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Background and objectiveMismatch repair (MMR) proteins are an integral part of the cell cycle, and they play an important role in the genomic stability of the microsatellite complex. Microsatellite instability (MSI) is associated with Lynch and multi-tumor syndromes. Identifying patients with Lynch syndrome is essential for screening, early detection, and surveillance of other Lynch syndrome-associated tumors. The role of MMR deficiency is well known in colorectal and endometrial adenocarcinoma. However, the role of MMR deficiency in prostatic adenocarcinoma is a matter of controversy. A few studies have been published to analyze the association between MMR deficiency and prostatic adenocarcinoma. In this study, we used immunohistochemistry to look into the expression of four MMR proteins in prostatic adenocarcinoma: MSH2, MSH6, MLH1, and PMS2. MethodologyThis was a cross-sectional descriptive study involving 74 cases of acinar prostatic adenocarcinoma, diagnosed with hematoxylin & eosin (H&E), over a period of six months between December 2021 and May 2022 at the Chughtai Institute of Pathology in Lahore, Pakistan. We performed the immunohistochemical (IHC) analysis and interpretation of four antibodies, i.e., MSH2, MSH6, MLH1, and PMS2. ResultsIn our study, the age of the patients ranged from 50 to 98 years, with a mean age of 67.99 ± 9.59 years. The specimens were collected through transurethral resection of the prostate (TURP), transurethral vaporization of the prostate (TVP), core biopsy, and radical prostatectomy. Isolated loss of each MSH2 and PMS2 was noted in nine cases (12.20%) and MSH6 in two cases (2.70%). There was no loss noted for MLH1. Furthermore, simultaneous loss of MSH2/MSH6 was observed in one case (1.35%). ConclusionOur study findings revealed a low frequency of IHC expression of MMR proteins, especially the concurrent loss of paired MMR proteins. However, prostatic adenocarcinoma is associated with the isolated loss of MMR proteins. Thus, the present study does not warrant reflex testing/screening in every case of prostatic adenocarcinoma, because of its low frequency, which is probably suggestive of its sporadic pattern.

Granular cell astrocytoma (GCA) is a rare glial neoplasm composed of abundant granular cytoplasm gives immunoreactivity for GFAP and S100 stains. We report a case of GCA in a 64 years old male presented with history of fits, right sided weakness and loss of consciousness. The microscopy showed sheets of large cells with abundant eosinophilic granular cytoplasm. No high-grade features were seen. Its differential diagnosis includes most of the benign histiocytic conditions. Granular cell astrocytoma has an aggressive clinical course and its survival rate is less than 1 year. That’s why early correct diagnosis is very essential.

Objective: Dengue infection (DI) is the most common arthropod-borne viral disease with symptoms ranging from mild flu like illness to fatal hemorrhagic fever. Thrombocytopenia is one of the common manifestations of dengue which can lead to life threatening bleeding. Currently, there is no validated test available that can predict the severity of thrombocytopenia in a dengue patient. Dengue has been well associated with presence of high fluorescence lymphocytes in the peripheral blood. High fluorescence lymphocyte count (HFLC) is a parameter generated at no extra cost when an automated complete blood count (CBC) is performed on Sysmex XN-1000 automated hematology analyzer. We aim to assess the significance and correlation of the HFLC with thrombocytopenia during the course of dengue infection especially during day 1 to 5 of the infection. Material and Methods: This is a cross sectional study and was conducted at Chughtai Institute of Pathology from August 2021 to October 2021. Total 312 patients, both males and females, who had NS1 positive confirmed dengue infection were included in the study. Their platelet count and HFLC were noted at the time of diagnosis using Sysmex XN-1000. Follow up CBC were analyzed for next 5 days to observe the severity of thrombocytopenia. Results: There is significant negative correlation between absolute HFLC and platelet count on day one to five of the infection. On receiver operator characteristic curve analysis, we found that HFLC < 0.5 x103/µL had 60% sensitivity and 71.8% specificity for severe thrombocytopenia (platelet count less than 50 x 103/µL on day 5 of the infection. Conclusion: HFLC is a negative predictive factor for severe thrombocytopenia and therefore can be used as an early predictor of disease progression. Key Words: Dengue infection, NS1 antigen, High fluorescence lymphocyte count, Thrombocytopenia, Automated hematology analyzer.