Introduction: Hematopoiesis usually occurs in bone marrow in adults and when it occurs at sites except for bone marrow, it is termed as extramedullary hematopoiesis (EMH). It is usually found in organs, which are vigorously involved in fetal hematopoiesis, including liver, spleen, and lymph nodes. FNAC is easy and rapid method to diagnose EMH.Aim: To study the spectrum of extramedullary hematopoiesis (EMH) on fine-needle aspiration cytology (FNAC).Material and methods: A total of 10 patients who were diagnosed with EMH on FNAC were studied over a period of 5.5 years. Smears were stained with May Grunwald Giemsa (MGG) and Hematoxylin and Eosin (H and E). The detailed clinical and cytomorphological spectrum of EMH were studied.Results: The mean age of the patient was 42.5 years, with age ranging between 14 and 78 years. The commonest site of EMH was lymph node (n = 8, 80%) followed by paravertebral area (n = 2, 20%). Clinical diagnosis was EMH in just one case. Mean hemoglobin of the patient was 7.9 g/L. Bone marrow examination was available in 6 cases. On FNAC, we saw variable mixture of bone marrow elements including megakaryocytes (2.6%, 0-6%), myelocytes and metamyelocytes (29.2%, 18-33%), erythroid precursors (3.2%, 0-7%), polymorphs (21.7%, 10-36%), blasts (1.1%, 0-4%), eosinophils (2.5%, 0-7%), and lymphocytes (39.7%, 21-60%).Conclusion: Cytopathologists must be alert of the clinical as well as cytological spectrum of extramedullary hematopoiesis for greater accuracy in diagnosis and to escape pitfalls in its diagnosis. K E Y W O R D Scytology, extramedullary hematopoiesis, fine-needle aspiration cytology

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Selenium (Se), an essential trace element and potent nutritional antioxidant, exerts its biological effects through incorporation into selenoproteins like glutathione peroxidase (GPx). Modest decrement in the levels of GPx could be partly responsible for peroxidation of RBCs, which results into hemolytic anemia. Therefore, it is hypothesized that dietary Se, as selenoproteins (GPx), can maintain the homeostasis in RBCs and regulate the erythropoiesis by preventing oxidative stress-mediated hemolysis. Se-deficient (0.01 ppm), Se-adequate (0.1 ppm sodium selenite), and Se-supplemented (0.5 ppm sodium selenite) status were created in Balb/c mice by feeding yeast-based diets for 8 weeks and established by measuring Se levels in plasma and activities, expressions of Se-dependent selenoproteins. Fifty percent of mice from each differential Se group were treated with phenylhydrazine (PHZ, 20 mg/kg, i.p.) to induce hemolytic anemia. Results indicated that PHZ-treated Se-deficient animals demonstrated increased hemolysis, abnormal RBC morphology, increase in Heinz bodies and reticulocytes, and denaturation of hemoglobin to globin precipitates and methemoglobin. Se supplementation protected against these hemolytic changes and makes RBCs less fragile. These findings were consistent with dietary Se concentration-dependent changes in activity and expression of GPx indicating that ROS-mediated oxidative stress is integral to hemolysis. Protective effects of Se supplementation against increased levels of ROS, protein carbonyls, and peroxide damage to membrane lipids and enzymatic antioxidants validated these observations. In conclusion, dietary Se supplementation protected the RBCs against hemolysis by mitigating ROS-mediated oxidative stress.

Blasts showing cup-like nuclei in acute myeloid leukemia (AML) have been identified in patients with nucleophosmin 1 gene (NPM1) mutation, that is, AML with cytoplasmic NPM (NPMc+ AML). We analyzed 100 consecutive cases of AML, and defined the cutoff percentages of cup-like blasts in peripheral blood and bone marrow aspirate smears that can predict NPMc+ AML. A lower cutoff level of ≥10% blasts in peripheral blood and ≥9% in bone marrow aspirate gave an excellent specificity for NPMc+ AML and a positive-predictive value of 90.9% and a negative-predictive value of 87.6% for NPMc+ AML. Cup-like nuclei were associated with higher total leukocyte count, higher blasts percentage, AML-M1 subtype, and human leukocyte antigen-DR region negativity. Our results suggest that cup-like nuclei represent an important morphologic clue that can predict NPMc+ AML and guide toward prioritizing the further workup of AML patients.

