Flow cytometric detection of intracellular antigens has become a standard method in establishing proper leukemic cell lineage affiliation. It has a non-debatable contribution to the diagnosis of hematolymphoid neoplasm as well as in minimal residual disease. Combination of analysis of fluorescence labeling and light scatter properties of cells allows rapid and better determination of target cell antigens. Regarding the detection of intracellular antigens, standardization of the procedure remains, however, a real challenge. Detection of intracellular antigens by flow cytometry (FCM) requires effective fixation and permeabilization of the cell membrane. In the available literature, some reports describe methodologies to achieve satisfactory results for detection of either cytoplasmic or nuclear antigens; however, no methodological consensus has yet been achieved among the laboratories. This article is an attempt to describe different approaches to detect intracellular molecules by FCM.

Listeria monocytogenes is a foodborne pathogen that can cause serious invasive illness, mainly in certain well-defined high-risk groups, including elderly and immunocompromised patients, pregnant women, newborns and infants. L. monocytogenes primarily causes abortion, septicemia or meningitis. Contaminated meats (such as hot dogs, delicatessen meats and patι), dairy products and seafood have all been implicated in outbreaks of listeriosis. The public health importance of listeriosis is not always recognized, particularly because listeriosis is a relatively rare disease compared with other common foodborne illnesses such as salmonellosis or botulism. However, because of its high case fatality rate, listeriosis ranks among the most frequent causes of death due to foodborne illness, ranking second after salmonellosis. L. monocytogenes emerged as an important foodborne pathogen in the latter part of the 20th century. Extensive work has been performed in many countries during the last decade to prevent outbreaks and decrease the incidence of listeriosis. An important reduction occurred in listeriosis incidence in some of these countries during the 90s, suggesting a relationship between preventive measures and incidence decrease of human listeriosis.

Malignancy arising in mixed tumors of the salivary gland is a distinct entity that can occur sporadically or in association with a background of pleomorphic adenoma. Carcinoma arising with a background of pleomorphic adenoma is well documented. However, there are rare occurrences of aggressive de novo carcinosarcomas of the parotid that have been reported. Various cell lineages such as the epithelial glandular cells and the stromal spindle cells are involved. We report 23 cases of tumors of the salivary gland comprising 18 cases of carcinoma ex pleomorphic adenoma, four cases of carcinosarcoma of the parotid and one case of benign metastasizing pleomorphic adenoma. The occurrence of various malignancies suggests that this phenomenon is not very uncommon and should be looked for when reporting a mixed tumor.

Background: Molecular genetics and immunopathologic analysis of bladder cancer have shown some abnormalities in a number of genes and proteins that have been implicated in the development and progression of such tumors, mainly in the p53 pathway. Aims: To investigate the rate of positively stained p53 protein in patients with urothelial papillary carcinoma of the bladder (UCB) by immunohistochemistry and its relationship with tumor grade, gender and age of the patients. Settings and Design: During the present cross-sectional study, 100 paraffin-embedded specimens of UCB, which were provided from biopsies of the bladder by transurethral access, were immunohistochemically stained and studied for p53 protein from May 2006 to May 2007 in our referral center pathology laboratory. Materials and Methods: First, 4 µm slices of paraffin sections were provided and then stained by the avidin-biotin peroxidase method. The rate of positively stained p53 protein (defined as positive nuclear staining in over 10% of the cells) was assessed. This rate was also estimated and compared between grades, genders and age-related groups (<70 years, ≥70 years). Statistical Analysis: The χ² , Fisher's exact test and Mann-Whitney U test were used for comparing. Results: The overall rate of positively stained specimens was 11% for nuclear p53 protein. This rate was significantly higher in females (10/29 vs. 1/71; P < 0.001; odds ratio [OR]: 0.23; 95% confidence interval [CI]: 4.43-306.08), patients with 70 or older than 70 years (8/42 vs. 3/58; P = 0.04; OR: 0.55; 95% CI: 1.07-17.39) and in high-grade tumors (10/58 vs. 1/42; P = 0.02; OR: 0.59; 95% CI: 0.01-0.95). Conclusions: The rate of positively stained p53 protein for UCB was lower in our population. This rate was also higher in females, patients with 70 or older than 70 years and high grade of UCB.

