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Sukumaran R, Nayak N, Nair RA, Kattoor J, Jacob PM, Narayanan G, Thankamony P. Hematolymphoid Neoplasms in Serous Effusions: Morphological Spectrum, Distribution, and Role of Ancillary Techniques—A Retrospective Analysis of 75 cases. Indian J Med Paediatr Oncol 2021. [DOI: 10.1055/s-0041-1731844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Abstract
Introduction Involvement of body fluids can occur at the time of diagnosis or during the disease course of hematolymphoid neoplasms. Cytodiagnosis of malignant effusion is important in effective clinical management.
Objectives (1) The aims of the study were to determine the frequency of distribution of various hematolymphoid neoplasms involving body fluids, (2) to study the morphology of hematolymphoid neoplasms in fluids, and (3) to assess the role of ancillary techniques in the diagnosis.
Materials and Methods In this retrospective study, all cases of hematolymphoid neoplasms involving body fluids diagnosed from January 2016 to December 2018 were evaluated.
Results During the 3-year period, there were 75 cases of hematological malignancies involving body fluids. These included 48 male patients and 27 female patients. Pleural fluid was involved in majority of cases (56 cases; 74.67%), followed by ascitic fluid (17 cases; 22.67%), and pericardial fluid (2 cases; 2.67%). High cellularity, monotonous population of cells, high nuclear-cytoplasmic (N/C) ratio, indentation/irregularity of nuclear membrane, immature chromatin/irregular clumping of chromatin, increased mitosis, and karyorrhexis were the key features which helped to differentiate between reactive and neoplastic processes. There were 35 cases of B-cell neoplasms, 33 cases of T-cell neoplasms, and seven cases of myeloid neoplasms involving body cavity fluids. T-lymphoblastic lymphoma was the most common subtype (29 cases; 38.7%), followed by diffuse large B-cell lymphoma (DLBCL) (12 cases; 16%). In 53 cases, effusion was present in the initial presentation itself. Initial diagnosis was made in effusion cytology in 25 cases (33.33% of the total), with the help of flow cytometry in 20 cases, and immunohistochemistry (IHC) in cell blocks in five cases.
Conclusion Diagnosis of hematolymphoid neoplasms in body fluids based on correlation with clinical details, critical evaluation of cytology findings, and comparison with previous diagnosis along with the judicious use of ancillary techniques helps in deciding an early treatment plan.
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Affiliation(s)
- Renu Sukumaran
- Department of Pathology, Regional Cancer Centre, Thiruvananthapuram, Kerala, India
| | - Nileena Nayak
- Department of Pathology, Regional Cancer Centre, Thiruvananthapuram, Kerala, India
| | - Rekha A. Nair
- Department of Pathology, Regional Cancer Centre, Thiruvananthapuram, Kerala, India
| | - Jayasree Kattoor
- Department of Pathology, Regional Cancer Centre, Thiruvananthapuram, Kerala, India
| | - Priya Mary Jacob
- Department of Pathology, Regional Cancer Centre, Thiruvananthapuram, Kerala, India
| | - Geetha Narayanan
- Department of Medical Oncology, Regional Cancer, Centre, Thiruvananthapuram, Kerala, India
| | - Priyakumari Thankamony
- Department of Paediatric Oncology, Regional Cancer Centre, Thiruvananthapuram, Kerala, India
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Seetharam S, Thankamony P, Gopakumar KG, Nair RA, Jacob PM, Jagathnath Krishna KM, Rajeswari B, Nair M, Guruprasad CS, Prasanth VR. Outcomes of pediatric mixed phenotype acute leukemia treated with lymphoid directed therapy: Analysis of an institutional series from India. Pediatr Hematol Oncol 2021; 38:358-366. [PMID: 33635170 DOI: 10.1080/08880018.2020.1871453] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
There is limited data regarding pediatric mixed phenotype acute leukemia (MPAL) and there is no global consensus on its management yet. In this retrospective study, we analyzed the outcomes of children diagnosed with MPAL at our institute. This study included children ≤ 14 years with MPAL who presented to a tertiary cancer center in India from January 1st 2009 to December 31st 2015. Over a seven-year period, 1390 patients with leukemia presented to our institute of which 22 patients (1.5%) had MPAL. Sixteen patients (72.7%) had B/myeloid leukemia, while 4 (18.1%) and 2 (9%) patients had T/myeloid and B/T leukemia respectively. Twenty-one patients were treated with a modified BFM ALL 95 protocol. 76.1% (n = 16) of patients had a good prednisolone response (GPR) on day 8 and end-of-induction (EOI) marrow was in remission in 90.5% (n = 19). A poor prednisolone response (PPR) on day 8 correlated with an inferior relapse-free survival (25% vs 79.5%, P=.025). The 4-year event-free survival (EFS) and overall survival (OS) for the entire group was 60.8% and 64.9% respectively while the EFS for patients who had a GPR and remission at the EOI (n = 15) was 80% as compared to 16.7% in patients with PPR or induction failure. Lymphoid directed chemotherapy is seen to have good survival outcomes in pediatric MPAL. However, a PPR on day 8 or a positive EOI marrow may be an indication for more aggressive treatment.
