NCMP-17. BEWARE: ALL POSTERIOR FOSSA MASSES IN CHILDREN ARE NOT BRAIN TUMORS

2021 ◽  
Vol 23 (Supplement_6) ◽  
pp. vi150-vi150
Author(s):  
Magimairajan Issai Vanan ◽  
Jie Li ◽  
Muhamad Almiski ◽  
Martin Bunge ◽  
Demitre Serletis ◽  
...  
Keyword(s):  
Posterior Fossa ◽  
Peripheral Blood ◽  
Complete Blood Count ◽  
Incidental Finding ◽  
Vasogenic Edema ◽  
Blood Film ◽  
Rare Presentation ◽  
Intracranial Mass ◽  
Adjacent Structures ◽  
Definitive Therapy

Abstract INTRODUCTION Isolated Myeloid sarcoma (MS) of the central nervous system (CNS-MS) is a very rare presentation of Acute Myeloid Leukemia (AML). A 10-year-old boy with a two-week history of intermittent headaches was referred to the emergency department (ED) by an optometrist for evaluation of bilateral papilledema. Physical examination in the ED confirmed the presence of papilledema with no other abnormal neurologic findings. Emergent MRI of the brain showed an avidly homogeneously enhancing extra-axial dural based mass in the right posterior fossa measuring 4.8 cm (AP) x 3.2 cm (CC) x 4.6cm (T), with significant mass effect and peri-tumoral vasogenic edema. Neuro-surgery consultation was obtained and complete blood count (CBC) was normal except for the presence of 13% blasts with occasional Auer rods seen on the peripheral blood smear. Bone marrow aspirate demonstrated 56% myeloblasts; A diagnosis of AML with CNS-MS (CNS-3c) was made and the initial lumbar puncture (LP) was deferred due to the risk of CNS herniation. Induction chemotherapy was initiated as per protocol. A CT scan done two weeks later showed complete resolution of the intracranial mass. DISCUSSION The incidental finding of papilledema, with imaging to investigate the intracranial pathology revealed a large posterior fossa mass in our patient. However, the atypical features of the mass (dural based extra-axial location; extensive infiltration into adjacent structures) and the finding of blasts with Auer rods in peripheral blood helped us to diagnose CNS-MS, and avoided an extensive neurosurgical procedure and a delay in definitive therapy. Our patient had a normal CBC and the review of the peripheral blood film by an experienced Hematologist was very crucial in making a clinical diagnosis of MS. CONCLUSION Myeloid sarcomas should be considered in the differential diagnosis of an intracranial mass, particularly when accompanied by abnormal findings in the CBC.

scholarly journals Sehgal index and its comparison with Mentzer's index and Green and King index in assessment of peripheral blood smear with marked anisopoikilocytosis

2020 ◽  
Vol 8 (8) ◽  
pp. 2972
Author(s):  
Naincy Rastogi ◽  
Arvind S. Bhake
Keyword(s):  
Developing Countries ◽  
Peripheral Blood ◽  
Predictive Value ◽  
Complete Blood Count ◽  
Blood Film ◽  
Beta Thalassemia ◽  
Cell Parameters ◽  
Microcytic Hypochromic Anaemia ◽  
Hypochromic Anaemia ◽  
Youden’S Index

Background: Mild microcytic hypochromic anaemias due to iron deficiency (IDA) and beta thalassemia trait(β-TT) continue to be a cause of significant burden to the society, particularly in the poorer developing countries. The objective of the present study was to study the RBC based indices in patients of marked anisopoikilocytosis in determining the etiology of it, to standardize few automated red cell parameters, and also objective grading of RBC morphology on peripheral smear and interpreting its utility in indicating a diagnosis. Also, to establish a relation between value of RBC indices with that of degree of anisocytosis.Methods: A total of 500 patients diagnosed with mild microcytic hypochromic anaemia on complete blood count and peripheral blood film were included in the study. Hb, RBC count, MCV, MCH and RDW obtained from the electronic cell counter were used to calculate discrimination indices by various mathematical formulae. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and Youden’s index (YI) were calculated.Results: Green and King index demonstrated the lowest sensitivity of 70.51%. Mentzer index demonstrated the highest specificity of 96.80%. The highest and lowest PPV were found for Mentzer index (97.09%) and Sehgal index (92.81%) respectively. Sehgal’s index demonstrated the highest NPV of 95.96% and lowest NPV was exhibited by G and K (87.9%). The highest and the lowest values for Youden’s index were shown by Sehgal’s index (87.82%) and G and K index (68.47%).Conclusions: Sehgal’s index followed by Mentzer index are highly sensitive and reasonably specific in differentiating β-TT from IDA and none of the indices is 100% sensitive and specific. Though HbA2 estimation is the gold standard for diagnosing β-TT, in developing countries, Sehgal index followed by Mentzer et al, index can be used to screen mild microcytic hypochromic anaemia cases to eliminate as many false positive cases as possible to reduce the financial cost.