Background: Immunohistochemical assessment of the hormone receptor status of breast carcinoma is a routine investigation. However, there is no worldwide consensus on the scoring system. The Quick Score is claimed to be a reliable scoring system, which assesses both the proportion of stained cells and the intensity of staining. Aims: To assess the value of Quick Score in terms of accepted clinicopathological parameters and to document the prevalence of hormone receptor-positive breast carcinomas in the study sample. Materials and Methods: Clinicopathological parameters of 151 breast cancers were compared with the Quick Scores for estrogen receptor (ER) and progesterone receptor (PR) status. Results and Conclusions: The Quick Score for ER was 0 in 54.3% (82/151) and for PR was 0 in 51.7% (75/145), indicating no hormone receptor expression in the majority. The Nottingham grade and the mitotic count had a significant inverse relationship with the Quick Score for hormone receptor status. The Nottingham Prognostic Index (NPI) also had an inverse relationship with the hormone receptor status.

Background: Oral cancers are a major health problem in India. Recently, parameters of cell proliferation and cell death have emerged as important diagnostic and prognostic tools. Aims: The aim was to study apoptosis in premalignant and malignant squamous cell lesions of the oral cavity and to evaluate its prognostic role in oral cancers. Materials and Methods: The study included 175 patients presenting with oral lesions. Evaluation of apoptotic index (AI) (using light microscopy) was performed on hematoxylin and eosin-stained sections. Statistical Analysis Used: Student's t test was performed. Results: The mean AI increased progressively with increasing dysplasia, with the maximum AI in well-differentiated (WD) squamous cell carcinoma, and a fall was noted with progression toward higher grades. The difference between WD SCC and poorly-differentiated SCC was significant (P < 0.05). Cases with lymph node metastasis had significantly (P < 0.05) lower mean AI values. Conclusion: Apoptosis can be fairly accurately assessed using light microscopy. Tumors that exhibit less apoptosis tend to show aggressive behavior and have a greater potential for metastasis.

A second malignant neoplasm has been found to be more frequent than might be expected from the general population rates. Therapy-related myelodysplastic syndrome and acute leukemia are dreaded long-term complications of five cases of hematological malignancies following treatment for successful breast cancer therapy (therapeutic drugs or radiotherapy). We encountered carcinoma from north India over a 7-year period from 1999 to 2005. The patients presented 2-5 years after treatment of breast carcinoma. Three patients underwent surgery and received chemoradiotherapy. One patient received chemotherapy after surgery. One patient underwent only surgery and after 3 years presented with acute myeloid leukemia and bone marrow metastasis of carcinoma of the breast. At the time of presentation, all the patients had either bicytopenia or pancytopenia. A close follow-up with complete blood cell counts of the patients who previously had carcinoma of the breast is suggested for early detection of hematological abnormalities. However, the poor prognosis, limited financial resources and poor health insurance coverage results in few patients and their family members opting for treatment.

This study was carried out to observe the trend in hormone receptors over the last 8 years in a tertiary cancer center in India. A total of 11,780 tumors analyzed for hormone receptors over the last 7 years were compared with the results of hormone receptor expression in a prior published study on 798 cases of breast cancer from the same institute. The patient's ages ranged from 18 to 102 years, Sixty percent of the patients were in the age group of 31-50 years. Seventy percent of the tumors were grade III tumors. The percentage of hormone receptor expression in breast cancer in the last 8 years varied from 52 to 57%. The overall receptor expression in the last 8 years shifted within a 5% range, confirming that the hormone receptor expression in Indian patients with breast cancer is low. However, there was redistribution within the pattern of estrogen receptor (ER) and progesterone receptor (PR) expression among tumors showing hormone receptor expression. Breast cancers showing only PR expression reduced dramatically from 21% in the year 1999 to in the year 2006, with a parallel increase in breast cancers showing combined ER and PR positivity (from 25 to 41.8%) and only ER expression (from 7.4 to 10.6%). The hormone receptor expression in breast cancers in India is and continues to be low but the high incidence of only PR-positive tumors in our population reported earlier was misrepresented.

