Primary cutaneous aspergillosis is a rare disease usually caused by Aspergillus fumigatus, Aspergillus flavus, Aspergillus terreus and Aspergillus ustus. It is usually seen in immunocompromised hosts, though some cases are also reported in immunocompetent hosts. We present a case of an immunocompetent farmer who presented with generalised nodules and plaques, mimicking erythema nodosum leprosum but turned out to be cutaneous aspergillosis caused by Aspergillus tamarii. The characteristic ascospores of Aspergillus species were found in skin lesions on fungus isolated in culture. The patient showed excellent response to antifungal therapy.

Multiple myeloma is clinically heterogeneous and risk stratification is vital for prognostication and informing treatment decisions. As bortezomib is able to overcome several high-risk features of myeloma, the validity of conventional risk-stratification and prognostication systems needs to be reevaluated. We study the survival data of 261 previously untreated myeloma patients managed at our institution, where bortezomib became available from 2004 for the treatment of relapse disease. Patient and disease characteristics, and survival data were evaluated overall, and with respect to bortezomib exposure. Overall, the international staging system (ISS), metaphase karyotyping and interphase fluorescence in situ hybridization (FISH) were discerning of survival outcomes, where the median for the entire cohort was 5.2 years. However, when stratified by bortezomib exposure, only metaphase karyotyping was still discriminating of long-term prognosis. The presence of an abnormal nonhyperdiploid karyotype overrides all other clinical and laboratory parameters in predicting for a worse outcome on multivariate analysis (median survival 2.6 years, P 5 0.001), suggesting that bortezomib used at relapse is better able to overcome adverse risk related to high tumor burden (as measured by the ISS) than adverse cytogenetics on conventional karyotyping. Metaphase karyotyping provides additional prognostic information on tumor kinetics where the presence of a normal diploid karyotype in the absence of any high-risk FISH markers correlated with superior survival and could act as a surrogate for lower plasma cell proliferation. Am. J. Hematol. 85:752-756, 2010. V

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BACKGROUND Tumours of central nervous system (CNS) are of varied histogenesis and show divergent lines of differentiation and morphological features. These tumours show specific predilection for age and sex groups, more commonly than of tumours of other systems. Though tumours of glial tissue are more common, other tumours of neural, ependymal and meningeal origin are not uncommon. Metastatic disease is the common encounter in elderly. Tumour diagnosis is not always straight forward as many non-neoplastic lesions and reactive proliferations mimic tumours. Immunohistochemistry may help in problematic cases and thus can be used as an adjuvant tool in the diagnosis of such cases in addition to the routine histopathological staining methods. An accurate histological diagnosis is of extreme importance in these sites as exact diagnosis helps in proper management and favourable clinical outcome. MATERIAL & METHODS This study is on a retrospective and prospective basis in our institution from January 2011 to January, 2016. Our institute is a tertiary care center attached to a medical college catering to the needs of a rural based population. During this period, a total of 717 central nervous system tumour specimens were received and diagnosed based on examination of Haematoxylin and Eosin stained sections of formalin fixed and paraffin embedded specimens. Immunohistochemical markers (IHC) were applied in selective cases for an accurate diagnosis and a number of rare cases were diagnosed based on morphology and IHC marker studies. RESULTS Age and sex incidence and anatomic distribution of various tumours were studied. In adults, meningiomas occurred most frequently in the present study followed by nerve sheath tumours, astrocytomas, metastatic deposits, glioblastomas and pituitary adenomas. Embryonal tumours occurred frequently in children. Other rare tumours identified are amyloidogenic pituitary adenoma, central neurocytoma, glioneuronal tumour with neuropil-like islands, ganglioglioma, large cell medulloblastoma, rhabdoid and secretory meningioma, immature teratoma and gliosarcoma. Grading of the tumours was done according to the revised World Health Organization criteria. CONCLUSION In this study, we discuss the process of establishing accurately the diagnosis of central nervous system tumours including spinal tumours, with emphasis on rare tumours encountered and how IHC helped in the diagnosis.

Leprosy, a relatively common chronic contagious disease having diverse modes of clinical presentation, can mimic a variety of unrelated diseases. For proper and adequate treatment, the diagnosis must be made accurately with subtyping which should be done with the help of bacillary index, histopathological features, and clinical correlation. This is extremely important in patient care as paucibacillary and multibacillary types have different modes of treatment. Our aim is to categorize leprosy into various types based on bacillary index, morphological findings both in slit skin smears, and biopsy along with clinical correlation.

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Diabetes mellitus (DM) is a global pandemic. Large platelets are highly thrombotic and thus put the patient at a higher risk. Mean platelet volume (MPV) is a determinant of platelet functionality and increased MPV are associated with increased risk for hyperglycemic complications. We aimed to investigate the association of MPV, a marker for platelet size and activity with fasting blood glucose (FBS), postprandial blood glucose (PPBS), glycosylated hemoglobin (HbA1c) and duration of diabetes. We also compared MPV in diabetics and healthy controls. This is a case control study carried out in both individuals with type II diabetes mellitus and healthy controls. All the patients who attended our hospital during September 2012 to march 2013 were included in the study, taking inclusion and exclusion criteria into consideration. In 171 individuals with type II DM and 37 healthy controls, MPV and platelet counts were analyzed by fully automated hematology analyzer SEIMENS ADVIA 2120. Samples were also subjected for FBS, PPBS and HbA1c. The control and test groups were compared with Z test; difference between two means. Pearson's coefficient of correlation (r value) was calculated to know the relationship between two variables. t Test was done to test the significance of r value obtained and p value was calculated. p Value < 0.05 is considered significant. The analysis was done by Microsoft excel sheet. MPV was significantly higher in diabetics when compared to healthy controls (7.91 + 0.87 > 6.91 + 0.71). There was also a statistically significant positive correlation between HbA1c and MPV (r value -0.5, p value -0.4). Though FBS and PPBS showed a negative correlation with MPV but were not statistically significant. MPV, a simple, reliable and cost effective tool can be used in diabetes mellitus as an accessory marker for monitoring vascular complications and glycemic control.

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