Z score analysis: A novel approach to interpretation of an erythrogram.

Context: Z score defines the shift of an observed value from the mean. Aims: By determining the direction of this shift and its absolute value for mean corpuscular hemoglobin (MCH) and mean corpuscular hemoglobin concentration (MCHC), one can quickly screen the hemogram for any spurious results in RBC parameters and also predict the type of anemia. This is because MCH and MCHC are derived parameters (from Hb, RBC, MCV) and thereby reflect the true as well as false changes in an erythrogram. Materials and Methods: A total of 975 hemograms were studied retrospectively. Basic statistical formulae using mean and standard deviation were applied to calculate z scores for MCH and MCHC. Results obtained were compared with the standard method and validated by an independent cohort of 100 random samples run on a different machine. Results and Statistical Analysis: Z score was found to be statistically significant (p <.001) in diagnosing iron deficiency anemias, megaloblastic anemias, hemolytic anemias, regenerative anemias, anemia of chronic disease and spurious findings. Z score was not significant (p = 0.9) in predicting beta thalassemia trait. The sensitivity was low for the differentials of microcytic hypochromic anemias. Conclusions: Despite this, Z score can be of immense help to the clinicians and pathologists in making quick interpretation of the underlying red cell abnormalities. Also, it can be used as a quality assessment tool in hematology laboratories taking pre analytical and analytical factors into account.

Sinonasal Angioleiomyoma: A Rare Entity.

The present case of angioleiomyoma of the nasal cavity in a 59-year-old male is unique, being the first case from North India and also because of its unique area of origin. The patient was referred to the Ear, Nose and Throat Outpatient Department with a diagnosis of an asymptomatic nasal mass. Biopsy done on the mass in another hospital reported angiofibroma. Excision was done after all relevant investigations. Histopathology revealed diagnosis of angioleiomyoma. Immunohistochemistry revealed desmin, SMA, and H-caldesmon positivity, consistent with the diagnosis of angioleiomyoma. Our case report thus highlights the im-portance of including this diagnosis in the differential diagnoses of nasal masses.

Mesonephric adenocarcinoma (endometrioid type) of endocervix with diffuse mesonephric hyperplasia involving cervical wall and myometrium: an unusual case report.

Malignant mesonephric tumors are rare variants of cervical adenocarcinoma, derived from remnants of mesonephric ducts and are associated with mesonephric remnants and/or mesonephric hyperplasia. Few cases have been described in literature. We report an unusual case of cervical mesonephric adenocarcinoma of endometrioid type with squamous morules in association with diffuse mesonephric hyperplasia involving the cervical walls and extending into the myometrium.

Pelvic periprostatic symplastic leiomyoma: an unusual case necessitating a radical surgery.

Most pelvic smooth muscle tumors are believed to be malignant, leiomyomas are extremely rare; more so in male patients. Very few cases of symplastic leiomyomas have been described in males. We report an extremely unusual case of a soft tissue mass of periprostatic and periseminal vesicle region in a young adult, which necessitated a radical surgery. Histologically, tumor comprised of smooth muscle bundles with numerous bizarre tumor cells which were immunoreactive with smooth muscle actin (SMA), desmin and h-caldesmon. The diagnostic and treatment dilemmas of these unusual tumors are discussed.