Harlequin Infant Born to a Varicella Infected Mother: A Case Report.

Harlequin ichthyosis is a rare, severe form of congenital ichthyosis characterised by distinct physical appearance of the infant. It has occurrence of 1 in 1 million births and over 100 cases have been reported so far. It is caused by mutation in ABCA12 gene involved in lipid transport leading to profound thickening of stratum corneum. The mainstay of management relies on supportive care & administration of retinoid derivatives. Outcome is usually fatal and most of the babies die during neonatal period. In this article, we report a case of harlequin baby born of non-consanguineous marriage with history of chicken pox in the mother during first trimester of pregnancy.

Development and Pilot Testing of a Comprehensive Mobile Application to Assist Cell Count Determination During Peripheral Smear and Bone Marrow Examination.

BACKGROUND: In the modern era of complete blood count analysis, manual differential count is performed whenever 'flags' are generated by an automated hematology analyzer. Traditionally, tally counters with five or eight keys are used for manual differential count. A few mobile applications are available to perform this task; however, the application features and cell representation are limited. OBJECTIVES: The primary objective of our study was to develop an indigenous, comprehensive mobile application to assist with manual blood cell differential count. The secondary objective was to measure the usability of a newly developed application among undergraduate medical students. MATERIALS AND METHODS: A new mobile application was developed using a Java development kit, Version 11.0.13 (Oracle Corporation, Austin, USA) in Android Studio Dolphin (2021.3.1) (Google, California, USA). The application content was validated by three pathologists with more than five years of experience. The app's usability was tested among 60 participants using a validated mHealth App Usability Questionnaire (MAUQ). The questionnaire had 18 items covering three domains: ease of use, interface & satisfaction, and usefulness. RESULTS: The newly developed application supports peripheral smear WBC differential count, platelet count, reticulocyte count, malaria parasite quantification, and bone marrow differential count. During usability testing, the app was easy to use in 95% (57/60) of participants, time-efficient in 91.7% (55/60), and helpful for healthcare practice learning in 96.7% (58/60). The total mean score was 6.11, indicating high usability. CONCLUSION: A comprehensive mobile application to assist manual differential count with adequate cell representation was developed. The mobile application was easy to use, time-efficient, and valuable among the study participants.

The Impact of Patient-Centric Interactive E-Module in Pathology Among Medical Undergraduates.

Introduction: COVID pandemic shifted healthcare-related education to digital platforms. With the widespread availability of learning management systems like MOODLE, many opportunities exist to create innovative e-modules. Its success depends on the interactive multimedia resources and structural framework. The present study aims to create two patient-centric e-modules on Diabetes and Alcoholic liver disease in Pathology by a medical undergraduate facilitated by faculty and to assess its impact on learning outcomes and learners' perceptions in relation to student seminars. Methodology: This mixed-method intervention study combines quantitative and qualitative research methods to gain deeper insight into learners' experiences. By random allocation, half of the second-year medical undergraduates (n = 60) attended an e-module, and the other half listened to a student seminar on the same topic with the same specific learning objectives. Pre- and post-test scores and feedback questionnaires were quantitatively analysed. Student-led focus group discussions (FGD) for learners' experiences underwent thematic analysis. Results: Pre- and post-tests for both learning techniques were statistically significant, while the feedback questionnaire's responses favoured e-module. Four focus group discussions yielded six themes for the e-module: Patient-driven holistic learning experience, Inquiry-based learning, Immersive learning, Higher level cognitive skills, Flexibility, repeatability and accessibility, and No human involvement. The five themes for the seminar were: Peer-driven camaraderie learning dynamic, Teacher-centric synchronous learning, Active vs passive listening, Basic learning, and Teacher-student interaction. Conclusion: While both learning techniques had comparable effects on test scores, they have merits and demerits. Hence, blending both techniques where seminars impart basic knowledge and e-module for deeper reinforcement will benefit the students.

Embryonal rhabdomyosarcoma of breast, pleura, and retroperitoneum diagnosed from pleural fluid cytology.