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Affiliation(s)
- Shwetha Seetharam
- Department of Pediatric Oncology, Regional Cancer Centre, Thiruvananthapuram, India
| | | | | | | | - Priya Mary Jacob
- Department of Pathology, Regional Cancer Centre, Thiruvananthapuram, India
| | - K M Jagathnath Krishna
- Department of Cancer Epidemiology and Biostatistics, Regional Cancer Centre, Thiruvananthapuram, India
| | - Binitha Rajeswari
- Department of Pediatric Oncology, Regional Cancer Centre, Thiruvananthapuram, India
| | - Manjusha Nair
- Department of Pediatric Oncology, Regional Cancer Centre, Thiruvananthapuram, India
| | - C S Guruprasad
- Department of Pediatric Oncology, Regional Cancer Centre, Thiruvananthapuram, India
| | - V R Prasanth
- Department of Pediatric Oncology, Regional Cancer Centre, Thiruvananthapuram, India
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Simi CM, Nair RA, Jacob PM, Jayasudha AV. Flowcytometry in Chronic B-Cell Lymphoproliferative Disorders: A Retrospective Study from a Tertiary Oncology Centre, Trivandrum, India. J Clin Diagn Res 2021. [DOI: 10.7860/jcdr/2021/46090.15375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Introduction: Chronic B-Cell Lymphoproliferative Disorders (B- CLPD) are malignant neoplasms of B lymphocytes characterised by accumulation of mature B lymphocytes in the Bone Marrow (BM), peripheral blood, and lymphoid tissues. Multiparameter flowcytometry has become a powerful tool in diagnosing B-CLPD that identifies a clonal light-chain restricted population expressing B-cell markers. Aim: To study the morphologic and immunophenotypic profile of B-CLPD by flowcytometry and to determine the incidence of various subtypes. Materials and Methods: All consecutively diagnosed cases of chronic B lymphoproliferative disorders at Regional Cancer Centre, Trivandrum, Kerala, India from 1st December 2016 to 30th November 2018 were retrospectively analysed and studied. Diagnosis of CLPD was made based on peripheral smear and BM aspiration and immunophenotyping by flowcytometry. Flowcytometry was performed using BD FACS Verse flowcytometer. The results of immunophenotyping by flowcytometry were reviewed and analysed. Results: During the study period, 231 cases were diagnosed as Chronic Lymphoproliferative Disorder (CPLD), of which 209 cases were B-CLPDs. Male to female ratio (M:F) was 2:1. In the present study, incidence of Chronic Lymphocytic Leukaemia (CLL) was 138 cases (66.03%), Follicular Lymphoma (FL) was 14 cases (6.7%), Hairy Cell Leukaemia (HCL) was 11 cases 5.26% and Mantle Cell Lymphoma (MCL) was 9 cases, (4.31%). Prolymphocytic leukaemia and splenic Marginal Zone Lymphoma (MZL) constituted 4 cases (1.91%) each. Some cases of B-CLPDs had no definite diagnoses which were diagnosed as CD5 positive B-CLPD unclassified 13 cases (6.22%) and CD5 negative B-CLPD unclassified 16 cases (7.66%). Conclusion: Flowcytometry has helped in definite subtyping of B-CLPD in most cases. Most common subtype in the present study was CLL. CD5+/CD23+ is highly specific for diagnosing CLL. CD200 is revealed to be an excellent marker to distinguish CLL from MCL.