Background: The prognostic and therapeutic significance of differentiating adenocarcinoma (AC) from reactive mesothelium (RM) in effusions cannot be overemphasized. To avoid diagnostic errors, ancillary techniques like immunohistochemistry are employed. However, results vary and no universal standard has been accepted so far. Objective: To study the combined diagnostic efficacy of epithelial membrane antigen (EMA), carcinoembryonic antigen (CEA), E-cadherin (EC), calretinin (CAL), desmin (DES) and vimentin (VIM) in distinguishing RM from AC cells in serous effusions. Study Design: Unequivocally diagnosed cases of 39 adenocarcinomatous and 38 RM populations were studied using sections from 49 formalin-fixed, paraffin-embedded cell blocks. Materials and Methods: The immunomarkers were applied on cell block sections using the avidin-biotin peroxidase technique. The distribution/intensity of immunostaining in mesothelial and AC cells were graded semiquantitatively. Statistical Analysis Used: Fischer's exact test was used to calculate the efficacy of individual markers and their combinations. Results: EMA was the best single marker for AC, with 100% sensitivity and 97.37% specificity. For the mesothelial cells, CAL exhibited 100% sensitivity and 92.31% specificity. DES was more specific than CAL but had a poor sensitivity of 55.26%. EC, CEA and VIM had unsatisfactory predictive values precluding their use as individual diagnostic markers. Among the combinations, two panels - EMA+ AND (CAL- OR DES-) for ACs and CAL+ AND (EMA- OR CEA-) for RM had 100% specificities and sensitivities. Conclusions: Most panel studies on fluid cytology are based on the arbitrary use of individual markers with the best statistical values, leading to a less than accurate diagnostic assessment. We believe that statistical parameters calculated in combination provide for a more practical and objective evaluation as well as allowing for meaningful comparative studies.

Background: Iron deficiency anemia (IDA) is one of the most common nutritional problems in the world, especially in developing countries. Infants aged between 4 and 24 months are among the population groups that are most affected by iron deficiency (ID). The aim of this study was to investigate the prevalence of ID and IDA in infants aged 12-15 months, living in Ahwaz, southwest of Iran. Materials and Methods: One hundred and twenty-six infants participated in the study. The mean corpuscular volume and hemoglobin (Hb), serum ferritin and hematocrit levels were measured. Anemia was defined when Hb <11g/dL and ID when ferritin <12µg/mL. Results: The prevalence of ID and IDA was 31.7 and 26.2%, respectively. The tendency to have IDA in infants fed with cow's milk and infants who did not receive ferrous sulfate was higher than in the other subjects. Conclusion: ID and IDA are common among infants aged 12-15 months living in Ahwaz, Iran. Maintenance of exclusive breastfeeding up to the 4-6th month of life and iron supplementation for the target group is needed.

Malaria is one of the most important parasitic diseases in humans affecting 103 countries worldwide. Aims: The present study aims to determine the diagnostic utility of cell counter data - hemoglobin, total leukocyte count, platelet count and depolarized laser light (DLL)-based purple-coded events (PCEs) in detection of acute malaria. This is a retrospective study of 523 patient data that came for complete blood count for the first time. Results : One hundred thirty-five of the 523 patients showed microscopic evidence of malaria. Platelet count showed the highest sensitivity of 77.77% (105/135). PCEs (≥1) showed 43.7% (59/135) sensitivity. Conclusions : It is concluded that a low platelet count (<150 × 109/L) is a good hematological parameter for presumptive diagnosis of malaria. If we change the cut-off for PCEs from ≥1 to ≥2, the sensitivity would be 56.29% (76/135) and the specificity would be 94.58% (367/388), respectively. The sensitivity of DLL was low, particularly with a low parasitic index (PI). The number of PCEs does not correlate with the PI. The cut-off number of PCEs in DLL-based malaria detection should be modified in highly endemic areas.

