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Papers by Priya Jacob

Research paper thumbnail of Flowcytometry in Chronic B-Cell Lymphoproliferative Disorders: A Retrospective Study from a Tertiary Oncology Centre, Trivandrum, India

JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH, 2021

Introduction: Chronic B-Cell Lymphoproliferative Disorders (B- CLPD) are malignant neoplasms of B... more Introduction: Chronic B-Cell Lymphoproliferative Disorders (B- CLPD) are malignant neoplasms of B lymphocytes characterised by accumulation of mature B lymphocytes in the Bone Marrow (BM), peripheral blood, and lymphoid tissues. Multiparameter flowcytometry has become a powerful tool in diagnosing B-CLPD that identifies a clonal light-chain restricted population expressing B-cell markers. Aim: To study the morphologic and immunophenotypic profile of B-CLPD by flowcytometry and to determine the incidence of various subtypes. Materials and Methods: All consecutively diagnosed cases of chronic B lymphoproliferative disorders at Regional Cancer Centre, Trivandrum, Kerala, India from 1st December 2016 to 30th November 2018 were retrospectively analysed and studied. Diagnosis of CLPD was made based on peripheral smear and BM aspiration and immunophenotyping by flowcytometry. Flowcytometry was performed using BD FACS Verse flowcytometer. The results of immunophenotyping by flowcytometry we...

Research paper thumbnail of Hematolymphoid Neoplasms in Serous Effusions: Morphological Spectrum, Distribution, and Role of Ancillary Techniques—A Retrospective Analysis of 75 cases

Indian Journal of Medical and Paediatric Oncology, 2021

Introduction Involvement of body fluids can occur at the time of diagnosis or during the disease ... more Introduction Involvement of body fluids can occur at the time of diagnosis or during the disease course of hematolymphoid neoplasms. Cytodiagnosis of malignant effusion is important in effective clinical management. Objectives (1) The aims of the study were to determine the frequency of distribution of various hematolymphoid neoplasms involving body fluids, (2) to study the morphology of hematolymphoid neoplasms in fluids, and (3) to assess the role of ancillary techniques in the diagnosis. Materials and Methods In this retrospective study, all cases of hematolymphoid neoplasms involving body fluids diagnosed from January 2016 to December 2018 were evaluated. Results During the 3-year period, there were 75 cases of hematological malignancies involving body fluids. These included 48 male patients and 27 female patients. Pleural fluid was involved in majority of cases (56 cases; 74.67%), followed by ascitic fluid (17 cases; 22.67%), and pericardial fluid (2 cases; 2.67%). High cellula...

Research paper thumbnail of Metastatic pituitary lymphoma: Report and literature review

Neurology India, 2019

Sir, Systemic lymphoma with metastasis to the pituitary gland is very rare accounting for <0.5... more Sir, Systemic lymphoma with metastasis to the pituitary gland is very rare accounting for <0.5% of all reported pituitary metastasis.[1] Their clinical presentation is not specific and may mimic pituitary adenomas.[1] Radiological distinction of pituitary lymphoma is essential for staging the disease as well as to select an appropriate treatment plan. In this case of systemic lymphoma metastasizing to the pituitary, we report the clinical findings at presentation and the distinctive radiological features of secondary pituitary lymphoma [SPL]. We also present a detailed review of literature from PubMed till 2018 on SPL.

Research paper thumbnail of Computer aided screening of natural antimicrobials against putative drug targets of Helicobacter pylori 26695- an In silico drug designing approach

Journal of natural science, biology, and medicine, 2011

Research paper thumbnail of Reducing surgical site infections in low-income and middle-income countries (FALCON): a pragmatic, multicentre, stratified, randomised controlled trial

The Lancet, 2021

Background Surgical site infection (SSI) is the most common postoperative complication worldwide.... more Background Surgical site infection (SSI) is the most common postoperative complication worldwide. WHO guidelines to prevent SSI recommend alcoholic chlorhexidine skin preparation and fascial closure using triclosan-coated sutures, but called for assessment of both interventions in low-resource settings. This study aimed to test both interventions in low-income and middle-income countries. Methods FALCON was a 2 × 2 factorial, randomised controlled trial stratified by whether surgery was cleancontaminated, or contaminated or dirty, including patients undergoing abdominal surgery with a skin incision of 5 cm or greater. This trial was undertaken in 54 hospitals in seven countries (

Research paper thumbnail of Outcomes of pediatric mixed phenotype acute leukemia treated with lymphoid directed therapy: Analysis of an institutional series from India

