Macrocytosis, a condition in which erythrocytes are larger than normal manifests as an increase in mean corpuscular volume (MCV) more than 100 fl. The aim of this study was to identify the underlying causes of macrocytosis, detected in routine hemograms and to evaluate the hematological features in different etiologies. This study included 178 adult patients whose detailed medical history was recorded, and Vitamin B12 assay, folate assay, thyroid function tests, liver function tests, complete blood counts and peripheral smear evaluation was performed. Alcoholism was identified as the etiological factor in 65 cases (36.5%), Vitamin B12 deficiency in 43 cases (24.1%) and drug related in 23 cases (12.9%). These three conditions accounted for 73.6% of macrocytosis. Other causes identified were folate deficiency, liver disease, Myelodysplastic syndrome, chronic renal failure and Aplastic anemia. In 41 cases, the cause of macrocytosis could not be explained. Anemia was observed in 95 cases (53.3%) being most common in Vitamin B12 deficiency. 9 cases (20.9%) of Vitamin B12 deficiency presented with isolated macrocytosis without anemia. It was observed that mean hemoglobin was lower and red cell distribution width (RDW) higher in megaloblastic conditions. Peripheral smear revealed hypersegmented neutrophils in 86% and macroovalocytes in 72% of the megaloblastic cases. Complete medical history, red cell parameters and peripheral blood smear are simple, inexpensive tools which assist in identifying the underlying cause of macrocytosis, particularly in resource limited settings. Macrocytosis needs to be evaluated even in the absence of anemia, as it may be the first clue to an underlying pathology.

Incisional endometriosis (IE) is a rare entity reported in 0.03–1.08% of women following obstetric or gynecologic surgeries. Most cases reported in literature have appeared after cesarean sections and were often clinically mistaken for hernia, abscess, suture granuloma or lipoma. We hereby report a case of IE following a second trimester hysterotomy, which was diagnosed by fine needle aspiration cytology (FNAC). Our patient was 26 years old, presenting with a mass over anterior abdominal wall, associated with incapacitating pain during each menstrual cycle. FNAC showed epithelial cells, stromal cells and hemosiderin laden macrophages. Based on the typical history, clinical and cytological features, the diagnosis of IE was established. Wide surgical excision was done and the resulting rectus sheath defect was repaired. Patient was followed for 6 months during which time she was symptom free. This article also reviews the spectrum of cytological features and the rare possibility of malignant transformation that can occur in IE.

Acquired hemolytic anemia is a group of disorders in which premature destruction of red cells is triggered by extrinsic factors. In this study, we have evaluated 38 cases of acquired hemolytic anemia. Immune hemolysis accounted for 52.6% (n=20) and fragmentation hemolysis 44.7% (n=17) of acquired hemolytic anemia. Autoimmune hemolytic anemia (AIHA) and microangiopathic hemolytic anemia (MHA) surfaced as the two most frequent causes accounting for 44.7% (n=17) and 39.5% (n=15) of acquired hemolysis. Erythrocyte morphology gives valuable clues concerning the cause of hemolysis. Spherocytes were observed in 94% (n=16) cases of immune hemolytic anemia. Schistocytes were observed in all cases of microangiopathic hemolytic anemia (MHA). In addition to schistocytes, microspherocytes were seen in 40% of MHA. Precise identification of spherocytes, schistocytes and microspherocytes is very important as it gives valuable information regarding the cause of acquired hemolysis.

Background: Thyroid lesion diagnosed as follicular neoplasm (FN) on fine-needle aspiration cytology is a challenge to both pathologist and surgeon. To recognize capsular and vascular invasion, histological evaluation is essential. Frozen section (FS) offers intraoperative histological diagnosis, identifies malignant lesions, and thereby guides the extent of surgery. Aims and Objectives: To assess the ability of FS to detect malignancy in cases of cytologically diagnosed as FNs. Materials and Methods: This study was conducted during 2014-2018 at ESIC Model Hospital, Rajajinagar, Bengaluru. Results: FS identified 10 cases of 18 cases reported malignant on FH. Sensitivity, specificity, positive predictive value, and negative predictive value were 56%, 100%, 100%, and 83%, respectively. Conclusion: FS is recommended for intraoperative diagnosis of FNs. It has high specificity and can, therefore, guide the extent of surgery in malignant cases.