Annals of Pathology and Laboratory Medicine
type: channel
description: Annals of Pathology and Laboratory Medicine (APALM) is a double-blind, peer-reviewed, open-access journal for pathologists, microbiologists, biochemists, and clinical laboratory scientists, published by Pacific Group of e-Journals (PaGe), India. Founded in 2014. pISSN: 2394-6466 | eISSN: 2349-6983 DOI prefix: 10.21276/APALM Indexed in: Embase (Elsevier)
publisher: Pacific Group of e-Journals (PaGe)
language: en
publication name: Annals of Pathology and Laboratory Medicine
issn: 2394-6466
copyright: Authors who publish with this journal agree to the following terms: Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal. Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal. Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access at http://opcit.eprints.org/oacitation-biblio.html).
items: Diagnostic Traps in Papillary Thyroid Carcinoma: Correlation of The Bethesda System for Reporting Thyroid Cytopathology with Histopathology: A Case Series
items: Cyclin D1 Overexpression in Breast Carcinoma and Its Correlation with Standard Clinicopathological Parameters
items: Clear Cell Sarcoma of the Pelvis in a Male Child, Diagnosed Using Ancillary Techniques - A Rare Case Report
items: Bacteriological Profile of Bloodstream Infections Among Adults in a Tertiary Care Hospital From Central India: An Analytical Cross-Sectional Study
items: Non-syndromic unilateral sex cord tumor with annular tubules in an adolescent female: A Rare Diagnosis
items: Spectrum of Pleural Fluid Cytology in a Tertiary Care Hospital: A Prospective Observational Study
items: Monomorphic Epitheliotropic Intestinal T-Cell Lymphoma Mimicking Benign Lymphocytic Infiltrates: A Pathologic Masquerade
items: Prevalence and Spectrum of Hemoglobinopathies Among Antenatal Women in Gujarat: An HPLC-Based Screening Study at a Tertiary Care Center
items: Embryonal Rhabdomyosarcoma of the Urinary Bladder: A Case Report
items: The Association of Red Blood Cell Indices with Glycosylated Hemoglobin and Microalbuminuria in Patients with Type 2 Diabetes Mellitus in a Tertiary Care Hospital – A Prospective Cross-sectional Study
items: Clinical Relevance of Anti-S and Anti-M Antibodies in Crossmatch Incompatibility: A Case Series
items: Antimicrobial Resistance Dynamics of Pseudomonas Aeruginosa in a Tertiary Care Hospital in Delhi
items: A Case Series of Rhinosporidiosis at Unfamiliar Sites: An Experience from a Tertiary Care Centre of Eastern India
items: Histopathological diagnosis of lymph node biopsies and subtyping of lymphomas based on immunohistochemistry at a tertiary care centre in South Kerala
items: Proximal-Type Epithelioid Sarcoma with Unusual Morphology: A Diagnostic Challenge with Detailed Immunohistochemical Workup
items: Malakoplakia in a Transplant Kidney: A Rare Case Report
items: Left Atrial Myxoma: An Enigma in Itself – Two Case Reports
items: Pulmonary Amyloidosis: Diverse Clinical and Histopathological Manifestations - A Series of Five Cases
items: Beyond the Matrix: A Rare Case of Pilomatrix Carcinoma with Histologic Insights
items: Sarcomatoid carcinoma of prostate: A rare variant

Diagnostic Traps in Papillary Thyroid Carcinoma: Correlation of The Bethesda System for Reporting Thyroid Cytopathology with Histopathology: A Case Series
type: item
