Annals of Pathology and Laboratory Medicine <p><strong>Annals of Pathology and Laboratory Medicine (APALM)</strong> is an international, Double-blind peer-reviewed, indexed, open access, online and print journal&nbsp;for pathologists, microbiologist, biochemist and clinical laboratory scientists, and is published by <strong><a href="" target="_blank" rel="noopener"><strong>Pacific group of e-Journals</strong>' (<strong>PaGe</strong>)</a>, </strong>an&nbsp;<em>ISO 9001:2008</em> Certified&nbsp;academic publishing house.</p> <p>Set up in 2014, APALM is a specialized journal, which publishes original, peer-reviewed articles&nbsp;in the field of Pathology and Laboratory Medicine which, <em>inter alia</em>, includes Histopathology, Cytopathology, Hematology, Clinical Pathology, Forensic Pathology, Blood Banking, Clinical Bio-Chemistry, Medical Microbiology (Bacteriology, Virology, Mycology, Parasitology), etc.</p> <p><strong>DOI: 10.21276/APALM (<a title="Verify APALM DOI " href="" target="_blank" rel="noopener"></a>)<br></strong></p> <p><strong>Index Copernicus (IC) Value (ICV 2016): 74.20</strong></p> en-US <p>Authors who publish with this journal agree to the following terms:</p> <ol> <li class="show">Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a&nbsp;<a href="">Creative Commons Attribution License</a>&nbsp;that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.</li> <li class="show">Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.</li> <li class="show">Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See&nbsp;The Effect of Open Access at</li> </ol> <p>&nbsp;</p> (Dr. Prashant Goyal) (Amit Saggar) Sat, 16 Mar 2019 16:54:30 +0000 OJS 60 Bone Marrow Cytomorphology And Clinico-Hematological Profile of Metastatic Solid Tumors: A 5-Year Audit from A Tertiary Care Centre in Northern India <p><strong>Introduction:</strong> Metastasis to bone marrow by solid malignancies is a rare event and it upgrades the tumor thereby worsening the prognosis. This is caused by an impaired response to therapy and other manifestation resulting from decreased hematopoiesis. The common malignancies to metastasize in male and female are carcinoma prostate and carcinoma breast, respectively. It is noted that metastasis from small round cell tumor (SRCT) predominates in children. Here, we present a series of cases of bone marrow metastasis by solid organ malignancies over a period of 5 years.</p> <p><strong>Objectives: </strong>The aim of this study was to investigate the clinical and hematological characteristics of patients with BM metastases of solid tumors diagnosed by bone marrow (BM) aspiration.</p> <p><strong>Materials &amp; methods:</strong> In this study, we reviewed 3520 bone marrow aspirates in our hospital from January 2013 to December 2017. Patients diagnosed with solid malignancies metastasizing to bone marrow were selected.</p> <p><strong>Results:</strong> We found a total of 26 cases of solid malignancies with metastasis to bone marrow. The age of the patients ranged from 2–88 years (mean age of 46 years). Most of the patients were adults (19/26), of which 77.7% were males. Seven of the 26 patients were in the pediatric age group, with an age range of 2-11 years. Various malignancies metastasizing to marrow were evaluated and clinical and hematological correlation was done. The common presenting sign &amp; symptoms were fever, anorexia and bodyache and organomegaly. Anemia was the most common hematological finding at the time of admission. Carcinoma prostate was the most common metastatic tumor in adults and small round cell tumor in children.</p> <p><strong>Conclusion:</strong> BM is one of the important and infrequent sites of metastasis of solid tumors. Detection of bone marrow metastasis has significant clinical implication with impact on therapeutic decisions and is associated with poor prognosis. Aspiration of the BM provides an easy and quick way of detecting involvement, however, biopsy with immunohistochemical and/or molecular techniques may be needed in case of microscopical tumor burden.