Background and Purpose: Resistance to fluoroquinolones and cephalosporins is a major problem with Salmonella enterica serovar Typhi and Paratyphi. An accurate determination of antibiotic susceptibility requires tests for minimum inhibitory concentration (MIC) of antibiotics. We describe a simple broth-disk method to determine the MIC of ceftriaxone on S. typhi and S. paratyphi . Materials and Methods: Sixteen strains of S. typhi and two strains each of S. paratyphi A and S. paratyphi B were used in the study. The MIC of ceftriaxone was determined using the simple broth-disk method and the conventional broth macrodilution method and the results were compared. Results: All salmonella strains were susceptible to ceftriaxone. The results of the broth-disk and the conventional broth macrodilution method were similar. Conclusion: The broth-disk method is a simple, reliable and cost-effective method to determine the MIC of ceftriaxone on S. typhi and S. paratyphi A.

Detection of slime in Pseudomonas aeruginosa can be useful in understanding the virulence of this organism. Here, comparative studies of two phenotypic methods using the tube method and the spectrophotometric method for slime production from 100 clinically and 21 environmentally significant isolates of P. aeruginosa were performed. A total of 68 isolates were positive by either of the tests whereas only 34 were positive by both the tests. The tube method detected slime significantly in more number of isolates than the spectrophotometric method. The tube test was found to be superior to the spectrophotometric method in ease of performance, interpretation and sensitivity. Among the clinical isolates, systemic isolates produce less slime compared to wound, respiratory and urinary isolates. Isolates from the hospital environment produced more slime indicating that this virulence marker helps the organism to survive for longer periods and cause nosocomial infections.

Aims and objectives: The etiological spectrum of any superficial mycosis is largely dependent on the flora in the immediate environment of the individual. It is influenced by the geographic, climatic and occupational factors. The study is basically to formulate baseline data for the species prevalence of various dermatophytes in patients with onychomycosis attending the Central Referral Hospital, Gangtok, Sikkim. Materials and Methods: Thirty-four clinically suspected cases of onychomycosis were subjected to mycological studies. Results: Thirty-two (94.12%) cases were positive for fungal elements by direct microscopy and 28 (82.35%) by culture. Young adults in the age group of 21-30 years were mainly affected. The male:female ratio was 1.125:1. Dermatophytes were isolated in 18 cases (64.29%). Trichophyton tonsurans (44.44%) was the most common isolate followed by T. mentagrophytes (22.22%), T. rubrum (11.11%), T. verrucosum (11.11%) and Microsporum audouinii (11.11%). Apart from dermatophytes, Aspergillus niger (21.43%) and Penicillium marneffei (14.28%) were also isolated. Conclusion: Dermatophytes, mainly T. tonsurans, as well as moulds other than dermatophytes were isolated from onychomycosis patients in Gangtok, Sikkim.

The present study was conducted in 300 female sex workers (FSWs) from Surat city in 2005-2006. Vaginal swabs, endocervical swabs and serum samples were collected from each of these FSWs. Vaginal samples were screened for bacterial vaginosis (BV), candidiasis and Trichomonas vaginalis . Endocervical swabs were screened for gonococcal infection. Serological tests for human immunodeficiency virus (HIV), hepatitis B surface antigen (HBsAg) and syphilis were performed. From a total of 300 FSWs, BV was detected in 40 (13.33%), trichomoniasis in six (2%), candidiasis in 31 (10.33%), HIV seropositivity in 35 (11.66%), HBsAg reactivity in 10 (3.33%) and rapid plasma regain (RPR) reactivity in 20 (6.66%) cases. RPR-positive serum samples were confirmed by the treponema pallidum hemaglutination test. Gonococcal infection was not found in any of the FSWs. Of the total of 35 HIV-positive patients, 20 patients had associated coinfection. Of the 35 HIV-seropositive FSWs, BV was detected in six (17.14%), candidiasis in six (17.14%), syphilis in five (14.28%) and HBsAg in two (5.71%). One (2.85%) HIV-positive FSW was positive for both candidiasis and syphilis.