description: Fine-needle aspiration cytology is a widely used first-line tool for evaluating thyroid lesions, with histopathology serving as the diagnostic gold standard. Despite its advantages, interpretation challenges arise due to overlapping cytomorphologic features, suboptimal sample adequacy, and inter-observer variability, occasionally leading to discordance and affecting patient management. This case series describes four diagnostically challenging cases of classical papillary thyroid carcinoma in which initial cytological interpretations differed from final histopathological findings. Each case was re-evaluated systematically with emphasis on adequacy of the aspirate, radiologic correlation, characteristic cytological features, and potential diagnostic pitfalls. Contributing factors such as papillary hyperplasia mimics, misleading ultrasound impressions, and low cellularity were analyzed to understand the basis of discordance. Final diagnoses were established through multidisciplinary collaboration among the surgeon, radiologist, and cytopathologist. Case 1 was initially reported as a benign colloid nodule (TBSRTC II) but was later confirmed as classical papillary carcinoma with nodal metastasis. Case 2 was categorized as AUS (TBSRTC III); histopathology revealed classical papillary carcinoma, infiltrating follicular subtype. Case 3 was diagnosed as follicular neoplasm (TBSRTC IV) on cytology, while final evaluation confirmed NIFTP. Case 4, also categorized as follicular neoplasm (TBSRTC IV), was ultimately diagnosed as encapsulated angioinvasive follicular variant of papillary thyroid carcinoma. TBSRTC remains a robust and standardized framework for thyroid cytology, providing consistent terminology and risk stratification. However, diagnostic limitations persist, emphasizing the need for meticulous cytologic assessment, close radiologic correlation, and interdisciplinary collaboration to minimize discordance and improve patient outcomes.
subject: Case Report / Case Series
  topic: section
subject: bethesda
  topic: keywords
subject: cytology
  topic: keywords
subject: thyroid
  topic: keywords
subject: papillary carcinoma
  topic: keywords
subject: follicular variant
  topic: keywords
subject: niftp
  topic: keywords
creator: Bindhuja Joseph
creator: Arya Prakash
creator: Kitty J Kuruvilla
rights: Copyright (c) 2026 Bindhuja Joseph, Arya Prakash, Kitty J Kuruvilla https://creativecommons.org/licenses/by/4.0
date: 2026-01-05
publication date: 2026-01-05
starting page: C1
ending page: C7
doi: 10.21276/apalm.3668

Cyclin D1 Overexpression in Breast Carcinoma and Its Correlation with Standard Clinicopathological Parameters
type: item
description: Background: Breast cancer remains the most frequently diagnosed malignancy among women worldwide, with a significant disease burden in India where incidence is rising at younger ages. Conventional prognostic and predictive markers, including ER, PR, and HER2, play a central role in guiding management, yet outcomes remain variable. Cyclin D1, a cell cycle regulatory protein encoded by CCND1, is increasingly recognized as a potential biomarker in breast cancer due to its role in cell cycle control and interaction with hormone receptor pathways. Evaluating Cyclin D1 expression and its association with established prognostic markers may provide valuable insights into disease behavior and therapeutic response. Materials and Methods: This study was carried out on 40 histologically confirmed cases of breast carcinoma. Expression of Cyclin D1, ER, PR, and HER2/neu was assessed using standard IHC protocols and scored according to ASCO/CAP guidelines. Statistical analysis was performed, with p < 0.05 considered significant. Results: Cyclin D1 expression was detected in 23 (57.5%) out of 40 cases. Cyclin D1 expression showed a significant positive correlation with ER (p < 0.001) and PR (p < 0.001) status, but not with HER2/neu. Significant association was also observed between Cyclin D1 and molecular subtypes (p < 0.001), with positivity in all Luminal A and Luminal B cases, and negative correlation with TNBC. Conclusion: Cyclin D1 expression was significantly associated with ER, PR, and Luminal A/B subtypes, but not with HER2, age, or nodal status, and showed negative correlation with TNBC. These findings suggest Cyclin D1 as a potential biomarker in hormone receptor–positive breast cancers, meriting validation in larger studies.