Pediatric Hematology and Oncology, 2021

Abstract There is limited data regarding pediatric mixed phenotype acute leukemia (MPAL) and ther... more Abstract There is limited data regarding pediatric mixed phenotype acute leukemia (MPAL) and there is no global consensus on its management yet. In this retrospective study, we analyzed the outcomes of children diagnosed with MPAL at our institute. This study included children ≤ 14 years with MPAL who presented to a tertiary cancer center in India from January 1st 2009 to December 31st 2015. Over a seven-year period, 1390 patients with leukemia presented to our institute of which 22 patients (1.5%) had MPAL. Sixteen patients (72.7%) had B/myeloid leukemia, while 4 (18.1%) and 2 (9%) patients had T/myeloid and B/T leukemia respectively. Twenty-one patients were treated with a modified BFM ALL 95 protocol. 76.1% (n = 16) of patients had a good prednisolone response (GPR) on day 8 and end-of-induction (EOI) marrow was in remission in 90.5% (n = 19). A poor prednisolone response (PPR) on day 8 correlated with an inferior relapse-free survival (25% vs 79.5%, P=.025). The 4-year event-free survival (EFS) and overall survival (OS) for the entire group was 60.8% and 64.9% respectively while the EFS for patients who had a GPR and remission at the EOI (n = 15) was 80% as compared to 16.7% in patients with PPR or induction failure. Lymphoid directed chemotherapy is seen to have good survival outcomes in pediatric MPAL. However, a PPR on day 8 or a positive EOI marrow may be an indication for more aggressive treatment.

Research paper thumbnail of Precursor B-cell Lymphoblastic Lymphoma of Bone in Children: A Close Mimicker of Ewing's Sarcoma

Indian Journal of Medical and Paediatric Oncology, 2018

Precursor B-cell lymphoblastic lymphoma (LBL) occurring as a primary bone tumor is a rare clinica... more Precursor B-cell lymphoblastic lymphoma (LBL) occurring as a primary bone tumor is a rare clinical presentation in children, and data regarding this condition are limited to small case series or a few individual case reports. We report two pediatric cases of precursor B-cell LBL of the bone. The tumor cells from bone biopsies of both patients were seen to be positive for leukocyte common antigen (LCA), terminal deoxynucleotidyl transferase, CD10, CD20 and weakly positive for CD99. Bone marrow studies were normal. They were treated according to the modified Berlin-Frankfurt-Münster acute lymphoblastic leukemia high-risk protocol. The first patient has completed treatment including local radiotherapy and has been disease free for the past 10 years. The second patient has recently completed treatment and shows good response.

Research paper thumbnail of Body cavity fluid flowcytometry in the diagnosis of haematolymphoid neoplasms

Journal of Medical Science And clinical Research, 2018

Introduction: Flow cytometry provides a rapid and accurate analysis of haematopoetic tumour cells... more Introduction: Flow cytometry provides a rapid and accurate analysis of haematopoetic tumour cells in serous fluids. Material & Methods: This is a study of body cavity fluids in which flow cytometry was used to characterize the haematopoetic cells. Period of study is from January 2012 to May 2018. Results: 39 patients were included in the study, out of which, there were 8ascitic fluid, 2 CSF (cerebrospinal fluid) and 29 pleural fluid samples. Among the asciticfluid samples, most common cases were of Burkitt lymphoma. In the 2 CSF cases, one was a rare case of leptomeningeal Diffuse Large B cell lymphoma and the other was a reactive lymphoid population. Among the pleural fluids, most common was T-Lymphoblastic Lymphoma. Among the pleural fluid samples there were 4 reactive lymphocytosis (3 associated with Classical Hodgkin Lymphoma & 1 with a Primary Mediastinal Large B cell Lymphoma). The 3 benign effusions associated with Classical Hodgkin Lymphoma showed an abnormal increased CD4:CD8 ratio. In addition to flow cytometry, in cases of DLBCL/ Burkitt lymphoma IHC markers like bcl2, bcl6, SIgM, TdT and MIB were done on cell block preparation to corroborate the diagnosis. Conclusion: Flow cytometry helps rapidly and accurately characterize benign and malignant haematolymphoid effusions and in conjugation with immunohistochemistry on cell block preparation obviates the need for a tissue biopsy .The increased CD4 T cell subset in pleural fluid samples of Classical Hodgkin Lymphoma probably corresponds to the increase in T regulatory cells with a CD4, CD25, CD152, and FoxP3 immunophenotype which has been identified in the background T cell population of Classical Hodgkin Lymphoma.

Research paper thumbnail of Primary Mediastinal Large B-Cell Lymphoma in a Child Presenting With Superior Mediastinal Syndrome and Chylous Pleural and Pericardial Effusion

Journal of Pediatric Hematology/Oncology, 2019

Primary mediastinal (thymic) large B-cell lymphoma is an aggressive B-cell lymphoma. It comprises... more Primary mediastinal (thymic) large B-cell lymphoma is an aggressive B-cell lymphoma. It comprises <3% of all pediatric non-Hodgkin lymphomas (NHLs). Primary mediastinal (thymic) large B-cell lymphoma usually presents with serous pleural effusion, but presentation with chylous pleural and pericardial effusions is rare. We present a child who presented with features of a superior mediastinal syndrome. Biopsy of the mediastinal mass confirmed the diagnosis of large B-cell lymphoma. In view of nonimprovement of respiratory distress with chemotherapy and persistence of features of superior mediastinal syndrome, the child was evaluated and found to have massive pleural and pericardial effusion on imaging. Therapeutic thoracentesis and pericardiocentesis revealed chylous nature of the fluid.

