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2.  Jejunal Diverticulosis with Perforation – A Challenging Differential Diagnosis of Acute Abdomen: Case Report 
Multiple diverticulosis of the jejunum represents a very rare entity. Jejunal diverticula are found to be the rarest of all small bowel diverticula. The disease is usually asymptomatic and often becomes clinically relevant when complicated. This rarity makes it a difficult differential diagnosis. Related complications such as diverticulitis, perforation, and bleeding and/or intestinal obstruction appear in about 10-30% of the patients which increase the morbidity and mortality rates in such individuals. Here, we present a case of jejunal diverticulosis with perforation who presented with symptoms of acute abdominal pain, vomiting and fever along with a brief review of literature.
PMCID: PMC4378744  PMID: 25859462
Abdominal pain; Diverticulitis; Intestinal perforation; Perforation
3.  Bone Marrow Granuloma in Typhoid Fever: A Morphological Approach and Literature Review 
Typhoid fever is one of the few bacterial infections in humans where bone marrow evaluation is routinely recommended. However, the morphological aspect of typhoid fever in bone marrow has been rarely described in the literature. We describe a 25-year-old male patient who presented with prolonged fever suspected to be of tubercular etiology. Bone marrow examination showed well-formed histiocytic and epithelioid granulomas and erythrophagocytosis; and the bone marrow aspirate culture grew Salmonella typhi A. In view of potential clinical implications, typhoid fever should be considered as a differential diagnosis to tuberculosis in the evaluation of prolonged fever; especially in high prevalent areas. We suggest that erythrophagocytosis may serve as a morphological marker in typhoid granulomas in the bone marrow; and bone marrow culture should be submitted in every suspected case for appropriate patient management.
PMCID: PMC4350621  PMID: 25789187
4.  A Rare Presentation of Gastric Signet Ring Cells: Signet Ring Cell Lymphoma 
We herewith present a rare and interesting case of gastric signet ring cell lymphoma (SRCL) in a 40-year-old retroviral positive lady. SRCL is a rare morphological variant of nodal lymphomas.Biopsy from the suspected lesion in the stomach showed diffuse sheets of cells with a large central vacuole displacing the nucleus to the periphery of the cell, imparting signet ring cell morphology. Negative reaction to PAS (Periodic acid Schiff) stain and subsequent strong positivity for the immunohistochemical markers such as CD45 (Leucocyte commonantigen) and CD20, a B-cell marker helped us to arrive at a diagnosis of signet ring B- cell lymphoma.
PMCID: PMC4316266  PMID: 25653960
Adenocarcinoma; Candidiasis; Lymphoid cells
5.  Hemophagocytic Lymphohistiocytosis: an Unusual Complication of Orientia tsutsugamushi Disease (Scrub Typhus) 
Hemophagocytic lymphohistiocytosis (HLH) is an uncommon, potentially fatal, hyperinflammatory syndrome that may rarely complicate the clinical course of Orientia tsutsugamushi disease (scrub typhus).
Here we describe the clinicopathological features, laboratory parameters, management, and outcome of three adult patients (1 female, 2 males) with scrub typhus associated HLH from a tertiary center. A brief and concise review of international literature on the topic was also added.
All three patients satisfied the HLH-2004 diagnostic criteria; one had multi-organ dysfunction with very high ferritin level (>30,000 ng/ml), and all had a dramatic recovery following doxycyclin therapy. Literature review from January 1990 to March 2014 revealed that scrub typhus associated HLH were reported in 21 patients, mostly from the scrub endemic countries of the world. These included 11 females and 10 males with a mean age of 35 years (range; 8 months to 81 years). Fifteen of 17 patients (where data were available) had a favorable outcome following early serological diagnosis and initiation of definitive antibiotic therapy with (N=6) or without (N=9) immunosuppressive/immunomodulator therapy. Mutation analysis for primary HLH was performed in one patient only, and HLH-2004 protocol was used in two patients.
We suggest that HLH should be considered in severe cases of scrub typhus especially if associated with cytopenia (s), liver dysfunction, and coagulation abnormalities. Further studies are required to understand whether an immunosuppressive and/or immunomodulator therapy could be beneficial in those patients who remain unresponsive to definitive antibiotic therapy.
PMCID: PMC4283929  PMID: 25574367
6.  Clinicopathological Profile of Salmonella Typhi and Paratyphi Infections Presenting as Fever of Unknown Origin in a Tropical Country 
Enteric fever, a common infection in the tropics and endemic to India, often manifests as an acute febrile illness. However, presentation as fever of unknown origin (FUO) is not uncommon in tropical countries.
We aim to describe the clinical, laboratory and pathological features of patients hospitalized with fever of unknown origin and diagnosed as enteric fever. All culture proven cases of enteric fever were analyzed retrospectively over a period of three years from January 2011 to December 2013.
Seven of 88 (8%) cases with enteric fever presented as FUO. Abdominal pain was the most common symptom besides fever. Relative bradycardia and splenomegaly were uncommon. Thrombocytopenia was the most common haematological abnormality while leucopenia was rare. Transaminase elevation was almost universal. S. Typhi and S. Paratyphi A were isolated from six cases and one case respectively. Yield of organisms from blood culture was superior to that of bone marrow aspirate. Multiple granulomas were identified in 4 out of 6 (67%) of the bone marrows studied, including that due to S. Paratyphi A and histiocytic hemophagocytosis was noted in two cases.
