Kiran Alam

ABSTRACT Primary signet-ring cell carcinoma (SRCC) of vermiform appendix is extremely rare. A 62-year-old man presented to the Surgical Clinics with right lower abdominal pain, where he was diagnosed with acute appendicitis based on the history and examination with hematologic investigations and computed tomography. Appendectomy specimen grossly showed acute inflammation with appendiceal adhesions and body of the appendix showed wall thickening and luminal occlusion. Microscopically nests of carcinoma cells were seen with compressed nuclei and intracytoplasmic mucin invading into the muscular layer. No lymphovascular permeation was seen. The cut margins were negative for carcinoma cells. Immunohistochemically, SRCC cells were positive for cytokeratin (CK) AE1/3, EMA, CEA, MUC2, and high Ki-67 labeling index. They were negative for CK5/6, CK7, Vimentin, MUC1 and chromogranin. Our patient is fine after 6 months of follow up, with no evidence of recurrence or metastasis.

Pancytopenia is a relatively common hematological disorder manifesting as anemia, leucopenia and thrombocytopenia. Causes of pancytopenia are varied and range from simple drug-induced bone marrow hypoplasia, megaloblastic anemia to fatal bone marrow aplasias and leukemias. Examination of the bone marrow is required in cases for pancytopenia to find out the underlying pathology and hence better patient management. This study was carried out to evaluate hematological and bone marrow findings in patients presenting with pancytopenia. 50 patients in the age group of 6 months- 60 years were included in this prospective study. Detailed history, clinical examination, hematological investigations and bone marrow examination were performed in all the cases. Pancytopenia was more common in second decade of life with slight male preponderance. Fever was the commonest presenting complaint and pallor was the commonest sign. Megaloblastic anemia was the most common cause (58%) of pancytopenia, hypersegmented neutrophils and macro-ovalocyte are very reliable indicators of megaloblastic anemia. Bone- marrow aspiration was diagnostic in majority (80%) of cases, and biopsy is not routinely indicated. Reticulocyte production index is a better indicator of bone-marrow status as compared to reticulocyte count. Nutritional deficiency is the most important cause of megaloblastic anemia, and was the underlying etiology in 58% cases of life-threatening pancytopenia. Findings of automated hematology counter must be correlated with manual peripheral blood smear examination in cases of pancytopenia. Bone- marrow aspiration is highly recommended and reticulocyte production index instead of reticulocyte count must be used to evaluate the actual hematopoietic potential of the bone- marrow.