Research paper thumbnail of CD34 Positive Pediatric T Lymphoblastic Leukemia: A Tertiary Care Centre Experience

journal of medical science and clinical research, 2017

Background: T lymphoblastic leukaemia (T ALL) carries a worse prognosis compared to B lymphoblast... more Background: T lymphoblastic leukaemia (T ALL) carries a worse prognosis compared to B lymphoblastic leukaemia (B ALL) especially in children. There are only a few published data about immunophenotype of T ALL in India. So we studied the immunophenotypic pattern of T ALL in children by flow cytometry and correlated it with clinical and pathological factors. Materials and Methods: 271 consecutive cases of paediatric acute leukaemias reported in the Regional Cancer Centre, Thiruvananthapuram, Kerala, were immunophenotyped by flow cytometry and clinicpathological analysis was done in all cases. The study period was from June 2009-June 2011. T ALL cases were followed up for two and a half years till the completion of treatment. Result: Among the 271 cases of myeloperoxidase negative acute leukaemia, 232 were BALL , 39 were TALL. Among 39 cases of T ALL, 25 cases (64%) were CD34 positive and 14(35.8%) were CD34 negative. Of the 25 CD34 positive cases, only 12 (48%) completed treatment compared to 10 out of 14(71%) CD34 negative cases. Conclusion: The occurrence of CD34 positivity in T ALL is high in children coming to our centre from different parts of Kerala which is in contrast to western studies. Even though T ALL is treated under high risk protocol, CD34 positive cases need special attention and they should undergo molecular studies to detect the bad prognostic factor.

Research paper thumbnail of Anatomic distribution and histologic subtypes of primary gastrointestinal lymphomas: A retrospective analysis of 152 cases

Clinical Cancer Investigation Journal, 2017

Background: Gastrointestinal (GI) lymphomas are a heterogeneous group of neoplasms. Studies have ... more Background: Gastrointestinal (GI) lymphomas are a heterogeneous group of neoplasms. Studies have demonstrated a wide variation in the sites of involvement and histologic subtypes, which are independent prognostic factors. Hence, it is important to study the frequency and distribution pattern of GI lymphoma in a particular region. Aim: The aim of this study was to study all cases of primary GI lymphomas presented to our center for 5 years with reference to the pattern of distribution and histologic subtypes and compare our data with the literature. Materials and Methods: In this retrospective study, all cases of primary GI lymphomas over a period of 5 years from 2010 to 2014 were analyzed. Results: There were 152 cases of primary GI lymphomas. Age ranged from 3 years to 83 years. There were 133 adult patients and 19 pediatric patients. Most common site of involvement was small intestine followed by stomach, large intestine, and esophagus. Most common histologic subtype was diffuse large B-cell lymphoma (DLBCL), followed by Burkitt lymphoma, extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT) lymphoma, follicular lymphoma, mantle cell lymphoma, B-cell lymphoma unclassifiable with features intermediate between DLBCL and Burkitt lymphoma, and plasmablastic lymphoma. There were five cases of T-cell non-Hodgkin lymphoma which included adult T-cell leukemia/lymphoma, anaplastic large-cell lymphoma, enteropathy-associated T-cell lymphoma, and T-lymphoblastic lymphoma. One case of Hodgkin lymphoma with predominant involvement of the large intestine and without any peripheral node involvement was also encountered. Conclusion: In our series, the most common site of involvement was the small intestine. This is in contrast to majority of studies where the most common site is the stomach. Similar to the other studies, DLBCL was the most common histologic subtype. Compared to other studies, there were more number of Burkitt lymphoma and lesser number of MALT lymphoma in our series.

Research paper thumbnail of Profiling of peripheral T-cell lymphomas in Kerala, South India: A 5-year study

Indian Journal of Pathology and Microbiology, 2017

Peripheral T-cell lymphomas (PTCLs) are non-Hodgkin&amp;amp;amp;amp;amp;amp;#39;s lymphomas (... more Peripheral T-cell lymphomas (PTCLs) are non-Hodgkin&amp;amp;amp;amp;amp;amp;#39;s lymphomas (NHLs) with considerable variation in incidence across the world. They show a wide variety of clinicopathological features and generally associated with poor clinical outcome. Lymphoma data from different geographic regions will definitely aid in routine clinical practice and research work. PTCLs are reported with a higher frequency in Asia as compared to Western countries. The objective of this study was to analyze the frequency and distribution of PTCLs diagnosed in a tertiary care cancer center in Kerala. This was a retrospective study carried out in the Division of Pathology, Regional Cancer Centre, Thiruvananthapuram, for 5 years from January 1, 2011, to December 31, 2015. All PTCLs diagnosed during this period were reviewed and then classified according to the 2016 revision of the World Health Organization classification of lymphoid neoplasms. Statistical significance of the results was evaluated using Chi-square test. Among the total 3108 cases of lymphomas diagnosed at our center, 2404 cases were NHLs (77.35%). PTCLs (n = 333) contributed 13.85% of all NHLs. Among these, PTCL, not otherwise specified, constituted the most common subtype (92 cases, 27.63%), followed by angioimmunoblastic T-cell lymphoma (79 cases, 23.72%), anaplastic large cell lymphoma (75 cases, 22.52%), mycosis fungoides (28 cases, 8.40%), and adult T-cell leukemia/lymphoma (ATLL) (28 cases, 8.40%). This is the largest study on PTCLs reported from Kerala. We document that the frequency of PTCLs is higher than that reported from Western studies. The frequency of ATLL reported from Kerala is much higher than that reported from other states.

