due to hemorrhagic expansion of the intra-atrial component of WT, immediately after commencement of chemotherapy, an uncommon incident.