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.

Introduction: Oral squamous cell carcinoma (OSCC) is the sixth most common cancer globally. Despite advances in therapeutic modalities, improvements in mortality and morbidity remain limited in early-stage OSCC. This variability in prognosis is due to the tumors biological heterogeneity and challenges in accurately predicting loco-regional recurrence (LRR). Objectives: The objective of the study is to evaluate the influence of the parameters that are included in Brandwein-Gensler (BG) risk model, i.e., lymphovascular invasion (LVI), lymph node metastasis, and depth of invasion (DOI) in predicting LRR in early-stage cases. Materials and Methods: A retrospective analysis was conducted on patients diagnosed with early-stage (T1/T2) OSCC over a 5-year duration who underwent primary surgical resection and had complete follow-up data available. Histopathological parameters were assessed using hematoxylin and eosin-stained sections, and BG risk score was applied based on standard criteria. Statistical analysis: Statistical analysis was done using Chi-square test and Fisher exact test where count is less than 5. Software used to conduct statistical analysis were MS Excel, and SPSS version 26, and P < 0.05 was considered to indicate statistical significance. Results: A total of 101 cases were included in this study, out of which 34 cases (33.67%) showed recurrence. Among evaluated parameters, LVI ( P = 0.004), perineural invasion (PNI) ( P < 0.001), worst pattern of invasion (WPOI) ( P < 0.001), DOI ( P < 0.001), lymphocytic host response (LHR) ( P < 0.001), and risk score ( P < 0.001) were found to be statistically significant predictors of LRR. Conclusions: The integration of histopathological factors such as LVI, PNI, WPOI, and LHR, particularly when evaluated using BG risk model, offers a valuable framework for identifying high-risk patients. Routine incorporation of this scoring system into initial diagnostic assessment can enhance prognostication and inform the selection of candidates for post-surgical adjuvant therapy, ultimately improving patient management and outcomes in early-stage OSCC.

Primary immunodeficiency diseases (PIDs)/inborn errors of immunity (IEI) are inheritable genetic disorders that disrupt immune cells either qualitatively or quantitatively in the performance of their functions. The case report is about a case of chronic granulomatous disease (CGD). A 10-month-old male child presented with a history of on-and-off fever, hepatomegaly (6 cm), splenomegaly (6 cm), and submandibular lymphadenopathy. On the peripheral smear, 12% of atypical cells/blasts were seen; a differential diagnosis, such as leukemoid reaction and juvenile leukemia, was considered. PIDs workup, including nitroblue tetrazolium/dihydrorhodamine (DHR) test, serum immunoglobulin assay, and lymphocyte subset analysis, was carried out as the mother gave a history of the child being unwell since 6 weeks of age. Bone marrow examination and serial peripheral smears after treatment with antibiotics ruled out leukemia. Chronic infantile leukemias like juvenile myelomonocytic leukemias should be differentiated from septic leukemoid reaction that can occur in the context of CGD. Furthermore, the authors conclude that infections can lead to normal progenitors being released into the periphery, and one should refrain from overdiagnosing these as leukemia cases.

Follicular lymphoma (FL) is an indolent B-cell neoplasm associated with an increased risk of secondary malignancies. Although these usually occur after cytotoxic therapy, we encountered a rare case of secondary acute myelomonocytic leukemia (AMMoL) developing without prior chemotherapy. We present the case of a man in his 70s undergoing maintenance dialysis, who was diagnosed with grade 1 FL during a pre-operative evaluation for gastric endoscopic submucosal dissection. After 8 months, he presented with AMMoL without prior exposure to chemotherapy. Intensive chemotherapy was avoided because of advanced age and poor cardiac function, and supportive care was provided. This report describes an exceptionally early onset of secondary AMMoL during the observation period, only 8 months after the diagnosis of FL. Continuous laboratory and clinical surveillance is essential for the early detection of secondary hematologic disorders, even in patients managed conservatively.

Objectives: The objective of this study was to evaluate suspected mumps cases presenting to a tertiary care center in Western Gujarat between March and September 2024, using molecular diagnostics by reverse transcription polymerase chain reaction (RT-PCR) and serological testing by immunoglobulin M enzyme-linked immunosorbent assay (IgM ELISA), and to analyze vaccination coverage and breakthrough infections. Materials and Methods: A hospital-based, cross-sectional study was conducted on 48 patients clinically diagnosed with mumps as per the World Health Organization case definition (acute onset of unilateral or bilateral parotitis lasting ≥2 days, with or without complications). Demographic data and vaccination history were recorded. Serum samples were tested for anti-mumps IgM by ELISA employing the NOVATEC Germany Mumps Virus IgM Antibody ELISA kit, and buccal swabs and urine samples were subjected to RT-PCR, targeting the small hydrophobic (SH) gene, for mumps viral RNA. Statistical analysis: Descriptive statistics were used to summarize demographic and diagnostic data. The sensitivity of RT-PCR on different specimen types was compared to ELISA results. Results: Of the 48 suspected cases, 31 (64.58%) were children (≤15 years) and 17 (35.42%) adults; males comprised 64.58%. Forty-three cases (89.58%) were confirmed by one or more tests. IgM ELISA was positive in 70.83% (34/48), and RT-PCR on buccal swabs also detected viral RNA in 70.83% (34/48), versus 20.83% (10/48) in urine. Seven samples with equivocal IgM results were RT-PCR negative. Two breakthrough infections occurred (a 3-year-old and a 26-year-old). Vaccination status was unvaccinated in 60.42% (29/48) and unknown in 35.42% (17/48). Conclusions: RT-PCR on buccal swabs offers superior sensitivity and should be regarded as the gold standard for early mumps diagnosis. The high proportion of unvaccinated and vaccination-uncertain individuals underscores the need to include measles, mumps, and rubella (MMR) in the Universal Immunization Program, alongside targeted awareness and booster-dose campaigns, to prevent future outbreaks.