Research paper thumbnail of Burkitt's lymphoma of the humerus

Journal of cancer research and therapeutics

Burkitt's lymphoma is an uncommon form of non-Hodgkin's lymphoma (NHL) in adults and repr... more Burkitt's lymphoma is an uncommon form of non-Hodgkin's lymphoma (NHL) in adults and represents < 5% of NHL adults. Burkitt's lymphoma involving primarily the appendicular skeleton is rarely described. We present the case of a young man with primary Burkitt's lymphoma involving the humerus as the only site of disease. He received R hyper CVAD and local irradiation and is in complete remission at 24 months.

Research paper thumbnail of Screening of natural antimicrobials against Putative drug targets of Helicobacter Pylori 26695-An in silico drug designing approach

Research paper thumbnail of Rhabdomyosarcoma masquerading as acute leukemia with lymphoid phenotype expression: A diagnostic trap

Clinical Cancer Investigation Journal, 2015

Rhabdomyosarcoma (RMS) can mimic acute leukemia both clinically and morphologically and can expre... more Rhabdomyosarcoma (RMS) can mimic acute leukemia both clinically and morphologically and can express a few surface markers characteristic of leukemic blasts. We report a case of a 21-year-old male patient who presented with pancytopenia. Bone marrow studies showed the atypical cells resembling blasts, expressing CD19 on flow cytometry and desmin by immunocytochemistry in bone marrow aspirate smears. A diagnosis of RMS infiltrating the bone marrow was made.

Research paper thumbnail of Flow cytometric analysis of Mixed phenotype acute leukemia: Experience from a tertiary oncology center

Indian journal of pathology & microbiology

Mixed phenotype acute leukemia (MPAL) is a rare subset of acute leukemia where the blasts exhibit... more Mixed phenotype acute leukemia (MPAL) is a rare subset of acute leukemia where the blasts exhibit lineage specific antigens of more than one lineage. Flow cytometric immunophenotyping is essential for the diagnosis of MPAL and the accurate diagnosis highly depends on the panel of markers used. The precise incidence of MPAL is uncertain as various institutions use different combinations of antibodies to assign the blasts to a particular lineage. The aim was to study the immunoprofile of acute leukemia including aberrant antigen expressions and to study the incidence, clinical features, laboratory findings, and immunophenotype of MPAL in our institution. All cases of acute leukemias in which flow cytometric analysis during 1-year period from July 2012 to July 2013 were included in this study. During the study period, flow cytometric analysis of 506 cases was performed. B lymphoblastic leukemia was the most common subtype of acute leukemia. CD13 was the most common aberrant antigen exp...

Research paper thumbnail of Primary renal lymphoma-a case report

Ecancermedicalscience, 2014

Primary renal lymphoma is a rare entity representing less than 1% of lesions in the kidney. We pr... more Primary renal lymphoma is a rare entity representing less than 1% of lesions in the kidney. We present the case of a 42-year-old male who was evaluated for pain and a mass in the abdomen. The computed tomogram of the abdomen showed a large lobulated homogeneously enhancing mass lesion of about 14×12×18 cm, involving the whole of the left kidney and encasing the left renal vessels and ureter. The patient underwent a biopsy, and the histopathology was diffuse large B cell lymphoma, positive for LCA, CD20, PAX 5, Bcl 2 and negative for SIgM, CD33, CD34, CD5, Tdt, with MIB 1 labelling index of 40%. He received chemotherapy with rituximab, cyclophosphamide, doxorubicin, vincristine and prednisolone (R CHOP) for eight cycles followed by radiation to the residual mass and achieved complete remission. Currently, he is alive and in remission at 28 months.

Research paper thumbnail of Aggressive natural killer-cell leukemia: classical presentation of a rare disease

Indian journal of pathology & microbiology

Aggressive natural killer-cell leukaemia is a rare aggressive form of natural killer-cell neoplas... more Aggressive natural killer-cell leukaemia is a rare aggressive form of natural killer-cell neoplasm. We report a case of a 40-year-old male who presented with jaundice, raised blood counts,generalised lymphadenopathy and hepatosplenomegaly. The diagnosis was established by flow cytometric analysis of bone marrow aspirate. The patient, however, succumbed to his illness within 2 weeks of starting chemotherapy. To the best of our knowledge, this is the third reported case from India.

Research paper thumbnail of Nodal metastatic, undifferentiated nasopharyngeal carcinoma and classical Hodgkin lymphoma: age old mimics

Indian journal of pathology & microbiology

Research paper thumbnail of Osteolytic bone lesions – A rare presentation of AML M6

Mediterranean Journal of Hematology and Infectious Diseases, 2015

Acute myeloid leukemia (AML) M6 is a rare form of AML accounting for < 5 % of all AML. Extr... more Acute myeloid leukemia (AML) M6 is a rare form of AML accounting for < 5 % of all AML. Extramedullary involvement is very rarely seen in this entity. Skeletal lesion has not been described in AML M6 before. We discuss the case of a 17 year old boy with AML M6 who presented with osteolytic lesion of right humerus. He was treated with induction and consolidation chemotherapy. The present case is the first report in literature of AML M6 presenting with skeletal lesions.