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Seetharam S, Thankamony P, Jacob PM, Nair RA. Precursor B-cell Lymphoblastic Lymphoma of Bone in Children: A Close Mimicker of Ewing's Sarcoma. Indian J Med Paediatr Oncol 2018. [DOI: 10.4103/ijmpo.ijmpo_149_16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
AbstractPrecursor B-cell lymphoblastic lymphoma (LBL) occurring as a primary bone tumor is a rare clinical presentation in children, and data regarding this condition are limited to small case series or a few individual case reports. We report two pediatric cases of precursor B-cell LBL of the bone. The tumor cells from bone biopsies of both patients were seen to be positive for leukocyte common antigen (LCA), terminal deoxynucleotidyl transferase, CD10, CD20 and weakly positive for CD99. Bone marrow studies were normal. They were treated according to the modified Berlin-Frankfurt-Münster acute lymphoblastic leukemia high-risk protocol. The first patient has completed treatment including local radiotherapy and has been disease free for the past 10 years. The second patient has recently completed treatment and shows good response.
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Affiliation(s)
- Shwetha Seetharam
- Division of Pediatric Oncology, Regional Cancer Centre, Thiruvananthapuram, Kerala, India
| | - Priyakumari Thankamony
- Division of Pediatric Oncology, Regional Cancer Centre, Thiruvananthapuram, Kerala, India
| | - Priya Mary Jacob
- Department of Pathology, Regional Cancer Centre, Thiruvananthapuram, Kerala, India
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Abstract
BACKGROUND Peripheral T-cell lymphomas (PTCLs) are non-Hodgkin's lymphomas (NHLs) with considerable variation in incidence across the world. They show a wide variety of clinicopathological features and generally associated with poor clinical outcome. Lymphoma data from different geographic regions will definitely aid in routine clinical practice and research work. PTCLs are reported with a higher frequency in Asia as compared to Western countries. OBJECTIVE The objective of this study was to analyze the frequency and distribution of PTCLs diagnosed in a tertiary care cancer center in Kerala. MATERIALS AND METHODS This was a retrospective study carried out in the Division of Pathology, Regional Cancer Centre, Thiruvananthapuram, for 5 years from January 1, 2011, to December 31, 2015. All PTCLs diagnosed during this period were reviewed and then classified according to the 2016 revision of the World Health Organization classification of lymphoid neoplasms. Statistical significance of the results was evaluated using Chi-square test. RESULTS Among the total 3108 cases of lymphomas diagnosed at our center, 2404 cases were NHLs (77.35%). PTCLs (n = 333) contributed 13.85% of all NHLs. Among these, PTCL, not otherwise specified, constituted the most common subtype (92 cases, 27.63%), followed by angioimmunoblastic T-cell lymphoma (79 cases, 23.72%), anaplastic large cell lymphoma (75 cases, 22.52%), mycosis fungoides (28 cases, 8.40%), and adult T-cell leukemia/lymphoma (ATLL) (28 cases, 8.40%). CONCLUSION This is the largest study on PTCLs reported from Kerala. We document that the frequency of PTCLs is higher than that reported from Western studies. The frequency of ATLL reported from Kerala is much higher than that reported from other states.
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Affiliation(s)
- Rekha A Nair
- Division of Pathology, Regional Cancer Centre, Thiruvananthapuram, Kerala, India
| | | | - Priya Mary Jacob
- Division of Pathology, Regional Cancer Centre, Thiruvananthapuram, Kerala, India
| | - Renu Sukumaran
- Division of Pathology, Regional Cancer Centre, Thiruvananthapuram, Kerala, India
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Parambil ASP, Prem S, Jacob PM, Nair RA. Mediastinal Mass with Hyper-eosinophilia in a Young Boy -A Diagnostic Dilemma. J Clin Diagn Res 2016; 10:XD03-XD04. [PMID: 27630938 DOI: 10.7860/jcdr/2016/19615.8202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Accepted: 05/24/2016] [Indexed: 11/24/2022]
Abstract
Mediastinal masses in children comprises of a heterogeneous group of tumours. In such cases, biopsy and histological analysis are mandatory for planning of treatment. We have reported an unusual aetiology for a mediastinal mass in a young boy presenting with features of Superior Vena Caval Obstruction (SVCO) who also had marked blood and marrow eosinophilia mimicking Chronic Eosinophilic Leukaemia (CEL). We have also discussed the differential diagnoses of mediastinal tumours with hyper-eosinophilia and possible therapeutic implications.
