Eastern Command Hospital

We report here the first case of sequential occurrence of peripheral T-cell lymphoma (PTCL)-not otherwise specified and T-lineage acute lymphoblastic leukemia (T-ALL) in a 50-year-old male diagnosed with the former on lymph node biopsy. He went into complete remission with 6 cycles of etoposide-based chemotherapy; however, he presented after 8 months with fever and generalized weakness. Peripheral smear showed 90% blasts, and his total leukocyte count increased to 80,000/cu mm over the next 2 days. Flow cytometry on peripheral blood showed 84% blasts, which were CD45 bright and positive for cytoplasmic CD3, CD8, CD5, CD7, and CD1a, and negative for surface CD3, CD34, and TdT. He was diagnosed with T-ALL in a treated case of PTCL and started on induction chemotherapy, to which he responded dramatically. However, he developed neutropenic colitis on day 14 of his illness and died.

Mixed phenotype acute leukemia (MPAL) with BCR: ABL1 rearrangement constitutes around 0.5% of all leukemias and rarely shows B-monocytic immunophenotype. We describe here a peculiar and intriguing case of a 40-year-old female who presented with anemia, leukocytosis, thrombocytopenia, and a peripheral smear showing 70% blasts of dual morphology resembling lymphoblasts and promonocytes. In cytochemistry, the promonocytes-like cells were strongly positive for non-specific esterase (NSE). Flow cytometry delineated two separate populations-the major one (57%) expressing strong CD19, CD10, CD22, cytoplasmic CD79a, CD34, CD13, CD33, CD14, and HLA-DR corresponding to the B-lineage and a minor population (10%) positive for CD14, CD64, CD11c, CD117, and dim myeloperoxidase suggestive of monocytic lineage. RT-PCR for BCR: ABL1 was positive for p210 transcript. A diagnosis of MPAL with BCR: ABL1 of B/monocytic immunophenotype was made, and the patient was managed with acute lymphoblastic leukemia (ALL) based induction chemotherapy and tyrosine kinase inhibitor. The uniqueness of the case is the presence of an additional population of bonafide promonocytes in an otherwise typical case of Philadelphia-positive B-ALL expressing CD13 and CD33. This case underscores the importance of morphology and cytochemistry in detecting and confirming minor blast populations, which may manifest as the dominant or the only clone at relapse.

Abstract BACKGROUND: Neutropenia, defined by a decreased neutrophil count, compromises the body’s ability to combat infections. Patients undergoing cytotoxic therapies or suffering from hematological malignancies often experience profound neutropenia. Although advancements in chemomobilization therapy and antimicrobial agents have lessened the reliance on granulocyte transfusions (GTXs), these transfusions remain a valuable therapeutic option for managing severe neutropenia, particularly in cases where other treatments fail to produce a sufficient response. MATERIALS AND METHODS: A retrospective and observational study was carried out at a tertiary care center to analyze the data from granulocyte harvests and transfusions performed between January 2022 and June 2024. Information was gathered on both the donors and the patients who received GTXs. RESULTS: A total of eight patients with febrile neutropenia received 23 GTXs, resulting in clinical improvement in five cases. The primary pathogens identified included Klebsiella pneumoniae, Escherichia coli, and Pseudomonas aeruginosa. GTXs led to a significant increase in total leukocyte count (TLC) and absolute neutrophil count, with a P < 0.05. Donor mobilization using steroids and granulocyte-colony stimulating factor effectively elevated donor TLC levels. However, the granulocyte harvest procedures were associated with a significant decrease in donor TLC, platelet count, hemoglobin, and hematocrit (P < 0.05). The apheresis process was generally well-tolerated, with minor donor adverse events. CONCLUSION: GTXs have the potential to improve neutrophil counts in patients with febrile neutropenia. However, their clinical effectiveness depends on multiple factors. Additional research is needed to explore the determinants of treatment response and to devise more effective approaches for managing this condition.

Introduction: Gamma Knife radiosurgery (GKRS) provides in general a high dose ionizing radiation to specific target location, which has already been defined by stereotaxy for the treatment. Arteriovenous malformations (AVMs) are one such indication for GKRS they are rare, occurring at an incidence of 15-18 cases per 100,000 adults, with a rupture rate of 2–4%. GKRS is indicated for small (< 3.5 cm), surgically high-risk, deep-seated and complex AVMs. Successful AVM treatment in GKRS eliminates the risk of intracranial haemorrhage, complete nidal obliteration, limiting the development of new deficit from radiation-induced changes. Materials and Methods: This study was conducted in the Department of Neurosurgery, a tertiary care center , New Delhi for the duration of two years (September 2019 to September 2021). A total of 40 patients (N) were studied. Variables included demographic profile, clinical profile, AVM grading, radiation dose and treatment outcomes particularly nidal obliteration and symptom resolution. The factors which affected obliteration of AVM and six-monthly follow-up were analysed. Results: The study showed among all variables that the initial volume of nidus, duration following GKRS were important predictors for AVM obliteration with statistically significant p-values (<0.05). Conclusion: GKRS is effective treatment modality in AVMs, especially those with low nidus volume, low Spetzler-Martin (SM) grade, deep venous drainage, young age and deep-seated lesions. However, in this study, the p-values were not statistically significant (p-value >0.05) for above parameters. Among all, the initial nidus volume, and the duration of post GKRS for the obliteration of AVM had significant p-values (<0.05).