Research paper thumbnail of Flowcytometry in Chronic B-Cell Lymphoproliferative Disorders: A Retrospective Study from a Tertiary Oncology Centre, Trivandrum, India

JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH, 2021

Introduction: Chronic B-Cell Lymphoproliferative Disorders (B- CLPD) are malignant neoplasms of B... more Introduction: Chronic B-Cell Lymphoproliferative Disorders (B- CLPD) are malignant neoplasms of B lymphocytes characterised by accumulation of mature B lymphocytes in the Bone Marrow (BM), peripheral blood, and lymphoid tissues. Multiparameter flowcytometry has become a powerful tool in diagnosing B-CLPD that identifies a clonal light-chain restricted population expressing B-cell markers. Aim: To study the morphologic and immunophenotypic profile of B-CLPD by flowcytometry and to determine the incidence of various subtypes. Materials and Methods: All consecutively diagnosed cases of chronic B lymphoproliferative disorders at Regional Cancer Centre, Trivandrum, Kerala, India from 1st December 2016 to 30th November 2018 were retrospectively analysed and studied. Diagnosis of CLPD was made based on peripheral smear and BM aspiration and immunophenotyping by flowcytometry. Flowcytometry was performed using BD FACS Verse flowcytometer. The results of immunophenotyping by flowcytometry we...

Research paper thumbnail of Hematolymphoid Neoplasms in Serous Effusions: Morphological Spectrum, Distribution, and Role of Ancillary Techniques—A Retrospective Analysis of 75 cases

Indian Journal of Medical and Paediatric Oncology, 2021

Introduction Involvement of body fluids can occur at the time of diagnosis or during the disease ... more Introduction Involvement of body fluids can occur at the time of diagnosis or during the disease course of hematolymphoid neoplasms. Cytodiagnosis of malignant effusion is important in effective clinical management. Objectives (1) The aims of the study were to determine the frequency of distribution of various hematolymphoid neoplasms involving body fluids, (2) to study the morphology of hematolymphoid neoplasms in fluids, and (3) to assess the role of ancillary techniques in the diagnosis. Materials and Methods In this retrospective study, all cases of hematolymphoid neoplasms involving body fluids diagnosed from January 2016 to December 2018 were evaluated. Results During the 3-year period, there were 75 cases of hematological malignancies involving body fluids. These included 48 male patients and 27 female patients. Pleural fluid was involved in majority of cases (56 cases; 74.67%), followed by ascitic fluid (17 cases; 22.67%), and pericardial fluid (2 cases; 2.67%). High cellula...

Research paper thumbnail of Metastatic pituitary lymphoma: Report and literature review

Neurology India, 2019

Sir, Systemic lymphoma with metastasis to the pituitary gland is very rare accounting for <0.5... more Sir, Systemic lymphoma with metastasis to the pituitary gland is very rare accounting for <0.5% of all reported pituitary metastasis.[1] Their clinical presentation is not specific and may mimic pituitary adenomas.[1] Radiological distinction of pituitary lymphoma is essential for staging the disease as well as to select an appropriate treatment plan. In this case of systemic lymphoma metastasizing to the pituitary, we report the clinical findings at presentation and the distinctive radiological features of secondary pituitary lymphoma [SPL]. We also present a detailed review of literature from PubMed till 2018 on SPL.

Research paper thumbnail of Computer aided screening of natural antimicrobials against putative drug targets of Helicobacter pylori 26695- an In silico drug designing approach

Journal of natural science, biology, and medicine, 2011

Research paper thumbnail of Reducing surgical site infections in low-income and middle-income countries (FALCON): a pragmatic, multicentre, stratified, randomised controlled trial

The Lancet, 2021

Background Surgical site infection (SSI) is the most common postoperative complication worldwide.... more Background Surgical site infection (SSI) is the most common postoperative complication worldwide. WHO guidelines to prevent SSI recommend alcoholic chlorhexidine skin preparation and fascial closure using triclosan-coated sutures, but called for assessment of both interventions in low-resource settings. This study aimed to test both interventions in low-income and middle-income countries. Methods FALCON was a 2 × 2 factorial, randomised controlled trial stratified by whether surgery was cleancontaminated, or contaminated or dirty, including patients undergoing abdominal surgery with a skin incision of 5 cm or greater. This trial was undertaken in 54 hospitals in seven countries (

Research paper thumbnail of Outcomes of pediatric mixed phenotype acute leukemia treated with lymphoid directed therapy: Analysis of an institutional series from India