subject: Original Article
  topic: section
subject: breast cancer
  topic: keywords
subject: cyclin d1
  topic: keywords
subject: estrogen receptor
  topic: keywords
subject: immunohistochemistry
  topic: keywords
subject: progesterone receptor
  topic: keywords
creator: Jasmine
creator: Ajay Kumar Kochhar
creator: Aditi Baghla
creator: Karandeep Singh
rights: Copyright (c) 2026 Jasmine, Ajay Kumar Kochhar, Aditi Baghla, Karandeep Singh https://creativecommons.org/licenses/by/4.0
date: 2026-01-05
publication date: 2026-01-05
starting page: A1
ending page: A7
doi: 10.21276/apalm.3710

Clear Cell Sarcoma of the Pelvis in a Male Child, Diagnosed Using Ancillary Techniques - A Rare Case Report
type: item
description: Clear cell sarcoma is a rare malignant neoplasm of uncertain differentiation that typically arises in the deep soft tissues, most frequently involving the tendons and aponeuroses of the extremities in young adults, particularly females. Diagnostic challenges often arise due to its striking histological and immunohistochemical resemblance to metastatic malignant melanoma. We report an exceptionally rare case of clear cell sarcoma occurring in a nine-year-old male child, located in the pelvis with direct extension into the right pelvic bone. Non-Contrast Computed Tomography (NCCT) and Magnetic Resonance Imaging (MRI) demonstrated tumour extension into the presacral space with intraspinal involvement, resulting in widening of the spinal canal and neural foramina. Trucut biopsy revealed nests of epithelioid to spindle-shaped cells with clear to eosinophilic cytoplasm and prominent nucleoli. Bone marrow aspiration from the right iliac region yielded tumour cells, confirming marrow infiltration. The diagnosis was established through a multimodal approach integrating radiological assessment, bone marrow aspiration cytology, and trucut core biopsy findings. Ancillary studies, including flow cytometry, immunohistochemistry, and special stains, further supported the diagnosis in this challenging presentation. A review of the relevant literature is provided, highlighting distinguishing features from morphologically similar lesions to enhance recognition of this aggressive, metastasis-prone malignancy.
subject: Case Report / Case Series
  topic: section
subject: clear cell sarcoma
  topic: keywords
subject: pelvis
  topic: keywords
subject: male
  topic: keywords
subject: child
  topic: keywords
creator: Pushpit Gupta
creator: Bembem Khuraijam
creator: Varuna Mallya
creator: Shaad Vali
creator: Sujoy Neogi
rights: Copyright (c) 2026 Pushpit Gupta, Bembem Khuraijam, Varuna Mallya, Shaad Vali, Sujoy Neogi https://creativecommons.org/licenses/by/4.0
date: 2026-01-05
publication date: 2026-01-05
starting page: C8
ending page: C13
doi: 10.21276/apalm.3675

Bacteriological Profile of Bloodstream Infections Among Adults in a Tertiary Care Hospital From Central India: An Analytical Cross-Sectional Study
type: item
description: Background: Bloodstream infections (BSIs) represent a significant cause of morbidity and mortality in hospital settings. The increasing emergence of antimicrobial resistance among the causative pathogens has further complicated patient management and is a pressing public health concern. This study aimed to identify the etiological agents responsible for BSIs and to provide their antibiotic susceptibility patterns. Methods: An analytical cross-sectional study was conducted from 1 June 2021 to 30 May 2023 in a tertiary care hospital. Blood samples were collected from adult patients with a clinical diagnosis of septicemia. Isolation and identification of organisms were performed according to standard microbiological guidelines. Antimicrobial susceptibility testing was carried out using the Kirby-Bauer disc diffusion method in accordance with Clinical and Laboratory Standards Institute (CLSI) guidelines. Results: Out of 430 clinically suspected adult bacteraemia cases, blood cultures were positive in 196 cases (45.58%). Gram-negative bacteria were the most common causative agents, accounting for 71.42% of isolates, among which Klebsiella pneumoniae (21.93%) was predominant, followed by Escherichia coli (13.26%), Acinetobacter baumannii (9.69%). Extended-spectrum beta-lactamase (ESBL) production was observed in 38.55% of Gram-negative isolates, with the highest rates among Klebsiella pneumoniae (54.76%). Gram-positive cocci comprised 26.02%, while Candida albicans was detected in 2.55% of cases. Methicillin resistance was detected in 33.33% of Staphylococcus aureus isolates. Conclusions: BSIs remain a major concern in tertiary care hospitals, with Gram-negative organisms being the predominant pathogens. Prompt diagnosis and timely reporting of antibiotic susceptibility results are crucial for guiding early and appropriate therapy.