UC a form of IBD is a chronic inflammatory disorder of large intestine, with unknown etiology. Reports suggest a critical role of COX-2 dependent prostaglandins (PGs) mediated inflammatory pathway in pathophysiology of UC. However, COX inhibition using NSAIDs exacerbate IBD and thus is not a viable solution. Currently, in DSS induced experimental colitis in mice, we have demonstrated that dietary Se supplementation (0.5ppm as sodium selenite) symptomatically resolves the signs of inflammation in a redox sensitive manner as compared to Se deficient (0.01ppm) conditions, as seen by modulation in oxidative stress markers, morphological changes, histopathological examinations, biochemical studies such as MPO activity, activity of intestinal markers enzymes as well as mRNA and expressions of various pro and anti-inflammatory factors such as, mPGES, hPGDS, TXAS, 15-PGDH, GPX-1 and GPX-2. These findings were validated and correlated with changes in the biophysical parameters such as membrane fluidity, electrical parameters (impedance), transport across the colonic tissue and FTIR. Current study not only concluded that Se at supranutritional concentrations by modulating the redox status relieves the signs of colitis by regulating COX dependent PG biosynthetic pathway, but also sheds light on the biophysical characterization of these inflammatory/resolution pathways involved in UC.

Bone marrow involvement in neuroblastoma indicates advanced stage of disease. The recent use of autologous bone marrow ''rescue'', has provided an additional important reason for accurate assessment of bone marrow status in newly diagnosed patients. In this study, we analyzed 44 cases of neuroblastoma for bone marrow infiltration status and their hematological parameters. Eighty-eight bone marrow aspirate and trephine touch imprint smears and 44 trephine biopsy sections were examined in these 44 patients. Of these, 24 cases (54.5 %) showed marrow infiltration. Leucopenia and bicytopenia were significantly (p \ 0.05) associated with marrow infiltration. Both bone marrow aspirate and biopsy were positive for infiltration in 16 out of 24 positive cases. Only aspirate smears were positive in 4 and only trephine biopsy in another 4 cases. The pattern of infiltration consisted of rosette formation in 40.7 % cases on aspirate smears and 22.2 % cases in trephine biopsies. Remaining cases showed diffuse and interstitial presence of tumor cells and cases positive only on trephine biopsy, showed marked stromal reaction. Bilateral trephine biopsies combined with aspirate smears picked up all positive cases compared to when they were assessed alone.

AimsAngioimmunoblastic T cell lymphoma (AITL) is often misdiagnosed in cytology. Hence, the present study was conducted to identify the distinctive cytomorphological features of AITL in lymph node fine-needle aspirates (LN-FNA).MethodsThis was a 4-year retrospective case–control study. Cases included LN-FNAs from patients with histopathologically confirmed AITL. The controls included LN-FNAs from patients with histopathologically confirmed reactive lymphoid hyperplasia (RLH; n=25). Eleven cytomorphological features were assessed in all the aspirates; the strength of association was determined by OR, Cramer’s V and multiple correspondence analysis (MCA).ResultsOf a total of 22 cases of AITL reported on histopathology, 19 adequate aspirates from 14 patients (63.6%) were available for review. On univariate analysis, 5 of 11 cytomorphological variables were found to be significant for AITL; however, on MCA, 3 of these parameters, viz absence of tingible body macrophages (OR=0.014; V=0.74), presence of atypical lymphoid cells (OR=10.8; V=0.41) and singly scattered epithelioid cells (OR=19.3; V=0.31), were found to be the strongest predictors of AITL.ConclusionsThe absence of tingible body macrophages, presence of atypical lymphoid cells and singly scattered epithelioid cells in polymorphic LN-FNAs are significant cytomorphological predictors of AITL in comparison with RLH. Knowledge of these diagnostic predictors, supplemented by clinicoradiological correlation and appropriate ancillary studies, can help diagnose AITL on aspiration cytology.

Primary seminal vesicle adenocarcinoma is a rare malignancy of the male genito‐urinary system with only a few confirmed reported cases. Initial tissue diagnostic modality is often a core biopsy specimen. Here, we report this rare entity in a 50‐year‐old male, highlighting the histomorphological and immunohistochemical approach to the core biopsy specimen of the seminal vesicle mass. The patient presented with a history of haematospermia and gross haematuria for one year, and radiological workup was found to have a right seminal vesicle mass. A trans‐rectal ultrasound guided core biopsy revealed a tumourous lesion with a predominant papillary architecture and cytological features of neoplasia. Based on positivity for CK7, PAX‐8 and CA‐125, and Ki‐67 index of 30%–40% and negativity for PSA, AMACR, CK20, CDX‐2, p63, GATA3, WT1 and calretinin, a diagnosis of primary seminal vesicle adenocarcinoma was offered. The diagnosis was also confirmed on the surgically resected specimen. This case depicts the approach of a pathologist to diagnose this rare entity on the core biopsy specimen and the possible differential diagnoses one must consider.