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Affiliation(s)
- Abdul Shahid Poovathum Parambil
- Consultant Medical Oncologist, Assistant Professor in General Medicine, Andaman and Nicobar Island Institute of Medical Sciences , Port Blair, Andaman and Nicobar Islands, India
| | - Shruti Prem
- Assistant Professor, Department of Medical Oncology, Regional Cancer Centre , Trivandrum, Kerala, India
| | - Priya Mary Jacob
- Lecturer, Department of Pathology, Regional Cancer Centre , Trivandrum, Kerala, India
| | - Rekha Appukuttan Nair
- Additional Professor, Department of Pathology, Regional Cancer Centre , Trivandrum, Kerala, India
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Sukumaran R, Nair RA, Jacob PM, Nair Anila KAR, Prem S, Binitha R, Kusumakumary P. Flow cytometric analysis of Mixed phenotype acute leukemia: experience from a tertiary oncology center. INDIAN J PATHOL MICR 2016; 58:181-6. [PMID: 25885130 DOI: 10.4103/0377-4929.155309] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Mixed phenotype acute leukemia (MPAL) is a rare subset of acute leukemia where the blasts exhibit lineage specific antigens of more than one lineage. Flow cytometric immunophenotyping is essential for the diagnosis of MPAL and the accurate diagnosis highly depends on the panel of markers used. The precise incidence of MPAL is uncertain as various institutions use different combinations of antibodies to assign the blasts to a particular lineage. AIM The aim was to study the immunoprofile of acute leukemia including aberrant antigen expressions and to study the incidence, clinical features, laboratory findings, and immunophenotype of MPAL in our institution. MATERIALS AND METHODS All cases of acute leukemias in which flow cytometric analysis during 1-year period from July 2012 to July 2013 were included in this study. RESULTS During the study period, flow cytometric analysis of 506 cases was performed. B lymphoblastic leukemia was the most common subtype of acute leukemia. CD13 was the most common aberrant antigen expression in acute lymphoblastic leukemia and CD7 was the most common aberrant antigen expression in acute myeloid leukemia. A diagnosis of MPAL was made in 15 cases, which accounted for 2.96% of all leukemias. 9 cases were diagnosed as T/myeloid, 5 cases as B/myeloid and 1 case as B/T. CONCLUSION Mixed phenotype acute leukemia is a rare subset of acute leukemia. Flow cytometry is critical in establishing a diagnosis of MPAL. The panel of antibodies used is important in the identification of the "mixed" phenotype. Cytoplasmic markers (cytoplasmic MPO, cytoplasmic 79a, cytoplasmic 22 and cytoplasmic CD3) should be included in the primary flow cytometric panel.
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Affiliation(s)
| | - Rekha A Nair
- Division of Pathology, Regional Cancer Centre, Trivandrum, Kerala, India
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Nair RA, Arunkumar N, Jacob PM, Nayak N. Subcutaneous panniculitis-like T-cell lymphoma: A report of five cases with review of literature. Indian J Cancer 2016; 52:675-6. [PMID: 26960515 DOI: 10.4103/0019-509x.178416] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Rekha A Nair
- Department of Pathology, Regional Cancer Centre, Thiruvananthapuram, Kerala, India
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Abstract
Burkitt's lymphoma is an uncommon form of non-Hodgkin's lymphoma (NHL) in adults and represents < 5% of NHL adults. Burkitt's lymphoma involving primarily the appendicular skeleton is rarely described. We present the case of a young man with primary Burkitt's lymphoma involving the humerus as the only site of disease. He received R hyper CVAD and local irradiation and is in complete remission at 24 months.