subject: Original Article
  topic: section
subject: bloodstream infections
  topic: keywords
subject: bacteriological profile
  topic: keywords
subject: antibiotic susceptibility pattern
  topic: keywords
subject: adults
  topic: keywords
subject: tertiary care
  topic: keywords
creator: Prerna Robinson
creator: M. S. Qazi
creator: Bhawana Bajare
rights: Copyright (c) 2026 Prerna Robinson, M. S. Qazi, Bhawana Bajare https://creativecommons.org/licenses/by/4.0
date: 2026-01-05
publication date: 2026-01-05
starting page: A8
ending page: A14
doi: 10.21276/apalm.3740

Non-syndromic unilateral sex cord tumor with annular tubules in an adolescent female: A Rare Diagnosis
type: item
description: Sex cord tumor with annular tubules (SCTAT) is a rare tumor of ovarian origin which is usually benign in origin but can show extraovarian spread in some cases. Here we present a case of 14-year-old female with abdominal pain which on radiology show unilateral ovarian cyst. Based on histopathological findings, diagnosis of SCTAT was confirmed. Non syndromic unilateral SCTAT usually presents in older women but can also be seen in younger age group and it should always be considered a differential diagnosis in ovarian tumors.
subject: Case Report / Case Series
  topic: section
subject: sex cord tumor
  topic: keywords
subject: annular
  topic: keywords
subject: tubules
  topic: keywords
subject: peutz-jeghers
  topic: keywords
creator: Vaishali Rohilla
creator: Shalini Gupta
creator: Manju Raghava
creator: Vishal
rights: Copyright (c) 2026 Vaishali Rohilla, Shalini Gupta, Manju Raghava, Vishal https://creativecommons.org/licenses/by/4.0
date: 2026-01-05
publication date: 2026-01-05
starting page: C14
ending page: C18
doi: 10.21276/apalm.3680

Spectrum of Pleural Fluid Cytology in a Tertiary Care Hospital: A Prospective Observational Study
type: item
description: Background: Pleural effusion (PE) is a frequent clinical finding with a wide spectrum of underlying etiologies, including infections, malignancies, and systemic disorders. Cytological examination of pleural fluid remains a valuable first-line diagnostic tool, offering rapid, minimally invasive, and cost-effective results. The adoption of standardized reporting frameworks such as The International System for Reporting Serous Fluid Cytopathology (ISRSFC/TIS) enhances diagnostic clarity and consistency. Methods: This was a prospective observational study conducted at a tertiary care hospital. A total of 155 pleural fluid samples were evaluated using cytological analysis and classified according to the TIS system. Patient demographics, sample adequacy, fluid appearance, predominant cellular patterns, and final cytological diagnoses were recorded and interpreted. Results: Out of 155 samples, mean age of patients was 49.93 years, with male predominance (62.6%). Straw-colored fluid was the most common macroscopic presentation (41.9%). Cytological, chronic inflammation with lymphocyte dominance was observed in 68.4% of cases. Malignant cells were identified in three cases (1.9%). Using the TIS classification, 92.9% of samples were categorized as Category II: Negative for Malignancy (NFM), facilitating standardized reporting system. Conclusion: Cytological examination of pleural fluid remains a valuable initial diagnostic tool for evaluating serous effusions. Incorporating the TIS system enhances diagnostic accuracy and consistency, thereby supporting timely clinical decision-making and improved patient outcomes.