Rapid diagnosis is prerequisite for effective treatment and reducing mortality and morbidity of malaria. This study was taken up to compare the efficacy of various methods available, i.e., thick and thin smear, quantitative buffy coat (QBC), plasmodium lactate dehydrogenase and aldolase in blood of patient. A total of 411 samples were collected from patients presenting with classic symptoms of malaria. For traditional microscopy; thick and thin smears were prepared and stained with Leishman's stain, taking thick smear as gold standard, thin smear had a sensitivity and specificity of 54.8% and 100%, respectively. QBC and antigen detection was done using commercially available kits; out of 411 samples, QBC and Malariagen were positive in 66 and 62 cases, with a sensitivity of 78% and 75%, respectively. Leishman's thick smear, although cost effective, is difficult to interpret for inexperienced microscopists; so if facilities are available, QBC should be used for routine diagnosis. In places where facilities are not available, rapid, simple and easy to interpret antigen detection test can be used despite low sensitivity.

Cystitis cystica and cystitis glandularis (CG) are relatively common appearances in the urinary bladder though CG may occasionally mimic a neoplasm. Microscopically, two types of CG are recognized, the usual type and intestinal type. This study was undertaken to study the morphology of CG and to highlight the differences in morphology between CG and adenocarcinoma. Eleven cases of CG were seen, of which 3 cases showed predominantly CG, usual type and eight cases showed CG of intestinal type. One case of primary adenocarcinoma was included in this study, where the adjacent bladder mucosa showed CG. Evaluation of the histological features of CG, especially intestinal type helps in correct categorization of this lesion and differentiation from adenocarcinoma of the bladder.

Myelodysplastic syndrome (MDS) is a clonal disorder of pluripotential stem cells of the bone marrow. The purpose of the study was to obtain epidemiological data of MDS. Thirty cases of MDS presented from April 1998 to May 2006 are included in this study. Complete blood counts were performed in an automated cell counter. Bone marrow aspiration, trephine biopsy and chromosomal study were carried out. The dry film was stained using a Romanwasky stain and Perl's stain. Fifteen cases were male and 15 cases were female. The mean age at presentation was 55 years (range 8-73 years). A majority of the patients presented with weakness (63.33%). Autoimmune manifestations in the form of joint pain were present in 13.33%. Patients were symptomatic for a prolonged period before diagnosis could be reached (average 358.8 days). A majority of the patients had MDS-refractory anemia (MDS-RA) or MDS-RA with excess blasts( MDS-RAEB-2) at presentation. Three patients had chromosomal abnormalities (27.27%). Eight patients (26.7%) were relatively young at presentation, less than 50 years of age. Three (10%) were children. A majority of the patients opted for symptomatic treatment only.

Rare cases of inflammatory pseudotumor (IPT) in two adolescents are reported. Both of them presented with significant weight loss and were operated upon with the impression of liver abscess and malignant liver tumor. These two cases are reported to emphasize IPT of the liver as a differential diagnosis of hepatic masses in children because recognition of this condition before operation can avoid unnecessary surgery.

Cystic hydatid disease may develop in almost any part of the body. Approximately 70% of the hydatid cysts are located in the liver followed by the lung (25%). The kidneys, spleen, mesentry, peritoneum, soft tissues and brain are uncommon locations for hydatid cysts. Renal involvement in echinococcosis is extremely rare. Hydatiduria accompanies only 10-20% of all cases of renal hydatidosis and is usually microscopic. Gross hydatiduria is an exceptional presentation of hydatidosis. We report an exceptionally rare case of multiple hydatidosis with cysts in the liver, spleen, kidney and peritoneal cavity, presenting with gross hydatiduria.

We report the case of a 45-year-old man who presented with a 4-year history of midline neck swelling associated with recent onset respiratory distress. Local examination showed a lobulated diffuse thyroid enlargement. A subtotal thyroidectomy was performed. The right lobe weighed 225 g and the left lobe weighed 130 g. Multiple sections from both the lobes revealed diffuse infiltration of the stroma by mature adipose tissue. There was no evidence of amyloid deposits or papillary carcinoma. A final diagnosis of diffuse lipomatosis of the thyroid gland was rendered. Lipomatosis or adenolipomatosis of the thyroid gland is an extremely rare entity. The various differential diagnoses of fat in the thyroid include benign entities like amyloid goiter, adenolipoma, lymphocytic thyroiditis, intrathyroid thymic or parathyroid lipoma and malignant tumors like liposarcoma and encapsulated papillary carcinoma. Adequate clinical details and a thorough histopathological examination are mandatory for diagnosis.

