Pediatric terminal deoxynucleotidyl tranferase (TdT)-negative precursor B- or T-lymphoblastic leukemia/lymphoma (B-LL and T-LL) cases are rare and their prognostic significance remains controversial. We aimed to determine the frequency of TdT-negative B- and T-LL in the community hospital setting. Between 2005 and 2015, 43 pediatric patients were diagnosed with lymphoblastic leukemia at our institution, of which 6 (14%) were characterized as TdT-negative by flow cytometric analysis. Four of these 6 patients had B-LL and the other 2 had T-LL. Two of the 6 TdT-negative patients also had undetectable CD34 expression by flow cytometry (TdT/CD34 double-negatives). Subsequent paraffin immunohistochemistry confirmed the negative CD34 expression in both cases. By contrast, all the 6 patients had weak TdT-like immunoreactivity in their marrow despite the negative flow cytometric analysis. Furthermore, neither TdT/CD34-negative cases showed myc rearrangement by fluorescent in situ hybridization, ruling out Burkitt leukemia as a differential diagnostic consideration. We conclude that TdT-negative pediatric B- and T-LL cases (especially those that are TdT/CD34 double-negative) may pose diagnostic challenge to hematopathologists, and ancillary studies (paraffin immunohistochemistry to detect TdT and fluorescent in situ hybridization to exclude myc rearrangement) may be instrumental in reaching the correct diagnosis.

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Objectives The significance of performing multistep level sections, including preparation of unstained sections in breast and gynecologic biopsy specimens, has been studied. Methods Consecutive H&E-stained level sections of 785 atypical and malignant biopsy specimens were included. The diagnostic material was categorized into present, absent, increased in size, or depleted. If the multistep level sections helped in establishing the diagnosis after a nondiagnostic material or the tissue significantly increased in size, this was considered a positive impact. Results No effect and positive impact of performing multistep level sections were obtained in 84.8% and 15.2% by preparing a second level and 97.2% and 2.8% by preparing a third level, respectively. Eighteen (2.3%) of the diagnoses could have been missed without performing a second level, while 8 (1%) could have been missed without performing a third level. The intervening unstained sections were used in 27 of 785 (3.4%) of the cases. Conclusions Staining two level sections with H&E significantly affected the diagnosis. However, preparing a third level did not improve the diagnosis. A universal protocol should be considered to standardize the handling of biopsy specimens among laboratories.

BACKGROUND: Human immunodeficiency virus (HIV) and Hepatitis Band C viruses (HBV and HCV) are the three most common chronic viral infections documented worldwide. [1,2] These viruses have similar routes of transmission, namely through blood and blood products, sharing of needles to inject drugs and sexual activity, enabling co-infection with these viruses a common event. [3-5] HBV and HCV co-infections in HIV positive individuals is of utmost importance due to the underlying consequences such as the hepatological problems associated with these viruses, which have been shown to decrease the life expectancy in the HIV-infected patients. [5] OBJECTIVES OF THE STUDY: To know the sero-positivity of Anti HCV and HbsAg in HIV positive patients. To compare it with the prevalence of Anti HCV and HbsAg positivity in normal persons. MATERIALS AND METHODS: This study was conducted on patients who were admitted to BTGH GULBARGA, meeting inclusion and exclusion criteria between 1-12-2012 to 31-5-2014, 110 patients infected with HIV were taken into the study. The patients belonged to both sexes and age range from 12 to 49 years. Detailed patient data including age, occupation, relevant history, examination finding were noted using prepared proforma and investigations like cbc, HIV, HbsAg, Anti HCV, LFT, were done and reports analyzed. 100 HIV negative persons with age and sex matched were taken as controls OBSERVATION: Out of 110 HIV positive patients 71 [64.54%] were males and 39 [35.46%] were males. In both sexes maximum number of cases was present in 40-49 years age group. Males 23.63% and females 11.81%. Out of 110 HIV positive patients 14(12.72%) were positive to HbsAg and 5(4.54%) were positive for Anti HCV. None of them were positive to both HbsAg and Anti HCV Among the HIV positive patients HbsAg was seen more in age group 30-39yr(6) followed by 40-49yr (4) years of age, showing co-infection is more common in sexually active age group. Males were more positive to HbsAg than females.57.14% for males and 42.85.% for females. Maximum number of cases of HbsAg positive were in age group 20-29 in males (21.4%) and 40 49yr age group for females (2.8%]. Maximum number of Anti HCV antibody positive patients were in age group 30-39 (3) followed by 40-49 (1) age group. This study shows the prevalence of HbsAg in HIV negative healthy individuals is 5% compared to 12 % for those in HIV positive patients. Anti HCV antibody was nil in controls compare to 4.54% in study group. This shows that HbsAg and Anti HCV antibodies are more common in patients having HIV infection.

Pediatric TdT-negative precursor B- or T-lymphoblastic leukemia/lymphoma (ALL) cases are rare and their prognostic significance remains controversial. We aimed to determine the frequency of TdT-negative ALL in the community hospital setting. Between 2005 and 2015, 43 pediatric patients were diagnosed with ALL at our Institution, of which six (14%) were characterized as TdT-negative by flow cytometric analysis. Four of these six patients had B-ALL and the other two had T-ALL. Two of the six TdT-negative patients also had undetectable CD34 expression by flow cytometry (TdT/CD34 double-negatives). Subsequent paraffin immunohistochemistry confirmed the negative CD34 expression in both cases. By contrast, all the six patients had TdT-like immunoreactivity in their marrow despite the negative flow cytometric analysis. Furthermore, neither TdT/CD34-negative cases showed myc rearrangement by FISH, ruling our Burkitt leukemia as a differential diagnostic consideration. We conclude that TdT-negative pediatric ALL cases (especially those that are TdT/CD34 double-negative) may pose diagnostic challenge to hematopathologists, and ancillary studies (paraffin immunohistochemistry to detect TdT and FISH to exclude myc rearrangement) may be instrumental in reaching the correct diagnosis.