Pediatric Hematology and Oncology, 2021

Abstract There is limited data regarding pediatric mixed phenotype acute leukemia (MPAL) and ther... more Abstract There is limited data regarding pediatric mixed phenotype acute leukemia (MPAL) and there is no global consensus on its management yet. In this retrospective study, we analyzed the outcomes of children diagnosed with MPAL at our institute. This study included children ≤ 14 years with MPAL who presented to a tertiary cancer center in India from January 1st 2009 to December 31st 2015. Over a seven-year period, 1390 patients with leukemia presented to our institute of which 22 patients (1.5%) had MPAL. Sixteen patients (72.7%) had B/myeloid leukemia, while 4 (18.1%) and 2 (9%) patients had T/myeloid and B/T leukemia respectively. Twenty-one patients were treated with a modified BFM ALL 95 protocol. 76.1% (n = 16) of patients had a good prednisolone response (GPR) on day 8 and end-of-induction (EOI) marrow was in remission in 90.5% (n = 19). A poor prednisolone response (PPR) on day 8 correlated with an inferior relapse-free survival (25% vs 79.5%, P=.025). The 4-year event-free survival (EFS) and overall survival (OS) for the entire group was 60.8% and 64.9% respectively while the EFS for patients who had a GPR and remission at the EOI (n = 15) was 80% as compared to 16.7% in patients with PPR or induction failure. Lymphoid directed chemotherapy is seen to have good survival outcomes in pediatric MPAL. However, a PPR on day 8 or a positive EOI marrow may be an indication for more aggressive treatment.

Research paper thumbnail of Precursor B-cell Lymphoblastic Lymphoma of Bone in Children: A Close Mimicker of Ewing's Sarcoma

Indian Journal of Medical and Paediatric Oncology, 2018

Precursor B-cell lymphoblastic lymphoma (LBL) occurring as a primary bone tumor is a rare clinica... more Precursor B-cell lymphoblastic lymphoma (LBL) occurring as a primary bone tumor is a rare clinical presentation in children, and data regarding this condition are limited to small case series or a few individual case reports. We report two pediatric cases of precursor B-cell LBL of the bone. The tumor cells from bone biopsies of both patients were seen to be positive for leukocyte common antigen (LCA), terminal deoxynucleotidyl transferase, CD10, CD20 and weakly positive for CD99. Bone marrow studies were normal. They were treated according to the modified Berlin-Frankfurt-Münster acute lymphoblastic leukemia high-risk protocol. The first patient has completed treatment including local radiotherapy and has been disease free for the past 10 years. The second patient has recently completed treatment and shows good response.

Research paper thumbnail of Body cavity fluid flowcytometry in the diagnosis of haematolymphoid neoplasms

Journal of Medical Science And clinical Research, 2018

Introduction: Flow cytometry provides a rapid and accurate analysis of haematopoetic tumour cells... more Introduction: Flow cytometry provides a rapid and accurate analysis of haematopoetic tumour cells in serous fluids. Material & Methods: This is a study of body cavity fluids in which flow cytometry was used to characterize the haematopoetic cells. Period of study is from January 2012 to May 2018. Results: 39 patients were included in the study, out of which, there were 8ascitic fluid, 2 CSF (cerebrospinal fluid) and 29 pleural fluid samples. Among the asciticfluid samples, most common cases were of Burkitt lymphoma. In the 2 CSF cases, one was a rare case of leptomeningeal Diffuse Large B cell lymphoma and the other was a reactive lymphoid population. Among the pleural fluids, most common was T-Lymphoblastic Lymphoma. Among the pleural fluid samples there were 4 reactive lymphocytosis (3 associated with Classical Hodgkin Lymphoma & 1 with a Primary Mediastinal Large B cell Lymphoma). The 3 benign effusions associated with Classical Hodgkin Lymphoma showed an abnormal increased CD4:CD8 ratio. In addition to flow cytometry, in cases of DLBCL/ Burkitt lymphoma IHC markers like bcl2, bcl6, SIgM, TdT and MIB were done on cell block preparation to corroborate the diagnosis. Conclusion: Flow cytometry helps rapidly and accurately characterize benign and malignant haematolymphoid effusions and in conjugation with immunohistochemistry on cell block preparation obviates the need for a tissue biopsy .The increased CD4 T cell subset in pleural fluid samples of Classical Hodgkin Lymphoma probably corresponds to the increase in T regulatory cells with a CD4, CD25, CD152, and FoxP3 immunophenotype which has been identified in the background T cell population of Classical Hodgkin Lymphoma.

Research paper thumbnail of Primary Mediastinal Large B-Cell Lymphoma in a Child Presenting With Superior Mediastinal Syndrome and Chylous Pleural and Pericardial Effusion

Journal of Pediatric Hematology/Oncology, 2019

Primary mediastinal (thymic) large B-cell lymphoma is an aggressive B-cell lymphoma. It comprises... more Primary mediastinal (thymic) large B-cell lymphoma is an aggressive B-cell lymphoma. It comprises <3% of all pediatric non-Hodgkin lymphomas (NHLs). Primary mediastinal (thymic) large B-cell lymphoma usually presents with serous pleural effusion, but presentation with chylous pleural and pericardial effusions is rare. We present a child who presented with features of a superior mediastinal syndrome. Biopsy of the mediastinal mass confirmed the diagnosis of large B-cell lymphoma. In view of nonimprovement of respiratory distress with chemotherapy and persistence of features of superior mediastinal syndrome, the child was evaluated and found to have massive pleural and pericardial effusion on imaging. Therapeutic thoracentesis and pericardiocentesis revealed chylous nature of the fluid.

