Gelatinous marrow transformation (GMT) or serous atrophy of bone marrow (BM) is a rare disease characterised by focal marrow hypoplasia, fat atrophy, and accumulation of extracellular mucopolysaccharides abundant in hyaluronic acid. This study reviews 11 cases of GMT from South India. Clinical and haematological parameters, BM aspirate, and biopsies of all patients diagnosed with GMT over a period of 7 years were studied. GMT was diagnosed in BM biopsy based on characteristic morphological appearance and was confirmed by alcian blue positive staining pattern at pH levels of 2.5 and 0.5. Eleven patients were diagnosed with GMT. All were males within the age range of 15 to 50 years. The underlying clinical diagnosis was human immunodeficiency virus positivity in 5 cases, 2 with coexistent disseminated tuberculosis, 1 with cryptococcal meningitis, and 1 with oral candidiasis; disseminated tuberculosis in 1 case; pyrexia of unknown origin in 2 cases; Hodgkin’s lymphoma in 1 case; acute lymphoblastic lymphoma with maintenance chemotherapy in 1 case; and alcoholic pancreatitis in 1 case. BM aspirates showed gelatinous metachromatic seromucinous material in 3 cases. BM biopsies were hypocellular in 7 and normocellular in 4 cases and showed focal GMT in 5 and diffuse GMT in 6 cases. Reactive changes were seen in 4 cases and haemophagocytosis in addition to GMT in 1 case. GMT is a relatively uncommon condition and an indicator of severe illness. It should be differentiated from myelonecrosis, amyloidosis, and marrow oedema. A high index of suspicion is required to diagnose this condition.
Background and Aim: Coexistence of hypertension (HTN) and type 2 diabetes (T2DM) multiplies the risk of cardiovascular events. Early identification and prompt management of elevated blood pressure in T2DM has shown to improve the quality of life and to reduce the economic burden to the patients. We studied blood pressure (BP) lowering effect of Azilsartan (AZST) monotherapy in newly diagnosed stage 2 hypertensives with a history of T2DM. We also analysed its effects on blood glucose and renal indices. Methods: T2DM Subjects attending a specialized diabetes clinic, who were diagnosed with HTN for the first time, were invited to participate. Mean of 3 BP readings was considered for analysis after due consent. Subjects with stage 2 hypertension were administered AZST 40mg once daily. After 3 months they had a repeat BP recording. Subjects underwent serum creatinine, Na+, K+, fasting (FPG) and postprandrial (PPG) plasma glucose measurements at baseline and after 3moths’ of enrolment. We compared BP lowering efficacy and changes in plasma glucose and renal parameters at baseline and after 3months of AZST therapy. Diabetic, dyslipidemic and other chronic medicines were continued unchanged during the study period. Results: Inclusion criteria were met by 474 subjects (117, 25% females). Mean age and duration of diabetes were 53.3 (95% CI 52.3-54.3) and 7.03 (CI 6.6-7.5) years respectively. With AZST therapy mean SBP dropped from 152.7 (CI 151.1-154.3) mm Hg to 136.4 (CI 134.9-138.0) mm Hg (p <0.05) and the post treatment DBP declined to 79.6 (CI 78.8-80.4) mm Hg from its baseline value of 90.5 (CI 89.6-91.4) mm Hg (p <0.05). The mean baseline FPG and PPG were 158.8 (CI 154.0-163.4) mg/dL and 237.3 (CI 231.9-242.7) mg/dL in order. There was a non-significant decline in plasma glucose, but no changes were seen in eGFR or electrolytes. No adverse event was reported. Conclusion: Azilsartan monotherapy was found to be safe and effective in managing newly diagnosed stage 2 hypertension in type 2 diabetes without hampering renal function. Disclosure H. Mahapatra: None. M. Khuntia: None. S. Mishra: None. S.K. Mishra: None. R.K. Padhi: None. B. Jena: None. S. Das: None. R.K. Khatua: None. A.R. Jena: None. R. Mahapatra: None. L. Mahapatra: None. A.K. Sahoo: None. Funding Jyoti Diabetes Research Foundation
Although the reported incidence of pENL is low in India compared to other parts of the world, the possibility of pENL should always be kept in mind even though it arises in an extranodal site.
Follicular Lymphoma (FL) is the second most common B-Non Hodgkin Lymphoma after diffuse large B cell lymphoma (DLBCL). Low grade FL is known for its indolent behavior; however, one subset of FL behave aggressively and may require intensive therapy. One of the diagnostic issues in FL is to identify this subgroup of cases. Proliferation index can have prognostic importance in this subset of cases. We discuss one case of low grade FL with a paradoxically high proliferative index. A 63 year male presented with generalized lymphadenopathy of one year duration, which was gradually increasing in size. On examination, patient had bilateral cervical, axillary and inguinal nodes. Biopsy of the left cervical lymph node was reported as FL-Grade 2, with high proliferative Index (60%). The patient was put on CHOP regimen targeted for high grade lymphomas, and had complete remission. High proliferative index in FL is a poor prognostic factor irrespective of the histologic grade. So, proliferative index should be assessed in all cases of FL as an adjunct to histologic grading.
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