A 49-year-old patient presented with a right ovarian mass, which, on microscopy, showed to consist of haphazardly oriented large pleomorphic cells with abundant cytoplasm. Periodic acid Schiff stain was positive but negative with diastase digestion. Immunohistochemical staining with Desmin showed intense cytoplasmic positivity in almost all the cells. Cytokeratin, epithelial membrane antigen, smooth muscle actin, HMB-45, S-100 and neurone-specific enolase were negative. Immunohistochemical staining with Myogenin showed intense nuclear positivity. There was no other primary tumor on extensive search. A diagnosis of primary sarcoma of the ovary with rhabdomyosarcomatous differentiation was made. The incidence of similar tumors of the ovary are low and therefore little data are available on this uniformly lethal tumor. Thus, such cases need to be reported to pool experience so that the tumor can be diagnosed early.

Inflammatory pseudotumor is an uncommon tumor with a variable natural course. We report a case of omental pseudotumor in a 6-year-old male child. The child's clinical presentation was suggestive of an omental mass, which was operated upon after investigations. Histopathology revealed it to be an inflammatory pseudotumor. The case is presented for its unusual location.

Luteinized thecomas are one of the sex cord stromal tumors of the ovary rarely undergoing ossification. We report a case of a 66-year-old post-menopausal female with the chief complaint of uterine bleeding of 7 months duration. Endometrial curettage performed showed features of endometrial adenocarcinoma. Follow-up total abdominal hysterectomy revealed bilateral luteinized thecomas of the ovary, one of which had undergone massive ossification converting the ovary into a bone. True bone formation in ovarian tumors is rare. This case is the second in the literature of osseous metaplasia in an ovarian luteinized thecoma, with the association of endometrial adenocarcinoma suggesting its functional status.

Primary mucinous carcinoma (PMC) of the skin is a rare adnexal tumor of sweat gland origin. A case report is presented of a 50-year-old female who presented with a gluteal mass, which was diagnosed as an injection abscess. Following incision and drainage, the incision site persisted as a non-healing ulcer. An edge biopsy of the lesion revealed mucinous carcinoma of the skin. Investigations excluded the possibility of a metastatic mucinous carcinoma. Thus, the lesion in the gluteal region was diagnosed as PMC of the skin, a rare site of occurrence.

Amebic colitis is common in developing countries, with its variable and non-specific symptoms. Amebomas occur rarely, resulting from the formation of annular granulation tissue, usually in the cecum and in the ascending colon. This report describes the case of a 59-year-old male who presented with abdominal pain. Radiological examination depicted concentric thickening of the cecal wall with mass formation and a cystic lesion in the liver. The endoscopy performed showed a growth in the ascending colon. Biopsy revealed extensive necrosis and inflammatory cells. The patient was referred to this hospital for surgical treatment with a provisional diagnosis of carcinoma of the colon. Peroperatively, a cecal mass was identified. However, suspected secondaries were not seen on the surface of the liver. Histological examination of the right hemicolectomy specimen revealed cecal and ascending colon amebomas. Trophozoites of Entamoeba histolytica were better recognized after periodic acid-Schiff staining. Treatment with Metronidazole for 2 weeks followed by diloxanide furoate for an additional 2 weeks was administered. The liver lesion resolved completely after 8 weeks. Colonic ameboma accompanied by amebic liver abscess may be misdiagnosed as metastatic colon cancer. A high index of suspicion is essential for diagnosis when dealing with colonic masses and liver lesions, especially in the tropics.

Extraovarian granulosa cell tumor (GCT) is a very uncommon tumor, assumed to arise from the ectopic gonadal tissue along the embryonal route of the genital ridge. One such rare case of extraovarian GCT was encountered in a 58-year-old female who presented with a large intraabdominal lump. Computerized tomography revealed one large retroperitoneal mass measuring 15cm × 16cm and another mesenteric mass of 8cm × 5cm size. The patient had a history of hysterectomy with bilateral salpingooophorectomy 20 years ago for uterine leiomyoma. Ultrasonography-guided aspiration smears revealed cytological features suggestive of GCT. Histopathological examination of the excised masses showed features of adult-type GCT. Because metastatic epithelial tumors, particularly from the ovaries, may show identical morphology, immunostains for inhibin and epithelial membrane antigen (EMA) were performed. The tumor showed positivity for inhibin while EMA was negative thus confirming the diagnosis of GCT. As this patient had no previous history of GCT and was oophorectomized 20 years ago, the tumor was considered as extraovarian. A diagnosis of extraovarian GCT should be carried out after excluding any previous history of GCT of the ovary. Immunostains help to differentiate GCTs from other neoplasms.