subject: Original Article
  topic: section
subject: the international system for reporting serous fluid cytopathology
  topic: keywords
subject: pleural effusion cytology
  topic: keywords
subject: pleural fluid
  topic: keywords
subject: risk of malignancy
  topic: keywords
creator: Sakshi Sharma
creator: Vishesh Dhawan
creator: Ayushi Kediya
creator: Anshul Kedia
rights: Copyright (c) 2026 Sakshi Sharma, Vishesh Dhawan, Ayushi Kediya, Anshul Kedia https://creativecommons.org/licenses/by/4.0
date: 2026-01-05
publication date: 2026-01-05
starting page: A15
ending page: A21
doi: 10.21276/apalm.3699

Monomorphic Epitheliotropic Intestinal T-Cell Lymphoma Mimicking Benign Lymphocytic Infiltrates: A Pathologic Masquerade
type: item
description: Monomorphic Epitheliotropic Intestinal T-cell Lymphoma (MEITL) is a rare aggressive T-cell lymphoma mostly found in Asia. It accounts for less than 5% of primary gastrointestinal malignant lymphomas, is rapidly progressing, and has a poor prognosis with a median survival of 7 months. The relatively small size of atypical cells coupled with brisk cryptitis can result in a misdiagnosis of lymphocytic proctocolitis. A strong index of suspicion is required to employ an appropriate IHC panel for this diagnosis. In this case report, we want to describe a 50-year-old patient who presented with chronic lower gastrointestinal symptoms and was diagnosed with MEITL involving the large intestine and ileum.
subject: Case Report / Case Series
  topic: section
subject: monomorphic epitheliotropic intestinal t-cell lymphoma
  topic: keywords
subject: immunohistochemistry
  topic: keywords
subject: lymphoma
  topic: keywords
creator: Kuljeet Kaur
creator: Maitrayee Roy
creator: Vishesh Dhawan
creator: Ayushi Kediya
rights: Copyright (c) 2026 Kuljeet Kaur, Maitrayee Roy, Vishesh Dhawan, Ayushi Kediya https://creativecommons.org/licenses/by/4.0
date: 2026-01-05
publication date: 2026-01-05
starting page: C19
ending page: C23
doi: 10.21276/apalm.3712

Prevalence and Spectrum of Hemoglobinopathies Among Antenatal Women in Gujarat: An HPLC-Based Screening Study at a Tertiary Care Center
type: item
description: Background: Hemoglobinopathies pose a significant public health challenge in India. Antenatal screening is vital for early detection and informed reproductive choices. While traditional complete blood count (CBC) methods lack specificity, High-Performance Liquid Chromatography (HPLC) offers a precise diagnostic tool. This study evaluated HPLC's effectiveness in antenatal females at a tertiary care center in Gujarat. Methods: This retrospective, observational study analyzed data from 484 pregnant women who underwent HPLC screening during their antenatal period at a tertiary civil hospital in Ahmedabad, Gujarat. Inclusion criteria ensured complete demographic, hematological (CBC), and interpretable HPLC results. Data were analyzed using descriptive statistics. Ethical approval with a waiver of informed consent was obtained. Result: Of 484 antenatal women screened, 86 (17.8%) were diagnosed with a hemoglobinopathy. Beta-thalassemia minor was most common (n=62, 72% of positive cases), followed by sickle cell trait (n=14, 16%). Less common findings included HbD Punjab (n=5, 6%), HbE trait (n=2, 3%), and single cases of HbE homozygous, SCD+BT, and delta-beta thalassemia (1% each). Hematological analysis showed elevated HbA2 and microcytosis in beta-thalassemia minor, distinct variant percentages (e.g., HbS 27.82% in sickle cell trait), and varying red cell indices. Conclusion: This study revealed a high prevalence of hemoglobinopathies (17.8%) among antenatal women in Ahmedabad, Gujarat, predominantly beta-thalassemia minor and sickle cell trait. HPLC proved crucial for accurate diagnosis of these diverse variants. The significant carrier burden underscores the urgent need for comprehensive antenatal screening, genetic counseling, and prenatal diagnostic options to reduce severe hemoglobinopathy incidence in India.