scholarly journals Ascites in a young male: idiopathic FIP1L1-PDGFRA-negative hypereosinophilic syndrome

JRSM Open ◽  
2020 ◽  
Vol 11 (1) ◽  
pp. 205427041989482
Author(s):  
Ganesh Kasinathan ◽  
Jameela Sathar
Keyword(s):  
Peripheral Blood ◽  
Eosinophil Count ◽  
Complete Blood Count ◽  
Epigastric Pain ◽  
Hypereosinophilic Syndrome ◽  
Blood Film ◽  
Whole Body ◽  
Wall Thickening ◽  
Medical Department ◽  
Absolute Eosinophil Count

Introduction Idiopathic hypereosinophilic syndrome is defined as persistently elevated peripheral blood absolute eosinophil count of more than 1.5 × 109/L for at least six months with no obvious secondary cause. Case Presentation We report the case of a 26-year-old gentleman of Malay ethnicity who presented to the medical department with a three-week history of abdominal distension associated with dyspepsia and epigastric pain. Physical examination revealed ascites. The complete blood count portrayed peripheral leucocytosis with eosinophilia of 8.84 × 109/L. Parasitic serology was negative. Paracentesis analysis showed exudative ascites with an absolute eosinophil count of 8 × 109/L. He was referred to the haematology department. He was noticed to have bilateral tonsillitis and pruritic skin rash at the legs. There were no palpable lymph nodes or organomegaly. A peripheral blood film showed 44% eosinophils with no excess blasts. Clonal eosinophilic fusion studies did not detect FIP1L1-PDGFRA mutation. JAK2 V617F and BCR-ABL1 mutations were undetected. Serum B12 and tryptase levels were normal. A whole-body computed tomography imaging showed bowel wall thickening at the duodenum, jejunum, ileum, rectosigmoid and splenic flexure. Sections of fragments taken from the endoscopy showed features of eosinophilic gastritis and colitis on histology. Bone marrow biopsy depicted marked eosinophilia. He was started on oral imatinib mesylate 200 mg daily and oral prednisolone 0.5 mg/kg daily which was tapered based on response. He achieved complete remission and is now asymptomatic. Conclusion The diagnosis of hypereosinophilic syndrome should be considered in a patient with unexplained ascites. Secondary sinister causes such as malignancy should always be excluded.

scholarly journals THE PERIPHERAL BLOOD FILM

1968 ◽  
Vol 21 (6) ◽  
pp. 788-788
Author(s):  
A. G. Signy
Keyword(s):  
Peripheral Blood ◽  
Blood Film ◽  
Peripheral Blood Film

BILATERAL PROPTOSIS - INITIAL AND RARE PRESENTATION: AML

2021 ◽  
pp. 17-18
Author(s):  
Tejasvini Chandra ◽  
Perwez Khan ◽  
Lubna Khan ◽  
Anshika Gupta
Keyword(s):  
Myeloid Leukemia ◽  
Blood Count ◽  
Complete Blood Count ◽  
Rare Condition ◽  
Metastatic Tumour ◽  
Blood Picture ◽  
Rare Presentation ◽  
Radiological Investigation ◽  
Presumptive Diagnosis ◽  
History Of

We report bilateral proptosis as the initial presentation of Acute Myeloid Leukemia (AML) in a child. An Eight year child presented with a history of painless proptosis in the both eyes within 10 days. Radiological investigation (CT scan) showed inltration of orbit with the metastatic tumour cell. AML was diagnosed with complete blood count, General Blood Picture (GBP) and bone marrow biopsy. The presumptive diagnosis of leukemic inltration of the orbit is made. We report this case as AML can rarely present in child as a bilateral proptosis due to leukemic inltration. Urgent treatment modality for this rare condition is radiation.

scholarly journals Pathophysiology, Diagnosis and Treatment of Immune Thrombocytopenia

2017 ◽  
Vol 5 (1) ◽  
pp. 32-36
Author(s):  
Mihnea-Alexandru Găman ◽  
Amelia Maria Găman
Keyword(s):  
Peripheral Blood ◽  
Immune Thrombocytopenia ◽  
Blood Count ◽  
Complete Blood Count ◽  
Anabolic Steroids ◽  
Peripheral Blood Smear ◽  
Intravenous Immunoglobulins ◽  
First Line Therapy ◽  
Anti Cd20 ◽  
Immunosupressive Therapy