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Affiliation(s)
- N Geetha
- Department of Medical Oncology, Regional Cancer Centre, Trivandrum, Kerala, India
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Abstract
Solitary plasmacytoma of the bone (SPB) is a plasma cell neoplasm that usually presents as a lytic lesion mainly localized within the axial skeleton. The occurrence of SPB in young individuals is exceedingly rare, but has been sporadically reported before. We report a case of SPB involving metacarpal bone in a 16-year-old male with a prior history of trauma at the same site.
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Affiliation(s)
| | - Rekha A Nair
- Department of Pathology, Regional Cancer Centre, Thiruvananthapuram, Kerala, India
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Jayasudha AV, Nair RA, Jacob PM, Renu S, Anila KR, Sindhu Nair P, Priya Kumari T, Kusuma Kumary P. Clinical and hematological profile of acute megakaryoblastic leukemia: a 2 year study. Indian J Hematol Blood Transfus 2015; 31:169-73. [PMID: 25825554 DOI: 10.1007/s12288-014-0413-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2013] [Accepted: 05/22/2014] [Indexed: 11/29/2022] Open
Abstract
Acute megakaryoblastic leukemia is a rare subtype of acute myeloid leukemia with a characteristic morphologic and immunophenotypic profile. It has to be distinguished from other subtypes of acute myeloid leukemia as well as acute myeloid leukemia with t (1; 22) (p13;q13) and acute megakaryoblastic leukemia in Down Syndrome because of its poor prognosis. We studied ten cases diagnosed over a period of 2 years (from July 2011 to June 2013). All the ten cases were in the pediatric age group ranging from 4 months to 2 years. On morphology, pointers to the diagnosis were clustering of blasts, presence of cytoplasmic blebs and platelet budding. An additional interesting morphological feature observed in our study was nuclear blebs which were seen in nine cases. Diagnosis was confirmed in all cases by positive immunostaining for CD61. Two of the cases had an extremely rare clinical presentation as granulocytic sarcoma. Although rare, acute megakaryoblastic leukemia should be kept in mind especially in leukemia in infants.
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Affiliation(s)
- A V Jayasudha
- Department of Pathology, Regional Cancer Centre, Thiruvananthapuram, India
| | - Rekha A Nair
- Department of Pathology, Regional Cancer Centre, Thiruvananthapuram, India
| | - Priya Mary Jacob
- Department of Pathology, Regional Cancer Centre, Thiruvananthapuram, India
| | - S Renu
- Department of Pathology, Regional Cancer Centre, Thiruvananthapuram, India
| | - K R Anila
- Department of Pathology, Regional Cancer Centre, Thiruvananthapuram, India
| | - P Sindhu Nair
- Department of Pathology, Regional Cancer Centre, Thiruvananthapuram, India
| | - T Priya Kumari
- Department of Pediatrics, Regional Cancer Centre, Thiruvananthapuram, India
| | - P Kusuma Kumary
- Department of Pediatrics, Regional Cancer Centre, Thiruvananthapuram, India
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Abstract
Primary renal lymphoma is a rare entity representing less than 1% of lesions in the kidney. We present the case of a 42-year-old male who was evaluated for pain and a mass in the abdomen. The computed tomogram of the abdomen showed a large lobulated homogeneously enhancing mass lesion of about 14×12×18 cm, involving the whole of the left kidney and encasing the left renal vessels and ureter. The patient underwent a biopsy, and the histopathology was diffuse large B cell lymphoma, positive for LCA, CD20, PAX 5, Bcl 2 and negative for SIgM, CD33, CD34, CD5, Tdt, with MIB 1 labelling index of 40%. He received chemotherapy with rituximab, cyclophosphamide, doxorubicin, vincristine and prednisolone (R CHOP) for eight cycles followed by radiation to the residual mass and achieved complete remission. Currently, he is alive and in remission at 28 months.
