Camphor is usually used in the USA to repel insects, but it is widely used in other countries as an herb. We report the case of a 52-year-old previously healthy Nepali man who ingested approximately 10 g of pure camphor with therapeutic intention. He developed grand mal seizures, and was evaluated in an emergency room. He failed to recall the camphor ingestion initially, and was treated with phenytoin for new-onset idiopathic seizures. Examining physicians only later found out about his camphor ingestion. Finding the cause of new-onset seizures is often challenging for emergency room physicians, internists and neurologists. In addition to other well-reported causes of secondary seizures, herbal medications and supplements must also be explored.

11064 Background: Reaching to the correct histo-pathological diagnosis of soft tissue sarcomas (STS) is a great challenge and is cornerstone for treatment planning. Need of expertise for diagnosis is limited by lack of expert pathologists and dedicated sarcoma oncologists in India. Through this study we highlight the pattern of pathological diagnosis and accuracy outside specialist centre. Methods: We did retrospective analysis of all patients referred to us with diagnosis of STS in the last 12 months (January 2016 to 2017). According to protocol, all patients had pathology review from our institute. If blocks were available then they were reviewed and if necessary, fresh biopsy was performed. Besides, pathological diagnosis was reviewed in joint clinic, giving clinico-radiological inputs to sarcoma pathologists. For patients diagnosed outside and had discordant report, we divided them into major discrepancy (including change of diagnosis of sarcoma to benign or other histological entity that could potentially change the treatment plan) or minor discrepancy (like mild change in grade or histopathological diagnosis not affecting the treatment plan). Results: There were 149 patients registered with median age of 36 years (14-77 years) and 93 patients (62.4%) were males. 85(57%) patients had localized disease. Most common subtypes were synovial sarcoma 16%, liposarcoma 9%, soft tissue ewings sarcoma 9%, MPNST 9%, leiomyosarcoma 8%, pleomorphic undifferentiated sarcoma 8% etc. Of 149 patients, 42 had not been worked up outside and thus comparison was not possible while 4 patients couldn’t retrieve blocks and repeat biopsy could not be performed. Of 97 patients (biopsy = 84, FNAC = 13) who had diagnosis from outside, 37% had major discrepancy and 24% had minor discrepancy compared with our biopsy review. Major discrepancy was more in non extremity than extremity STS (p = 0.003). Conclusions: Pathological diagnosis of more than half of patients referred from outside was discordant with respect to diagnosis of our centre with major implications on 37%. We believe this is due to lack of sarcoma pathology experts and virtually non-existent multidisciplinary clinics in set up outside tertiary care centres.

e18553 Background: Philadelphia chromosome (Ph) negative Myeloproliferative neoplasm (MPN) is a rare heterogeneous group of clonal hematological malignancy. We aim to describe the clinico-pathological features, treatment, outcomes and complications of this disorder. Methods: It is an ambispective study. All Ph negative MPN patients registered during 2001 to 31st December 2015 at our institute were reviewed for demographic data, diagnosis based on WHO 2008 criteria, treatment, complications and outcomes. SPSS software was used. Results: There were 55 patients registered with PMF (37), ET (9), PV (7), CNL (1) and MPN-U (1). PMF showed median age 51.2 years (23-70), male: female ratio of 1.46, symptomatic (36), splenomegaly (29), mean hemoglobin 9.7 gm/dl (3-16), JAK2 mutation positive (14), CALR mutation positive (1). Most of the patients were DIPSS intermediate-1 risk 22 (59.4%) grouping. They received hydroxyurea (13), steroids (9), ruxolitinib (6), immunomodulators/steroids (4), aspirin (3), allogeneic stem cell transplantation (2), interferon (1), radiation (1), danazol (1) and observation (1). Median OS was not reached. OS at 5 years is 84% (95% CI 70% to 98%). Survival probability at 36 months is significant for circulating blasts <1% and high bone marrow fibrosis but not significant on multivariate analysis. Progression probability at 36 months is significant for circulating blast <1% and high DIPSS score but not significant in multivariate analysis. PV showed median age 58 years (23-70), male: female ratio 6:1, symptomatic (7), splenomegaly (6), mean hemoglobin 18.4 gm/dl (16.6-21.5), JAK2 mutation positivity (5), low risk (2), high risk (5). They received hydroxyurea (6), phlebotomy (3) and aspirin (1). Five out of 7 patients are in stable condition. ET showed median age 39 years (24-72), male: female ratio 2:1, symptomatic (4), splenomegaly (2), mean hemoglobin 12.2 gm/dl (7.5-15.4), JAK2 mutation positivity (4), low risk (7) and high risk (2). They received aspirin (6), hydroxyurea (5), and observation (1). Three patients are in stable condition. CNL (1) developed pneumothorax and was lost to follow up. MPN-U (1) received hydroxyuea. Seven died due to pneumonia (5), transfusion hypersensitivity (1) and AML transformation (1). Conclusions: PMF is the most common Ph negative MPN in our institute with DIPSS intermediate-1 being the most common risk group. At a median follow up of 36 months overall survival at 5 years is 84%.