Immune thrombocytopenia (ITP) is an acquired disorder characterized by isolated thrombocytopenia with a peripheral blood count < 100.000/ mm3 in the absence of any obvious initiating or underlying causes, by antibody mediated destruction of platelets and suppression of megakaryocyte and platelet production on the basis of immune deregulation. ITP is idiopathic (primary) in 80% of cases and secondary to several associated disorders in 20% of cases. A diagnosis of exclusion, based on patient history, physical examination, complete blood count and examination of the peripheral blood smear, is used for ITP. The treatment of ITP is indicated in adult patients with platelet counts below 20.000-30.000/ mm3, with bleedings or risk for bleeding. First line therapy is represented by corticosteroids, intravenous immunoglobulins and intravenous anti-RhD. Second-line treatment is represented by: splenectomy, inhibition of the monocytic phagocytic system therapy, immunosupressive therapy, anabolic steroids, anti-CD20 therapy, and thrombopoietin receptor agonists.

scholarly journals Hoarseness of Voice as a Rare Presentation of Tuberculosis: A Case Report Study

2019 ◽  
Vol 7 (19) ◽  
pp. 3262-3264
Author(s):  
Taher Felemban ◽  
Abdullah Ashi ◽  
Abdullah Sindi ◽  
Mohannad Rajab ◽  
Zuhair Al Jehani
Keyword(s):  
Laryngeal Carcinoma ◽  
Incidental Finding ◽  
Chain Reaction ◽  
Rare Presentation ◽  
Case Presentation ◽  
X Ray ◽  
History Of ◽  
Chest X Ray ◽  
Polymerase Chain ◽  
Laryngeal Tuberculosis

BACKGROUND: Having hoarseness of voice as the first clinical manifestation of tuberculosis is rare. This atypical presentation causes some confusion since other more common conditions, such as laryngeal carcinoma, present similarly and might require more invasive tests to confirm the diagnosis. CASE PRESENTATION: A 38-year-old male presented to the otorhinolaryngology clinic with a four-month history of change in voice. Laryngoscopy demonstrated a right glottic mass, raising suspicion of laryngeal cancer. The computed tomography showed a mass and incidental finding of opacities in lung apices. Chest x-ray demonstrated findings suggestive of tuberculosis. Polymerase chain reaction and culture of sputum samples confirmed the diagnosis and the patient was started on anti-tuberculosis treatment. CONCLUSION: Despite accounting for only 1% of pulmonary tuberculosis cases and having a similar presentation to laryngeal carcinoma, we recommend considering laryngeal tuberculosis when evaluating hoarseness of voice in endemic areas.

scholarly journals An Automated Draft Report Generator for Peripheral Blood Smear Examinations Based on Complete Blood Count Parameters

2018 ◽  
Vol 38 (6) ◽  
pp. 512-517
Author(s):  
Young-gon Kim ◽  
Jung Ah Kwon ◽  
Yeonsook Moon ◽  
Seong Jun Park ◽  
Sangwook Kim ◽  
...  
Keyword(s):  
Peripheral Blood ◽  
Blood Count ◽  
Blood Smear ◽  
Complete Blood Count ◽  
Peripheral Blood Smear ◽  
Draft Report

Extra-axial tentorial medulloblastoma: a rare presentation of a common posterior fossa tumour

2021 ◽  
Vol 14 (6) ◽  
pp. e242865
Author(s):  
Somesh Singh ◽  
Amrin Israrahmed ◽  
Vikrant Verma ◽  
Vivek Singh
Keyword(s):  
Differential Diagnosis ◽  
Posterior Fossa ◽  
Fourth Ventricle ◽  
Imaging Features ◽  
Total Excision ◽  
Posterior Fossa Tumour ◽  
Rare Presentation ◽  
Preoperative Workup ◽  
Radiological Features ◽  
Axial Mass

Medulloblastoma is a common paediatric posterior fossa tumour typically presenting as midline intra-axial mass involving the cerebellar vermis and/or roof of fourth ventricle with typical radiological features. These can be extra-axial in extremely rare instances with less than 50 cases reported so far in literature. We present a case of 18-year-old boy presenting with ataxia and headache. MRI showed dural mass (involving the left tentorium cerebellum) with typical imaging features of extra-axial lesion. The patient underwent near total excision of the tumour. Histopathology along with immunohistochemistry revealed the mass to be medulloblastoma. We present this case to highlight rarity of this location for medulloblastoma and the importance of considering this in the differential diagnosis of atypical posterior fossa extra-axial lesions. This can help in performing other relevant preoperative workup similar on the lines of medulloblastoma and planning of relevant management.

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