Research paper thumbnail of CD34 Positive Pediatric T Lymphoblastic Leukemia: A Tertiary Care Centre Experience

journal of medical science and clinical research, 2017

Background: T lymphoblastic leukaemia (T ALL) carries a worse prognosis compared to B lymphoblast... more Background: T lymphoblastic leukaemia (T ALL) carries a worse prognosis compared to B lymphoblastic leukaemia (B ALL) especially in children. There are only a few published data about immunophenotype of T ALL in India. So we studied the immunophenotypic pattern of T ALL in children by flow cytometry and correlated it with clinical and pathological factors. Materials and Methods: 271 consecutive cases of paediatric acute leukaemias reported in the Regional Cancer Centre, Thiruvananthapuram, Kerala, were immunophenotyped by flow cytometry and clinicpathological analysis was done in all cases. The study period was from June 2009-June 2011. T ALL cases were followed up for two and a half years till the completion of treatment. Result: Among the 271 cases of myeloperoxidase negative acute leukaemia, 232 were BALL , 39 were TALL. Among 39 cases of T ALL, 25 cases (64%) were CD34 positive and 14(35.8%) were CD34 negative. Of the 25 CD34 positive cases, only 12 (48%) completed treatment compared to 10 out of 14(71%) CD34 negative cases. Conclusion: The occurrence of CD34 positivity in T ALL is high in children coming to our centre from different parts of Kerala which is in contrast to western studies. Even though T ALL is treated under high risk protocol, CD34 positive cases need special attention and they should undergo molecular studies to detect the bad prognostic factor.

Research paper thumbnail of Anatomic distribution and histologic subtypes of primary gastrointestinal lymphomas: A retrospective analysis of 152 cases

Clinical Cancer Investigation Journal, 2017

Background: Gastrointestinal (GI) lymphomas are a heterogeneous group of neoplasms. Studies have ... more Background: Gastrointestinal (GI) lymphomas are a heterogeneous group of neoplasms. Studies have demonstrated a wide variation in the sites of involvement and histologic subtypes, which are independent prognostic factors. Hence, it is important to study the frequency and distribution pattern of GI lymphoma in a particular region. Aim: The aim of this study was to study all cases of primary GI lymphomas presented to our center for 5 years with reference to the pattern of distribution and histologic subtypes and compare our data with the literature. Materials and Methods: In this retrospective study, all cases of primary GI lymphomas over a period of 5 years from 2010 to 2014 were analyzed. Results: There were 152 cases of primary GI lymphomas. Age ranged from 3 years to 83 years. There were 133 adult patients and 19 pediatric patients. Most common site of involvement was small intestine followed by stomach, large intestine, and esophagus. Most common histologic subtype was diffuse large B-cell lymphoma (DLBCL), followed by Burkitt lymphoma, extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT) lymphoma, follicular lymphoma, mantle cell lymphoma, B-cell lymphoma unclassifiable with features intermediate between DLBCL and Burkitt lymphoma, and plasmablastic lymphoma. There were five cases of T-cell non-Hodgkin lymphoma which included adult T-cell leukemia/lymphoma, anaplastic large-cell lymphoma, enteropathy-associated T-cell lymphoma, and T-lymphoblastic lymphoma. One case of Hodgkin lymphoma with predominant involvement of the large intestine and without any peripheral node involvement was also encountered. Conclusion: In our series, the most common site of involvement was the small intestine. This is in contrast to majority of studies where the most common site is the stomach. Similar to the other studies, DLBCL was the most common histologic subtype. Compared to other studies, there were more number of Burkitt lymphoma and lesser number of MALT lymphoma in our series.

Research paper thumbnail of Profiling of peripheral T-cell lymphomas in Kerala, South India: A 5-year study

Indian Journal of Pathology and Microbiology, 2017

Peripheral T-cell lymphomas (PTCLs) are non-Hodgkin&amp;amp;amp;amp;amp;amp;#39;s lymphomas (... more Peripheral T-cell lymphomas (PTCLs) are non-Hodgkin&amp;amp;amp;amp;amp;amp;#39;s lymphomas (NHLs) with considerable variation in incidence across the world. They show a wide variety of clinicopathological features and generally associated with poor clinical outcome. Lymphoma data from different geographic regions will definitely aid in routine clinical practice and research work. PTCLs are reported with a higher frequency in Asia as compared to Western countries. The objective of this study was to analyze the frequency and distribution of PTCLs diagnosed in a tertiary care cancer center in Kerala. This was a retrospective study carried out in the Division of Pathology, Regional Cancer Centre, Thiruvananthapuram, for 5 years from January 1, 2011, to December 31, 2015. All PTCLs diagnosed during this period were reviewed and then classified according to the 2016 revision of the World Health Organization classification of lymphoid neoplasms. Statistical significance of the results was evaluated using Chi-square test. Among the total 3108 cases of lymphomas diagnosed at our center, 2404 cases were NHLs (77.35%). PTCLs (n = 333) contributed 13.85% of all NHLs. Among these, PTCL, not otherwise specified, constituted the most common subtype (92 cases, 27.63%), followed by angioimmunoblastic T-cell lymphoma (79 cases, 23.72%), anaplastic large cell lymphoma (75 cases, 22.52%), mycosis fungoides (28 cases, 8.40%), and adult T-cell leukemia/lymphoma (ATLL) (28 cases, 8.40%). This is the largest study on PTCLs reported from Kerala. We document that the frequency of PTCLs is higher than that reported from Western studies. The frequency of ATLL reported from Kerala is much higher than that reported from other states.