</p> Vijay Kumar, Rohan Sardana, Manjari Kishore, Sadhna Marwah, A S Nigam, Minakshi Bhardwaj ##submission.copyrightStatement## Sat, 16 Mar 2019 16:55:08 +0000 Celiac Disease: Comparison of Oberhuber Classification and Corazza- Villanacci Classification <p><strong>Background:</strong> Celiac disease occurs in genetically predisposed individuals on consumption of certain grains. The diagnosis is based on biopsy showing the presence of characteristic histological changes in duodenum and jejunum that improve after gluten free diet. The Oberhuber Classification is very widely used by pathologists. The new Corazza-Villanacci Classification simplifies the criteria.</p> <p><strong>Methods:</strong> Retrospectively diagnosed 200 patients of Celiac disease according to Oberhuber classification over duration of 05 years were considered. The 200 cases were retrieved from the records and were sent to two pathologists, who were blinded to each other and were not given any clinical information. Each pathologist received the set of biopsy specimens on two separate occasions and had reclassified them according to both grading systems in a random order. The interobserver variation was then determined after re-examination according to Oberhuber classification and after using to Corazza-Villanacci classification too</p> <p><strong>Result:</strong> Mean kappa values were 0.77 (good) for the Oberhuber classification versus 0.98</p> <p>&nbsp;(very good) for the Corazza -Villanacci classification</p> <p><strong>Conclusion: </strong>The Corazza-Villanacci classification gives better interobserver agreement compared with the Oberhuber classification and contributes to the validity of diagnosis in celiac disease.</p> Shikha Ghanghoria, Sachin Sharma, Priya Jain ##submission.copyrightStatement## Sun, 17 Mar 2019 18:03:57 +0000 Correlation of Serum Tissue Transglutaminase Antibody Levels and Marsh Grading of Duodenal Biopsy in Patients of Celiac Disease <p><strong><em><u>Background:</u></em></strong> Celiac disease (CD) is a chronic small intestinal immune-mediated enteropathy precipitated in genetically predisposed individuals by ingestion of wheat gluten and related proteins of barley and rye. It is an under-diagnosed gluten-sensitive enteropathy, usually presenting with atypical/extra-intestinal features. Duodenal biopsy is considered as the gold standard in the diagnosis of CD. Serum anti tissue transglutaminase (anti-tTG) antibodies is auto antibodies directed against tissue transglutaminase (tTG) enzyme. <em><u>Aims and objective:</u></em> The aim of the study is to find out the prevalence of CD among clinically suspected cases of malabsorption, to assess the correlation of anti-tTG levels with modified Marsh grading of duodenal biopsy, to find out sensitivity, specificity and predictive values of anti-tTG test and to calculate the cut off values of anti-tTG diagnostic of high grade CD.</p> <p><strong><em><u>Methodology</u></em></strong><em><u>:</u></em> The present study included 118 clinically suspected patients of malabsorption in which both duodenal biopsy and anti-tTG test was done. The mucosal damage graded according to the modified Marsh grading and anti-tTG tests were done in serum using ELISA kit.</p> <p><strong><em><u>Results:</u></em></strong> The prevalence of CD among clinically suspected cases of malabsorption was 12.7%. The incidence was highest in middle aged male patients. The most common clinical symptom was chronic diarrhea and commonest presenting sign was anemia. Anti-tTG levels were found to be proportionately increasing with the severity of CD and showed a positive correlation(r=0.433). Patients with anemia and chronic diarrhea showed statistically significant (p value=0.0242 and 0.0089 respectively) mean anti-tTG levels in Celiac patients in relation to non-Celiac patients. Although the mean levels of anti-tTG was 6.3 times higher than baseline in grade 3 disease, the ROC analysis showed that anti-tTG in isolation had no significance in exactly grading the disease (AUC=0.30).