Choroidal melanoma is rare in young individuals and often presents at a later stage due to low clinical suspicion. This case series describes a group of young patients, all under the age of 30 years, who presented with advanced choroidal melanoma requiring enucleation. A prospective observational study was conducted from January 2019 to December 2023 at a tertiary care center. Twelve young patients diagnosed with choroidal melanoma were assessed. Patient’s demography, clinical presentation, tumor characteristics and histopathological findings were noted. Histopathologically tumors were classified as epithelioid, mixed and spindle cell type. The treatment protocol was devised based on the size, extent of the lesion and any involvement of systemic system. There were 10 females and 02 males. The mean age of patients in the current study was 23±3.5 years. Right eye was involved in 05 patients and left eye was involved in 07 patients. All patients had advanced choroidal melanoma at the time of presentation at our center. The mean basal diameter of the tumor was 21±2 mm and thickness were 11±1.5 mm. Primary enucleation with implant was the most common treatment modality in all patients. Epithelioid cell type choroidal melanoma was the commonest histology pattern was found in the current study. No mortality or death occurred at the end of 02 years follow-up in any patient. This series highlights the aggressive nature of choroidal melanoma in young individuals when diagnosed at an advanced stage. It emphasizes the importance of early clinical suspicion, timely referral, and appropriate imaging in any atypical choroidal lesion in the young population.

Angiofibroma of the lacrimal sac is an extremely rare condition, and very few studies have mentioned about this entity in the literature. Here, we report an unusual case of lacrimal sac angiofibroma in a young male patient who initially presented with watering from right eye for 2 years and was provisionally diagnosed as a case of chronic dacryocystitis in the affected eye. Patient was advised external dacryocystorhinostomy to cure this condition. However, during routine dacryocystorhinostomy surgery, suspicious finding like highly vascularized and enlarged sac was noticed which hinted the presence of lacrimal sac tumor. The lacrimal sac was removed in toto, and conventional dacryocystorhinostomy (DCR) was converted to flapless DCR. Histopathology and immunohistochemistry showed features favoring angiofibroma of the lacrimal sac. This case highlights the need of tissue biopsy whenever an abnormal finding is encountered during routine lacrimal surgery for chronic dacryocystitis.

Objectives: The objective of this study was to study the alteration in levels of testosterone, luteinising hormone (LH), follicle-stimulating hormone (FSH) and prolactin in male cancer patients’ post-chemotherapy who have been started on drugs causing grade III or more haematological toxicity requiring granulocyte colony-stimulating factor support. Materials and Methods: An open-labelled prospective single-centre study for the assessment of Gonadal dysfunction in male cancer patients on chemotherapy from August 2010 to October 2012. Results: Patients had a significant alteration in testosterone (23% n = 11), LH (52.08% n = 25), FSH (83.3% n = 40) and prolactin levels (22.92% n = 11) post-chemotherapy, which was statistically significant (P < 0.05). The high dose, as well as the low dose Cisplatin group, were associated with substantial gonadal dysfunction in testicular tumour patients. Hence, regimens using low-dose cisplatin at the cost of compromising the cure rate for the motive of preservation of fertility are not warranted. There was no statistically significant difference found in alteration in mean testosterone, mean LH or mean FSH Prolactin levels among cisplatin, cyclophosphamide or combined cisplatin and cyclophosphamide chemotherapy group, at least in the initial weeks of post-chemotherapy. Conclusion: There is a significant gonadal dysfunction in cancer patients receiving cytotoxic chemotherapy. Hence, increasing awareness to prevent, detect and treat expected long-term toxicities is crucial. Prechemotherapy cryopreservation of semen and assisted reproductive technologies are good options to describe the rate of involuntary infertility without affecting the survival of patients by decreasing doses of chemotherapy.

Sufentanil exhibits potent analgesic efficacy with a prolonged duration of action, making it a frequently utilized agent for labor analgesia. This study aimed to investigate the association between SLC6A4 rs1042173 polymorphisms and the efficacy of sufentanil epidural analgesia during labor in primiparous women. This study enrolled 288 full-term primiparas eligible for vaginal delivery. The polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) was utilized to detect the SLC6A4 rs1042173 polymorphism. The Hardy-Weinberg equilibrium test was conducted to assess the representativeness of the samples relative to the population. Logistic regression analysis was performed to examine the association between the SLC6A4 rs1042173 polymorphism and labor analgesia, as well as to identify independent influencing factors. The pharmacokinetics of sufentanil in pregnant women were significantly influenced by the SLC6A4 rs1042173 polymorphism. The Visual Analogue Scale (VAS) indicated that the SLC6A4 rs1042173 genotype significantly influenced the analgesic response patterns in pregnant women. In the early stages of drug action, the TT and TG genotypes exhibited higher sensitivity (P < 0.001). Regarding specific adverse reactions, significant differences were noted in the incidences of nausea, urinary retention, and abnormal fetal heart rate monitoring among pregnant women with different genotypes (P < 0.05). Logistic regression analysis revealed significant correlations between the rs1042173 polymorphism and both the VAS score at 2 hours (P = 0.014) post-administration and the Activity, Pulse, Grimace, Appearance, Respiration (Apgar) scores at 1 minute (P < 0.001) of newborns. SLC6A4 rs1042173 gene polymorphisms were significantly associated with the analgesic efficacy of sufentanil epidural anesthesia in primiparas.