Malignant teratomas of the thyroid are rare tumors. We report a case of primary malignant teratoma of the thyroid in a child with lymph node metastases. Fine needle aspiration biopsy was suggestive of malignancy. Near-total thyroidectomy with right side neck dissection revealed a malignant teratoma of the thyroid with metastases in the lymph nodes. The patient is alive and in complete remission 4 years after the initial diagnosis.

Chickenpox (Varicella) representing the primary infection by Varicella zoster virus is a common benign and self-limited infectious disease of childhood. Although the disease can be associated with complications, they are generally mild and tend to occur in adults and immunocompromised children. Severe and life-threatening complications are extremely rare, particularly those involving the cardiovascular system. We report a malnourished 5-year-old girl with chicken pox complicated by hemorrhagic pericarditis and deep vein thrombosis leading to fatal pulmonary thromboembolism. Though varicella infection runs a benign self-limiting course, it continues to cause significant morbidity and mortality when associated with complications, particularly in malnourished children. Hence, the importance of vaccination and early recognition of complications is emphasized.

Placental site nodule is an uncommon, benign, generally asymptomatic lesion of trophoblastic origin, which may often be detected several months to years after the pregnancy from which it resulted. This entity may have bizarre histologic findings and should be distinguished from other aggressive lesions like placental site trophoblastic tumor, epithelioid trophoblastic tumor and squamous cell carcinoma.

Cutaneous angiomyolipomas are rare. We report a case in a 45-year-old male with a well circumscribed lesion located on the chin. This lesion, probably hamartomatous in nature, differs from renal angiomyolipoma in terms of nonassociation with tuberous sclerosis, circumscription, and male predominance. Another characteristic feature is the absence of epithelioid cells. Differential diagnosis includes angiolipoma, angioleiomyoma, hemangioma, and myolipoma. It is distinguished from the abovementioned entities by the presence of a combination of thick-walled blood vessels, smooth muscle, and fat.

Carcinosarcoma of the gallbladder is an uncommon neoplasm. We herein report the case of a patient with carcinosarcoma of the gallbladder, treated by simple cholecystectomy for a tumor which was confined to the gallbladder.

A 44-year-old Japanese woman presented with a left low back pain. Abdominal ultrasonography revealed the left hydroureteronephrosis. She had the past history of endometriosis interna 3 years before. Retrograde pyelography showed the defect in the ureter, and on ureteroscopy, a polypoid mass was identified. Biopsy specimen from the ureteral mass showed endometrioid epithelia and edematous endometrial stroma, immunohistochemically positive for progesterone receptor (PgR), estrogen receptor (ER), and CD 10. For the lesion (endometrioma), partial resection of the ureter and ureteroneocystostomy with Boari flap were performed. The resected specimen showed a 2-cm polypoid mass. Histologically, the lesion was ureteral endometriosis. The postoperative course was uneventful, the patient showed no evidence of local recurrence after the initial resection and continues to be under close follow up. Urinary tract involvement of endometriosis is uncommon. Endometriosis should be included in the differential diagnosis of ureteral strictures in sexually active young females.

Mammary hamartomas are uncommon benign lesions rarely associated with malignancy. We report a case of a 25-year-old female patient presenting with a lump in the left breast. Fine needle aspiration cytology showed features of invasive ductal carcinoma along with normal benign glands that were mistaken for normal breast tissue. However, the mastectomy specimen revealed the malignant mass within a larger hamartomatous mass. Mammary hamartomas are benign lesions but, on exceedingly rare occasions, they may be involved by incidental, coexisting carcinoma, as illustrated in this case report.