Objectives: Acute respiratory tract infections (ARTIs) in adults are associated with severe disease onset. Failure to provide an accurate diagnosis leads to unnecessary antibiotic exposure and antibiotic resistance. Inflammatory markers such as procalcitonin (PCT), C-reactive protein (CRP), and total white blood cell (WBC) counts are often used in clinical settings to analyze the severity of ARTIs. The goal of this study was to determine the ability of these markers to discriminate between bacterial and viral respiratory tract infections (RTIs). Materials and Methods: This prospective and cross-sectional study included 408 patients. A total of 222 patients with confirmed bacterial RTIs (n = 162) and viral RTIs (n = 60) were considered positive for RTIs. The CRP, PCT, and WBC levels were evaluated. Statistical analysis: Predictive values, likelihood ratios, receiver operating characteristic (ROC) curves, Chi-square test with Yates correction, and P-value were calculated for distinguishing between bacterial and viral respiratory infections using by Statistical Package for the Social Sciences software. Results: ROC curve analysis and other statistical data revealed that for bacterial RTIs, WBC counts, and CRP counts were significantly higher than PCT (ROC area under the curve [AUC]:0.631), sensitivity: 93%, P < 0.0001, while for viral RTIs, CRP, and PCT levels were marginally higher than WBC count (ROC AUC:0.551, sensitivity: 90%, P = 0.0486). Conclusions: PCT and WBC are more elevated in bacterial infections, whereas CRP and PCT slightly outperform WBC in viral cases. Combined, these biomarkers aid accurate infection diagnosis and targeted treatment.

Objectives: Cutaneous metastases (CM) can occur in a variety of internal malignancies and may be signs of clinically indolent primary cancer. Skin metastases can occur in 0.6–10.4% of all patients, which accounts for 2% of all cancers. The objective of this study was to describe the clinicopathologic profile of patients with CM diagnosed by cytology and histopathology. Materials and Methods: A total of 118 cases of CM were diagnosed by cytology (91 cases) and histopathology (27 cases) over 5 years. Hematolymphoid malignancies involving skin and primary cutaneous malignancies were excluded from the study. Statistical analysis: Data analysis was done using the Statistical Package for the Social Sciences software (version 20). Categorical variables were expressed using frequency and percentages. Quantitative variables were expressed using the mean. The demographic data such as age and sex, are expressed in percentages and ratios. Results: Of 118 cases, the male-to-female ratio was 1:2.1, and age ranged from 12 to 85 years. The most common clinical presentation was skin nodules (93.1%), and the site of metastases was the chest wall (41%). The most common primary site was the breast (42.8%) followed by the stomach (12.2%). Among the 98 known primary cases, loco-regional metastasis was seen in 54 cases (55%), and distant metastases were seen in 27 cases (27.5%). Twenty cases were of primary origin unknown. Conclusions: A high index of suspicion, good knowledge of morphology, and relevant immunohistochemical approach help in the timely diagnosis of CM.

A growth-faltered preterm newborn weighing 1150 g was referred to our retinal unit for advanced retinopathy of prematurity.The infant had three interrelated ailments at presentation: Severe thrombocytopenia (<10,000/mm 3 ), rashes, and advanced fibroproliferative retinopathy of prematurity.The preterm newborn was admitted and investigated for the ailments.The infant was hemodynamically stable, antibiotics for late-onset sepsis were ongoing, and striking rashes limited to palms and soles were noted [Figure 1].Initial investigations for C-reactive protein, renal, and liver function tests were unremarkable.Blood/urine cultures for bacterial/fungal elements were negative.Titers for the congenital and perinatal infection etiology, including TORCHes, were non-reactive.Viral cultures were not available in our center.Maternal syphilis titers were non-reactive.Maternal antinuclear antibody was negative.The infant was managed for severe thrombocytopenia with serial platelet transfusions, optimized enteral nutrition, and retinal intervention of laser photocoagulation.The birth hospitalization of the male infant was for the vaginal premature birth at 28 weeks of gestation and 930 g, appropriate for gestation.He was cared for respiratory distress syndrome and possible sepsis.At 4-6 weeks of age, the newborn was detected for advanced retinopathy https://jlabphy.org/