subject: Original Article
  topic: section
subject: hplc
  topic: keywords
subject: beta-thalassemia minor
  topic: keywords
subject: sickle cell trait
  topic: keywords
subject: hbd punjab
  topic: keywords
subject: hbe trait
  topic: keywords
creator: Nirali Rakeshbhai Panchal
creator: Meena Avinash Patel
creator: Bhargav Babulal Darji
rights: Copyright (c) 2026 Nirali Rakeshbhai Panchal, Meena Avinash Patel, Bhargav Babulal Darji https://creativecommons.org/licenses/by/4.0
date: 2026-01-05
publication date: 2026-01-05
starting page: A22
ending page: A26
doi: 10.21276/apalm.3658

Embryonal Rhabdomyosarcoma of the Urinary Bladder: A Case Report
type: item
description: Embryonal rhabdomyosarcoma accounts for 4.5% of the childhood cancers. Rhabdomyosarcoma is the most common malignant soft tissue sarcoma in children and has the following subtypes: embryonal, alveolar, pleomorphic and spindle cell/sclerosing. About 17% of rhabdomyosarcomas occur in genito-urinary tract. A 2-year-old male child presented with complaints of excessive crying while passing urine and dribbling of urine for 1 day. Patient underwent cystoscopic biopsy and histopathological examination was done after taking written consent by the parents following which showed a cyst arising from bladder neck extending into right lateral wall of prostate. Partial excision of the cystic lesion was done. Gross examination of the biopsy revealed multiple grey-white to grey-brown soft tissue bits largest measuring 2cms in length and smallest measuring 0.2cm in length. Microscopy revealed a malignant neoplasm composed of poorly differentiated tumor cells arranged in sheets. Individual cells are primitive ovoid to spindle shaped with moderate pleomorphism and hyperchromatic nuclei with minimal cytoplasm admixed with myxoid areas. Few scattered Rhabdomyoblast like elongated cells with cytoplasmic eosinophilia and sparse atypical mitosis noted. Cambium layer was seen. Margin status were not assessed as the specimen was received in piece meal. Differential diagnosis of small round blue cell tumor was considered. Immunohistochemistry showed positivity for smooth muscle Actin, Desmin, Myogenin and MyoD1 suggesting Embryonal Rhabdomyosarcoma. Embryonal Rhabdomyosarcoma is the most common subtype of pediatric rhabdomyosarcoma. Age, Stage at diagnosis and treatment received are the predictors of the survival of Embryonal RMS.
subject: Case Report / Case Series
  topic: section
subject: rhabdomyoblast
  topic: keywords
subject: embryonal
  topic: keywords
subject: genito-urinary tract.
  topic: keywords
creator: Mythreyi M U
creator: Priyadarshini Devendrappa
creator: Jyothi A Raj
creator: Shashikala K
creator: Dedena Khumbongmayum
rights: Copyright (c) 2026 Mythreyi M U, Priyadarshini Devendrappa, Jyothi A Raj, Shashikala K, Dedena Khumbongmayum https://creativecommons.org/licenses/by/4.0
date: 2026-01-05
publication date: 2026-01-05
starting page: A24
ending page: A27
doi: 10.21276/apalm.3721

The Association of Red Blood Cell Indices with Glycosylated Hemoglobin and Microalbuminuria in Patients with Type 2 Diabetes Mellitus in a Tertiary Care Hospital – A Prospective Cross-sectional Study
type: item
description: Background: Type 2 Diabetes Mellitus (T2DM) is a major global health concern, often presenting asymptomatically and diagnosed only after complications arise. Poor glycemic control is linked to increased morbidity, including diabetic nephropathy. This study investigates the association between red blood cell (RBC) indices, glycosylated hemoglobin (HbA1c), and urinary albumin-to-creatinine ratio (UACR) to explore their potential in predicting early diabetic complications. Methods: A prospective cross-sectional study was conducted in a tertiary care hospital after institutional ethical clearance. Relevant clinical and laboratory data—including hemoglobin, MCV, MCH, MCHC, RDW, HbA1c, and UACR—were collected from patients with T2DM. Statistical analysis was performed using SPSS and EZR software. Normality was assessed using the Kolmogorov-Smirnov and Shapiro-Wilk tests. Associations were analyzed using Spearman’s correlation and the Mann–Whitney U test, with p < 0.05 considered statistically significant. Results: A weak, though statistically non-significant, positive correlation was observed between RDW and HbA1c (p = 0.50). No significant association was found between HbA1c and other RBC indices. A statistically significant positive correlation was observed between HbA1c and UACR, suggesting that poor glycemic control is associated with early renal impairment. Conclusion: RDW may serve as a useful indicator for early hematologic alterations in T2DM, while elevated UACR reflects early nephropathy associated with poor glycemic control. These markers could aid in the timely detection and prevention of diabetic complications.