Peripheral blood smear examination is the most specific as well as the most common test performed for the diagnosis of malaria. Schizonts, ring forms (trophozoites) and gametocytes are the stages of malarial parasite that are commonly seen in the peripheral blood smear of a patient. Here, we report an extremely rare case of a 40-year-old male patient who presented with Plasmodium vivax infection with multiple exflagellated microgametes in the peripheral blood smear with review of the literature. Exflagellation of microgametes in malarial parasites is only seen in the definitive host, mosquito, and is very unusual to see during the developmental phases in the intermediate host, human. It is important to recognize these exflagellated microgametes in the peripheral blood smear as they may lead to diagnostic confusion with organisms such as spirochetes and trypanosomes.

Pseudo Chediak-Higashi anomaly in acute leukemia is a rarely described entity. The significance of this intriguing morphological finding largely remains unknown, although some authors have predicted a poorer outcome in such cases because of a higher susceptibility to fulminant infections. Our case also had a fatal outcome.

A new born with a mongoloid slant, brachycephaly and low-set ears presented at birth with a total leucocyte count of 57 x 10 ³ /µL and the differential leucocyte count revealed 70% of these to be blasts. The morphology of the blasts was not characteristic of myeloid and lymphoid lineage. Cytochemistry showed myeloperoxidase (MPO), Sudan Black B (SBB), periodic acid-Schiff (PAS) and non-specific esterase (NSE) negativity. Flowcytometry showed blasts that were positive for CD-33, CD-34 and CD-7. On second follow-up on the 10th day, the same picture persisted on morphology. On subsequent follow-up, the blasts disappeared. This was thus confirmed to be a case with transient leukemia with Downs syndrome.

Hemophagocytic syndrome is rare syndrome characterized by unregulated proliferation and activation of macrophages and phagocytosis of the platelet, erythrocytes, lymphocytes and their hematopoietic precursors in the bone marrow, resulting in cytopenias. It is associated with stimuli-like infections, malignancies and immunocompromised states. We present here a case of generalized lymphadenopathy, hepatosplenomegaly and progressive cytopenias in a 17-year-old male.

Rhodococcus equi is an unusual pathogen causing infections mostly in immunocompromised patients, particularly in those with human immunodeficiency virus (HIV). It has rarely been reported to affect immunocompetent hosts, where it usually presents as an isolated extrapulmonary lesion. We report a case of osteomyelitis caused by this organism in an immunocompetent host.

Most of the Bartholin's gland abscesses have been thought to be caused by colonizing micro-organisms of the perineal region. We encountered an interesting case of acute Bartholins abscess caused by Streptococcus pneumoniae in a primigravida. The abscess was incised and drained. The patient was treated with Cefuroxime. This case is presented for its rarity.

Cryptosporidia are intestinal spore forming protozoa, which cause intracellular infections, predominantly in the epithelial cells of the intestine. Extra-intestinal infections with Cryptosporidium parvum have been rarely reported. However, a few reports of pulmonary cryptosporidiosis in HIV/AIDS cases have been mentioned in literature. In immunocompromised individuals who do not have HIV-related disease, Cryptosporidiosis has been rarely reported. We present a case of respiratory infection caused by C. parvum . The patient was a 10-year-old child with nephrotic syndrome and was receiving corticosteroids for 6 months. The child had history of low-grade fever, breathlessness and cough with expectoration of 3 months duration. The patient was nonreactive for HIV, and there was no evidence of primary immunodeficiency. Major serum immunoglobulins (IgG, IgA, and IgM) were in normal range. Simultaneous gastrointestinal involvement with C. parvum was observed.

Brain abscess is an uncommon and serious life-threatening infection in children. Focal intracranial infections caused by Salmonella spp. in this age group are also rare. We report the case of a 4-month-old male infant with a frontoparietal brain abscess caused by Salmonella typhimurium , the presence of which was not suspected clinically.

Two cases of squamous cell carcinoma (SCC) arising in a mature cystic teratoma (MCT) are being discussed for their rarity and pattern of infiltration of tumor cells in the stroma (alpha mode, beta mode and gamma mode), which is a key factor in deciding the prognosis and patient survival.