Osteosarcoma is the most common malignant bone tumor characterized by the formation of disorganized immature bone or osteoid tissue from mesenchymal tumor cells. It most commonly occurs in the appendicular skeleton involving the metaphysis of long bones. It is the third most common cancer in adolescence with an annual incidence of 5.6 cases per million children under the age of 15 years. Giant cell-rich osteosarcoma (GCRO) is an exceedingly rare histological variant of conventional primary osteosarcoma. It constitutes about 1%-3% of all osteosarcomas. A 20-year-old male presented with the complaints of pain and swelling over the right knee. Examination revealed a tender 15×10×8 cm swelling palpable on the distal femur. Radiological investigations showed features suggesting right femoral osteosarcoma in the meta-epiphyseal region. A core needle biopsy from the lesion was performed and 15 ml of fluid obtained from the biopsy site was sent for cytological examination, which showed features suggestive of osteosarcoma. Biopsy showed features of osteosarcoma probably of giant cell rich type confirming the fluid cytology findings. Cell block preparation also revealed giant cell predominance. Osteosarcoma is a bone tumor found in areas of rapid bone turnover, most commonly the distal femur and proximal tibia of adolescent patients. Cytology plays a vital role in diagnosing bone tumors, being a rapid, easy, and minimally invasive outpatient department procedure. Histopathology, since it gives a complete architectural pattern of tissue, remains the gold standard diagnostic tool.

Background: In healthy adults and older children, NRBCs are normally found only in the blood-building bone marrow where they mature. Their appearance in peripheral blood points to extramedullary erythropoiesis or disruption of the blood-bone marrow barrier. Aim of current study was to evaluate and compare the prognostic significance of NRBCs in the peripheral blood of intensive care patients (ICU) and non-intensive care patients (non-ICI) and to assess the morbidity and mortality risk associated with NRBCs among ICU and non-ICU patients. Methods: Relevant clinical details and investigations were collected from the Haematology nominal Register of the Department of Pathology, Saveetha Medical College. Blood samples were routinely drawn in the morning. The presence of NRBCs in the peripheral blood was detected with the help of an automated analyser (Sysmex XN 1000) and confirmed by a peripheral smear. Results: Among the NRBC-positive study population, mortality rate was 28% and was associated with ICU admission status, and death was predominantly due to cardiovascular causes. The highest NRBC value during the period of admission was significantly associated with deceased patients and ICU patients (p values of <0.001 and 0.002 respectively). The Pearson correlation of NRBC shows a significant positive correlation with serum creatinine and a negative correlation with platelets. Conclusions: The presence of NRBCs in the peripheral blood of critically ill adults is a significant prognostic marker of morbidity and mortality, laying down the emphasis on daily screening of peripheral smears for NRBCs.