Embryonal rhabdomyosarcoma (ERMS) is a malignant small blue round cell tumor which is commonly seen in head and neck region. Breast and pleural involvement are uncommon. Rhabdomyosarcoma has been rarely reported in the body fluids like ascitic, pleural, and cerebrospinal fluid. In this article, we report an interesting case of ERMS which had deceptive small blue round cells in pleural fluid. The cytomorphological features along with a panel of immunocytochemical markers helped in arriving at the definite diagnosis. Later, biopsy from the breast lump and retroperitoneal mass also revealed the same tumor. This case is reported since it is rare to find sarcoma cells in pleural fluid and highlight the diagnostic difficulties faced during interpretation.

Unusual morphology of amyloid cast nephropathy in renal biopsy portending poor prognosis.

Light chain cast nephropathy is the most frequent form of renal disease in plasma cell neoplasm showing precipitation of monoclonal immunoglobulin light chains in the lumen of the distal tubules. This has a typical morphological feature characterised by the presence of a fractured cast. In this article, we report an unusual case of light chain cast nephropathy exhibiting amyloidogenic potential with lamellated, spiculated appearance. These casts were positive for periodic acid-Schiff and Jones' silver stain, fuchsinophilic in Masson trichrome stain and showed apple-green birefringence under polarised light in Congo red stain. Complete haematological evaluation confirmed the presence of underlying plasma cell myeloma. The connotation of intratubular amyloid cast lies in the fact that this may represent an early phenomenon during the development of light chain cast nephropathy-associated systemic amyloidosis and may precede the formation of light chain amyloid in renal or extrarenal location.

Bronchial brush cytology of primary anaplastic large cell lymphoma of lung.

Primary pulmonary lymphoma is defined as clonal lymphoid proliferation affecting one or both lungs in a patient with no extrapulmonary involvement at the time of diagnosis or during the subsequent 3 months. Anaplastic large cell lymphoma (ALCL) is a rare T-cell neoplasm which occurs as two distinct clinical entities-cutaneous and systemic variant. Primary lung involvement is extremely uncommon. It can be classified on the basis of being positive or negative for ALK rearrangement which carries prognostic significance. The 2016 revision of World Health Organization (WHO) classification of lymphoid neoplasm recognizes three types of ALCL namely ALK-positive, ALK-negative, and breast implant associated. Here, we report a case of primary pulmonary ALK-1 positive ALCL which was initially recognized in bronchial brushing cytology based on distinct morphologic clues.

Composite lymphoma with coexistence of diffuse large B-cell lymphoma and anaplastic large cell lymphoma: Diagnostic pitfalls.

Composite lymphoma is a rare tumor composed of two or more distinct lymphomas in the same topographic site or tissue. Several combinations of B-cell non-Hodgkin lymphoma (NHL), T-cell NHL, and Hodgkin lymphoma can occur with different prognoses and treatments. The coexistence of a B-cell NHL and a T-cell NHL is unusual. The exact etiology of composite lymphoma is unknown; however, few mechanisms have been proposed to explain its pathogenesis. The chemotherapeutic protocols are heterogeneous but are essentially targeted against the high-grade component. Most of the cases show worse outcome with a median survival of 12 months. In this article, we report a case of composite lymphoma which was initially diagnosed as diffuse large B-cell lymphoma, and the presence of CD3-positive atypical cells in the bone marrow urged us to re-evaluate the lymph node biopsy following which a focus of Alk-1-positive anaplastic large cell lymphoma was identified.

Granular Cell Tumor of Cecum: A Common Tumor in a Rare Site with Diagnostic Challenge.

Granular cell tumor (GCT) also known as Abrikossoff's tumor is a benign neoplasm that is usually seen in the fourth to sixth decades of life with slight female preponderance. It is most frequently seen in the oral cavity, skin, and subcutaneous tissue. Gastrointestinal tract involvement is uncommon, in which esophagus is the most commonly affected site. There are case reports of GCT in stomach, appendix, colon and rectum. In this article, we report a case of GCT involving cecum. The cell of origin in GCT is controversial. There are various pools of thoughts regarding its histogenesis, the details of which are reviewed in this article with emphasis on the diagnostic difficulties encountered in this tumor.