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Affiliation(s)
- N Geetha
- Department of Medical Oncology, Regional Cancer Centre, Trivandrum 695011, India
| | - Abdul Shahid
- Department of Medical Oncology, Regional Cancer Centre, Trivandrum 695011, India
| | - Varun Rajan
- Department of Medical Oncology, Regional Cancer Centre, Trivandrum 695011, India
| | - Priya Mary Jacob
- Department of Pathology, Regional Cancer Centre, Trivandrum 695011, India
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Abstract
Extramedullary plasmacytomas are plasma cell tumors that occur outside the bone marrow. They constitute around 4 % of all plasma cell neoplasms. The most common site of extramedullary plasmacytoma is the upper aerodigestive tract-nasal cavity, paranasal sinuses and oronasopharynx. We are presenting a case of extramedullary plasmacytoma of the trachea. Trachea is an extremely rare site of plasmacytoma. When extraosseous plasmacytoma occur in uncommon sites, the distinction from B cell lymphomas showing extensive plasmacytic differentiation can be difficult and diagnostically challenging.
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Affiliation(s)
- Renu Sukumaran
- Division of Pathology, Regional Cancer Centre, Trivandrum, 695011, Kerala State, India,
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Mathew AJ, Wann VC, Abraham DT, Jacob PM, Selvan BS, Ramakrishna BS, Nair AN. The effect of butyrate on the healing of colonic anastomoses in rats. J INVEST SURG 2010; 23:101-4. [PMID: 20497012 DOI: 10.3109/08941930903469367] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Butyrate, a short-chain fatty acid (SCFA) formed by the fermentation of complex carbohydrates by the bacteria in the colon, is the main source of nutrition for colonocytes. The aim of this experiment was to investigate the effect of butyrate on the healing of colonic anastomosis in a rat model. MATERIALS AND METHODS Forty male Wistar rats were fed a fibre-free diet for 2 days. They then underwent laparotomy, transection, and anastomosis of both left and right colon, with a defunctioning caecostomy. The animals were then randomly assigned to receive butyrate or saline enemas from the third postoperative day and underwent another laparotomy on the seventh postoperative day when the bursting pressures of both anastomoses were measured. RESULTS Out of the 40 rats, 23 were available for the final data analysis. The mechanical strength of the anastomosis was measured by the bursting wall tension (BWT), which was calculated from the bursting pressure and the anastomotic circumference. The anastomoses in the butyrate arm showed a significantly higher BWT for both the right (48.9 s 64.71 dyne10(-3)/cm, p value .04) and the left (51.44 vs 72.38 dyne 10(-3)/cm, p value .01). CONCLUSION This experiment suggests that butyrate has a significant role in increasing the mechanical strength of colonic anastomoses in rats.
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Affiliation(s)
- A J Mathew
- Department of General Surgery Unit VI, CMC Hospital, Vellore, Tamil Nadu, India.
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Jacob PM, Sukumar GC, Nair A, Thomas S. Parathyroid adenoma with necrotizing granulomatous inflammation presenting as primary hyperparathyroidism. Endocr Pathol 2005; 16:157-60. [PMID: 16199902 DOI: 10.1385/ep:16:2:157] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Abstract
The presence of cotinine, a nicotine metabolite, in urine above a specified cutoff concentration is commonly used to distinguish smokers from nonsmokers, as in smoking cessation studies. A stability study of cotinine in urine was carried out after questions arose concerning analyte stability at elevated storage and shipment temperatures. Aliquots from a smokers urine pool were stored at 5, 25, 40, 50 and 60 degrees C for 30 days. Another set of aliquots, obtained by diluting the smokers pool 1:1 with nonsmokers urine, were stored under the same conditions. Free cotinine levels, determined by a stability-indicating gas chromatographic/mass spectrometric (GC/MS) assay, increased over the 30-day period at higher storage temperatures. Cotinine concentrations in the aliquots stored at 60 degrees C, for example, nearly doubled over 30 days (1301 to 2476 ng/ml), with similar proportional increases observed in the aliquots diluted with nonsmokers urine. Since cotinine can be excreted to a large degree as cotinine-N-glucuronide, this conjugated metabolite was determined by an indirect method. As the storage temperature increased, the free/conjugated cotinine ratio dramatically increased, pointing to cotinine-N-glucuronide as the source of the additional free cotinine at the higher storage temperatures. The results of this study are of much practical importance, since urine samples with free cotinine concentrations just below a cutoff value may become positive for smoking status if suitably low temperatures cannot be maintained during sample handling and shipment.
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Affiliation(s)
- R L Hagan
- Clinical Investigation Facility, David Grant Medical Center, Travis Air Force Base, CA 94535, USA.
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