</p> <p><strong><em><u>Conclusion</u></em><u>:</u></strong> Positive correlation was found between anti-tTG levels and modified Marsh grading. Anti-tTG showed proportionate increase with severity of duodenal damage. Anti-tTG test showed low sensitivity (42.86%) and high specificity (84.34%). Hence it is not a reliable tool in isolation to screen CD but should be used in combination with duodenal biopsy. It can be used to assess the severity of CD and for follow up. </p> Benjith Paul, Prateek Kinra, Bhaskar Nandi, AS Prasad ##submission.copyrightStatement## Sun, 17 Mar 2019 18:23:59 +0000 Cutaneous Pseudolymphoma: A Brief Review and Report of a Case Treatment Using Rituximab <p>Cutaneous pseudolymphoma (C-PSL) is characterized by heterogenous lymphoproliferative processes contributing to skin lesions which histologically and clinically mimic malignant cutaneous lymphomas. It is of most importance to diagnose such case precisely and discriminate them from malignant lymphomas since treatment protocols are distinctive. Standard medical approaches for C-PSL includes elimination of causative factors, topical, intralesional and systemic steroids, hydroxychloroquine, and photodynamic therapy. Rituximab as an anti CD20 monoclonal antibody was used in this study to treat a patient with 8 years clinical features of pseudolymphoma with no positive response to routine medications. Follow up of almost more than 18 months revealed a successful treatment without noticeable side effects or disease recurrence.</p> Mahdi Aghazadeh Barenji, Shahin Behrouz Sharif, Akbar Mokhtarpour Neilagh ##submission.copyrightStatement## Sun, 17 Mar 2019 19:02:35 +0000 Pancoast Tumor: A Rare presentation of Hepatocellular Carcinoma <p>Lung is the first most common site for metastasis of hepatocellular carcinoma. Pancoast’s tumor is usually caused by adenocarcinoma of lung. Hepatocellular carcinoma is very notorious in remaining asymptomatic for prolonged time.&nbsp; But metastatic Hepatocellular carcinoma presenting as apical lobe lung mass eroding the ribs (Pancoast’s tumor) is unusual.</p> <p>We, describe here a 66year old male who presented with left shoulder pain which was subsequently diagnosed to be due to metastatic tumor of upper lobe lung from liver primary.</p> <p>To our knowledge Pancoast’s syndrome due to metastatic hepatocellular carcinoma is rare and only two cases have been reported previously to the best of our knowledge. This case report will allow the clinicians to consider metastatic HCC as a differential for Pancoast’s tumor.</p> Enam Murshed Khan, Arpita Sutradhar ##submission.copyrightStatement## Tue, 19 Mar 2019 07:35:54 +0000 Diagnostic Pleural Fluid Cytology of Nocardial Infection in A Patient of Systemic Lupus Erythematosus <p>Systemic lupus erythematous is a chronic autoimmune inflammatory connective tissue disease. Infection remains the major cause of morbidity and mortality in such autoimmune disorders. Nocardia is an uncommon opportunistic pathogen. Due it its low incidence it is often missed by clinicians and pathologists. Delay in diagnosis and treatment is the major cause of dissemination and complications of this disease. Here we report a case of nocardiosis diagnosed on pleural fluid cytology smears using special stains.</p> <p>A known case of systemic lupus erythematous diagnosed 7 years back complained of heaviness in chest, shortness of breath and fever. Ultrasonography of chest showed pleural effusion and consolidation of underlying lung. Pleural fluid was aspirated and sent for cytology. Giemsa and Papaniculaou stained smears showed dense degenerated acute and chronic inflammatory cells in a necrotic background with negatively stained shadows which were negative for ZN and PAS stains. However, gram stain and modified ZN stain (1%H2SO4) showed positively stained clumps of long branching filamentous organism; consistent with Nocardia spp which was later confirmed by culture studies.</p> <p>This case highlights the importance of high index of suspicion for nocardia in cytology samples of pulmonary origin, especially in cases patients with immunosuppressed states. More so special stains like Gram’s stain and modified ZN stain in such cases can aid in a definitive diagnosis.</p> Sneha Singh, Prajwala Gupta, Minakshi Bhardwaj ##submission.copyrightStatement## Tue, 19 Mar 2019 07:42:16 +0000 Typical Carcinoid: Cytological Diagnosis of a Case and Mimickers in Cytological Sampling Techniques with Brief Review of Literature <p>Typical carcinoids are the most well differentiated and least aggressive of pulmonary neuroendocrine tumors. Cytologic diagnosis on trans bronchial needle aspirate (TBNA) smears is quite diagnostic; however, may be challenging on other cytologic specimens like bronchial brushings and bronchial washings. We discuss such a case of typical carcinoid in a 30 years old female.</p> Shashikant Singh, Prajwala Gupta, Purnima Malhotra, Minakshi Bhardwaj, Desh Deepak ##submission.copyrightStatement## Tue, 19 Mar 2019 07:54:13 +0000