FUO is a relatively common manifestation of enteric fever in the tropics. Clinical and laboratory features may be atypical in such cases, including absence of relative bradycardia, leucopenia, and presence of thrombocytopenia, bicytopenia or pancytopenia. In addition, in endemic countries, enteric fever should be considered as a differential diagnosis, next to tuberculosis, in the evaluation of bone marrow granulomas in cases with FUO and culture correlation should be mandatory.
PMCID: PMC4344176  PMID: 25745548
7.  Sertoli-Leydig Cell Tumor of Ovary- A Diagnostic Dilemma 
Sertoli Leydig Cell Tumours (SLCTs) are rare, unilateral, sex cord stromal tumours of ovary, which constitute less than 1% of all the ovarian neoplasms. These tumours can be functionally diverse and they may have heterologous elements. We aim to report a case of a 25-year- old woman who presented with suprapubic pain of 5 days duration, a unilateral adnexal mass, hypertestosteronism without virilization. Intraoperative frozen section of the unilateral salpingo-oophorectomy specimen was suggestive of granulosa cell tumour. Histopathological examination, supplemented with alpha-inhibin immunohistochemistry, was diagnostic of Meyer’s type II SLCT. Clinical presentation, pathology and the diagnostic pitfalls in the present case have been presented with a brief review of literature.
PMCID: PMC4003607  PMID: 24783104
Sertoli-Leydig cell tumour; Ovary; Alfa-Inhibin; Frozen section
8.  Cyclin D1 expression in multiple myeloma by immunohistochemistry: Case series of 14 patients and literature review 
Cyclin D1 dysregulation is an early and unifying oncogenic event in patients of multiple myeloma (MM). This may be detected up to 30% cases by immunohistochemistry (IHC) and up to 40-50% cases by molecular studies. However, studies on the clinical significance of cyclin D1 dysregulation in MM have been inconclusive. We aimed to study the pattern of cyclin D1 expression in MM by IHC and correlate with selected clinicopathologic features.
Materials and Methods:
Formalin fixed, decalcified, bone marrow trephine sections from 14 symptomatic patients of MM (13 newly diagnosed and one relapsed) were subjected to cyclin D1 IHC by using a rabbit monoclonal antibody to cyclin D1 (clone EPR2241).
Cyclin D1 expression (in ≥10% tumor cell nuclei) was observed in 8 of 14 cases (57%). Cyclin D1 positive (+) group had significantly lower hemoglobin level (P = 0.03) than cyclin D1 negative (−) group (n = 6); though both groups showed no statistical significance (P > 0.05) in regard to age, gender, Durie and Salmon stage, lytic bone lesions, light chain phenotype, creatinine, calcium, lactate dehydrogenase, leukocyte and platelet count and bone marrow histology. Ten of 14 (71.5%) showed a favorable response (follow-up; 7 days to 34 months) to thalidomide and/or bortezomib based chemotherapeutic regimen. Four of eight cyclin D1− patients showed complete response, two had a partial response (PR) and two died of the disease; whereas 4/6 cyclin D1 − patients had PR, one refused definitive therapy and one was lost to follow-up (P > 0.05, Fischer's exact test).
IHC may be a feasible tool for the demonstration of cyclin D1 expression on adequately processed trephine biopsy specimen in MM patients in a resource poor setting. Negative IHC results should be correlated with molecular techniques for prognostication.
PMCID: PMC3932597  PMID: 24604959
Bone marrow; cyclin D1; immunohistochemistry; multiple myeloma; prognosis
9.  Pleural Tuberculosis Mimicking Inflammatory Pseudotumour 
A pseudotumour is a rare presentation of bronchopulmonary tuberculosis which occurs in immunocompetent patients, which can simulate malignancy, both clinically and radiologically, and may cause delay in its diagnosis and treatment. The incidence of bronchopulmonary pseudotumours was found to vary from 2-4%, as was seen in various studies. A mycobacterial pseudotumour of the pleura is a rare entity. We are reporting a case of a pleura based tubercular pseudotumour in a 59 years old patient who presented with a four month history of the nonspecific symptoms of cough and chest pain. The radiological investigations showed that a pleural based mass lesion was occupying the right lower hemithorax. The initial biopsy was suggestive of a hyalinizing variant of an inflammatory pseudotumour. The follow-up surgical resected mass was consistent with the features of a tubercular granuloma. The clinical presentation and the histopathological findings have been presented, with a brief review of the literature. Due to its varied and unusual presentation, bronchopulmonary tuberculosis should always be kept in mind when a patient with a similar clinical and a radiological picture is being evaluated.
PMCID: PMC3644451  PMID: 23730653
Tuberculosis; Malignancy; Pseudotumour; Pleura
10.  Comparative Evaluation of Simultaneous Bone Marrow Aspiration and Bone Marrow Biopsy: An Institutional Experience 
Bone marrow aspirations and bone marrow biopsies are important diagnostic procedures. A comparative study of both the procedures done simultaneously was retrospectively reviewed in 160 cases where the clinical history is correlated with BMA and BMB results. The advantage of each method is analyzed. Correlation of our findings with that given in the literature is done to give a guideline for both techniques. We have found that 61.25% of the cases showed a positive correlation between bone marrow aspiration and bone marrow biopsy. However, we found that tuberculous granulomas and Hodgkin disease involvement of the marrow were detected better in bone marrow biopsies. The advantage of both the procedures done together provided more material and enabled us to study the cytomorphology of the cells, with the pattern of distribution of the cells depending on the cases. However, when both the procedures are done simultaneously, a proper technique is required so as to yield good diagnostic material.
PMCID: PMC3002064  PMID: 21629634
Bone marrow aspirate; Bone marrow biopsy; Simultaneous; Comparative evaluation

Results 1-10 (10)