Research paper thumbnail of Burkitt's lymphoma of the humerus

Journal of cancer research and therapeutics

Burkitt's lymphoma is an uncommon form of non-Hodgkin's lymphoma (NHL) in adults and repr... more Burkitt's lymphoma is an uncommon form of non-Hodgkin's lymphoma (NHL) in adults and represents < 5% of NHL adults. Burkitt's lymphoma involving primarily the appendicular skeleton is rarely described. We present the case of a young man with primary Burkitt's lymphoma involving the humerus as the only site of disease. He received R hyper CVAD and local irradiation and is in complete remission at 24 months.

Research paper thumbnail of Screening of natural antimicrobials against Putative drug targets of Helicobacter Pylori 26695-An in silico drug designing approach

Research paper thumbnail of Rhabdomyosarcoma masquerading as acute leukemia with lymphoid phenotype expression: A diagnostic trap

Clinical Cancer Investigation Journal, 2015

Rhabdomyosarcoma (RMS) can mimic acute leukemia both clinically and morphologically and can expre... more Rhabdomyosarcoma (RMS) can mimic acute leukemia both clinically and morphologically and can express a few surface markers characteristic of leukemic blasts. We report a case of a 21-year-old male patient who presented with pancytopenia. Bone marrow studies showed the atypical cells resembling blasts, expressing CD19 on flow cytometry and desmin by immunocytochemistry in bone marrow aspirate smears. A diagnosis of RMS infiltrating the bone marrow was made.

Research paper thumbnail of Flow cytometric analysis of Mixed phenotype acute leukemia: Experience from a tertiary oncology center

Indian journal of pathology & microbiology

Mixed phenotype acute leukemia (MPAL) is a rare subset of acute leukemia where the blasts exhibit... more Mixed phenotype acute leukemia (MPAL) is a rare subset of acute leukemia where the blasts exhibit lineage specific antigens of more than one lineage. Flow cytometric immunophenotyping is essential for the diagnosis of MPAL and the accurate diagnosis highly depends on the panel of markers used. The precise incidence of MPAL is uncertain as various institutions use different combinations of antibodies to assign the blasts to a particular lineage. The aim was to study the immunoprofile of acute leukemia including aberrant antigen expressions and to study the incidence, clinical features, laboratory findings, and immunophenotype of MPAL in our institution. All cases of acute leukemias in which flow cytometric analysis during 1-year period from July 2012 to July 2013 were included in this study. During the study period, flow cytometric analysis of 506 cases was performed. B lymphoblastic leukemia was the most common subtype of acute leukemia. CD13 was the most common aberrant antigen exp...

Research paper thumbnail of Primary renal lymphoma-a case report

Ecancermedicalscience, 2014

Primary renal lymphoma is a rare entity representing less than 1% of lesions in the kidney. We pr... more Primary renal lymphoma is a rare entity representing less than 1% of lesions in the kidney. We present the case of a 42-year-old male who was evaluated for pain and a mass in the abdomen. The computed tomogram of the abdomen showed a large lobulated homogeneously enhancing mass lesion of about 14×12×18 cm, involving the whole of the left kidney and encasing the left renal vessels and ureter. The patient underwent a biopsy, and the histopathology was diffuse large B cell lymphoma, positive for LCA, CD20, PAX 5, Bcl 2 and negative for SIgM, CD33, CD34, CD5, Tdt, with MIB 1 labelling index of 40%. He received chemotherapy with rituximab, cyclophosphamide, doxorubicin, vincristine and prednisolone (R CHOP) for eight cycles followed by radiation to the residual mass and achieved complete remission. Currently, he is alive and in remission at 28 months.

Research paper thumbnail of Aggressive natural killer-cell leukemia: classical presentation of a rare disease

Indian journal of pathology & microbiology

Aggressive natural killer-cell leukaemia is a rare aggressive form of natural killer-cell neoplas... more Aggressive natural killer-cell leukaemia is a rare aggressive form of natural killer-cell neoplasm. We report a case of a 40-year-old male who presented with jaundice, raised blood counts,generalised lymphadenopathy and hepatosplenomegaly. The diagnosis was established by flow cytometric analysis of bone marrow aspirate. The patient, however, succumbed to his illness within 2 weeks of starting chemotherapy. To the best of our knowledge, this is the third reported case from India.

Research paper thumbnail of Nodal metastatic, undifferentiated nasopharyngeal carcinoma and classical Hodgkin lymphoma: age old mimics

Indian journal of pathology & microbiology

Research paper thumbnail of Osteolytic bone lesions – A rare presentation of AML M6

Mediterranean Journal of Hematology and Infectious Diseases, 2015

Acute myeloid leukemia (AML) M6 is a rare form of AML accounting for < 5 % of all AML. Extr... more Acute myeloid leukemia (AML) M6 is a rare form of AML accounting for < 5 % of all AML. Extramedullary involvement is very rarely seen in this entity. Skeletal lesion has not been described in AML M6 before. We discuss the case of a 17 year old boy with AML M6 who presented with osteolytic lesion of right humerus. He was treated with induction and consolidation chemotherapy. The present case is the first report in literature of AML M6 presenting with skeletal lesions.