subject: Original Article
  topic: section
subject: type 2 diabetes mellitus
  topic: keywords
subject: erythrocyte indices
  topic: keywords
subject: glycated hemoglobin a
  topic: keywords
subject: microalbuminuria
  topic: keywords
creator: Sandra Peter
creator: Varughese Padinjattadathu George
creator: Varsha Jose
rights: Copyright (c) 2026 Sandra Peter, Varughese Padinjattadathu George, Varsha Jose https://creativecommons.org/licenses/by/4.0
date: 2026-01-05
publication date: 2026-01-05
starting page: A27
ending page: A32
doi: 10.21276/apalm.3674

Clinical Relevance of Anti-S and Anti-M Antibodies in Crossmatch Incompatibility: A Case Series
type: item
description: Background: Alloimmunization is a challenge in transfusion medicine, especially among patients with prior transfusions or pregnancies. Crossmatch incompatibility from unexpected red cell antibodies can delay transfusions, impact outcomes, and cause hemolysis.Aim: To highlight the clinical significance of anti-S and anti-M antibodies of the MNS system in crossmatch incompatibility, by summarizing six cases managed in our department.Methods: We present a retrospective case series of six patients exhibiting serologic incompatibility during pre-transfusion testing between May 2024 and May 2025 at a tertiary care center. Antibody screening and identification were conducted using column agglutination technology (CAT, Ortho vision) with 3-cell and 11-cell commercial panels. Quality control was ensured according to manufacturer protocols. Compatible and incompatible units were recorded using standardized grading and QC systems.Results: Among 55,542 crossmatched patients, six (all females; mean age 36 years; range 11–53) showed crossmatch incompatibility owing to Anti-S (4/6) or Anti-M (2/6) antibodies. Most had prior transfusion or pregnancy history. Anti-M was reactive at 37°C/AHG phase in both cases. Compatible units were identified and transfused as indicated; overall, 51 units were crossmatched (29 incompatible, 22 compatible, see Table 1). Four patients were transfused uneventfully with compatible antigen-negative units.Conclusion: Early identification of clinically significant red cell antibodies and provision of antigen-negative blood are crucial for safe transfusion. Anti-S and Anti-M antibodies, although uncommon, should be considered during incompatibility evaluation, particularly in settings with high transfusion exposure or pregnancy rates.
