Hematological parameters like total leukocyte count (TLC), neutrophil, lymphocyte, and absolute eosinophil counts (AEC), and neutrophil-to-lymphocyte ratio (NLR) are known to predict the severity of novel coronavirus disease 2019 (COVID-19) patients. In the present study, we aimed to study the role of complete blood count parameters in triaging these patients requiring intensive care unit (ICU) admission. A retrospective study was done over a period of 2 months. Patients, who were ≥ 18 years of age with COVID-19 confirmed on SARS-CoV-2 reverse transcription-polymerase chain reaction (RT-PCR) and whose routine hematology counts were sent within 24 h of admission, were included in the study. Cut-off values of 47.5 years for age, 11.3 × 10
9
/L for TLC, and 9.1 for NLR were predictive of disease severity among COVID-19 patients. Relative neutrophilia ≥ 70% (
p
< 0.007), relative lymphopenia ≤ 20% (
p
< 0.002), AEC ≤ 40/cumm (
p
< 0.001), and NLR ≥ 9.1 (
p
< 0.001) were significantly associated with ICU admission. Routine hematological parameters are cost-effective and fast predictive markers for severe COVID-19 patients, especially in resource-constrained health care settings to utilize limited ICU resources more effectively.
Background: Intraoperative crush smear is an adjuvant in diagnosing central nervous system (CNS) lesions on tissue sent for frozen section. Besides rapid decision-making, it also ensures that minimum injury is caused to the normal brain structures surrounding the intracranial neoplasm. A rapid intraoperative diagnosis helps the surgeon in planning the appropriate surgery.Objective: Our objective is to review all the discordant cases between intraoperative and histopathological diagnosis and also to study the crush smear slides for morphological clues that could have been helpful in minimizing such errors, especially for an inexperienced neuropathologist/general pathologist. The surgeon's perspective on the impact of these errors on management is also discussed.Method: A prospective study of six years from 2013 to 2019 was conducted. Crush smears were made and stained with rapid hematoxylin and eosin (H&E). The rest of the tissue was processed for permanent tissue sections. Slides in which there was discordance between the intraoperative and permanent paraffin sections were reviewed to ascertain the reasons thereof.Results: A total of 81 specimens of CNS tumors were sent for intraoperative consultation. Out of these, discordance was seen in 13 (16%) cases.
Conclusion:To minimize diagnostic errors, it is important to do regular analyses of the misinterpreted cases. Knowledge of the pre-operative radiological differential diagnosis is mandatory. Discussion with the surgeon regarding the clinical impact of the errors made will give a clearer picture to the pathologists regarding clinically relevant reporting during intraoperative consultation.
Background
High-grade transformation Adenoid cystic carcinoma (HGT-AdCC) of the parotid gland is a rare transformation noted in slow growing low grade AdCC. Perineural invasion and spread is an important feature of this tumor. Temporal bone involvement is rare. A total of only 10 cases of HGT-AdCC in parotid gland has been reported in literature so far predominantly in the elderly with peak incidence in 5th–6th decade.
Case presentation
We present a young lady of HGT-AdCC of right parotid gland with temporal bone involvement in the form of isolated perineural invasion (PNI) of facial nerve till the tympanic segment. She underwent right radical parotidectomy with modified radical neck dissection with modified lateral temporal bone resection and pectoralis major myocutaneous flap reconstruction. Histopathological examination revealed both low- and high-grade areas. Sections from facial nerve showed tumor invasion.
Conclusion
The radiological features of isolated perineural spread in intratympanic part of facial nerve can be easily missed if not specifically looked for. Every attempt should be made preoperatively and intraoperatively to determine the complete extent of the tumor for adequate disease clearance. A combined clinico-radiological approach aided by histopathology examination helps in early detection of this carcinoma and in better patient management.
Angiomyolipoma is a benign mesenchymal neoplasm of the renal parenchyma, accounting for 1% of all renal parenchymal tumors. However, this entity may rarely occur in extrarenal sites. Extrarenal angiomyolipoma has been documented in various sites of the body, but angiomyolipoma of the broad ligament was reported in only two cases. We report the reputed third case of angiomyolipoma of the broad ligament in a 33-year-old female, who presented clinically with abdominal distension. With a working diagnosis of low-grade neoplasm, an en-bloc excision of the left broad ligament mass was performed. Based on histopathology and immunohistochemistry, a diagnosis of the classical variant of angiomyolipoma of the left broad ligament was made. The post-operative period was uneventful with no recurrence after 6 months of follow-up.
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