subject: Case Report / Case Series
  topic: section
subject: alloimmunization
  topic: keywords
subject: transfusion medicine
  topic: keywords
subject: crossmatch incompatibility
  topic: keywords
subject: red cell antibodies
  topic: keywords
subject: anti-s
  topic: keywords
subject: anti-m
  topic: keywords
subject: mns blood group system
  topic: keywords
creator: Dipshikhaa Ravi
creator: Ashwin Anadan
creator: R. Krishnamoorthy
creator: Niranj Rathan
creator: Sampat Kumar
rights: Copyright (c) 2026 Dipshikhaa Ravi, Ashwin Anadan, R. Krishnamoorthy, Niranj Rathan, Sampat Kumar https://creativecommons.org/licenses/by/4.0
date: 2026-01-05
publication date: 2026-01-05
starting page: C28
ending page: C33
doi: 10.21276/apalm.3725

Antimicrobial Resistance Dynamics of Pseudomonas Aeruginosa in a Tertiary Care Hospital in Delhi
type: item
description: Background: Pseudomonas aeruginosa, non-fermenting gram-negative bacilli are a major cause of healthcare-associated infections. The rise in multidrug-resistant (MDR) strains globally has been associated with increased morbidity and mortality. In India, antimicrobial resistance (AMR) presents a significant challenge, necessitating effective policies and infection control measures. This study explores the resistance dynamics of P. aeruginosa in a tertiary care hospital, evaluating the findings in relation to the data from the Indian Council of Medical Research (ICMR). Methods: A total of 1,536 P. aeruginosa isolates from 31997 clinical samples of pus, wound, and burn swabs, respiratory specimens and body fluids submitted for routine culture were analyzed. Antimicrobial susceptibility testing was performed using the Kirby-Bauer disk diffusion method. Blood, urine, cerebrospinal fluid (CSF), and stool were excluded. Results: P. aeruginosa accounted for 5th most frequent pathogen with prevalence declining from 15.7% (136/869) in 2020 to 7.7% (249/3236) in 2024. Among the isolates, 34.2% (525/1536) were susceptible to all tested antimicrobials, while 13.2% (203/1536) were MDR and 10.6% (163/1536) were extensively drug-resistant (XDR). Improved susceptibility was observed for piperacillin-tazobactam, carbapenems, aztreonam, and aminoglycosides, whereas, fluoroquinolones and monobactams showed persistently low susceptibility. Conclusion: Continuous monitoring of MDR pathogens like P. aeruginosa and their resistance dynamics are crucial for guiding treatment strategies and infection control measures.
subject: Original Article
  topic: section
subject: pseudomonas aeruginosa
  topic: keywords
subject: antimicrobial resistance
  topic: keywords
subject: hospital-acquired infections
  topic: keywords
subject: icmr
  topic: keywords
creator: Seema Gangar
creator: Nisha Goyal
creator: Nimisha Jain
creator: Hage Yaja
creator: Neha Sharma
creator: Shukla Das
rights: Copyright (c) 2026 Seema Gangar, Nisha Goyal, Nimisha Jain, Hage Yaja, Neha Sharma, Shukla Das https://creativecommons.org/licenses/by/4.0
date: 2026-01-05
publication date: 2026-01-05
starting page: A33
ending page: A40
doi: 10.21276/apalm.3700

A Case Series of Rhinosporidiosis at Unfamiliar Sites: An Experience from a Tertiary Care Centre of Eastern India
type: item
description: Classical anatomic sites are implicated in most diseases. They help the clinician to make a substantial diagnosis. However there exists indistinct chances of occurrence of diseases at sites that are unusual and unexpected. The same is true for the disease Rhinosporidiosis as well. We have attempted to illustrate cases of Rhinosporidiosis with presentations at infrequent sites in this compilation of cases. Tissue diagnosis has ultimately culminated in formulating the conclusive diagnosis here.
subject: Case Report / Case Series
  topic: section
subject: urethra
  topic: keywords
subject: conjunctiva
  topic: keywords
subject: cutaneous
  topic: keywords
subject: histopathological examination
  topic: keywords
creator: Chhanda Das
creator: Soumyadip Das
creator: Anannya Ghatak
creator: Asmita Das
creator: Ayan Saha
rights: Copyright (c) 2026 Chhanda Das, Soumyadip Das, Anannya Ghatak, Asmita Das, Ayan Saha https://creativecommons.org/licenses/by/4.0
date: 2026-01-05
publication date: 2026-01-05
starting page: C34
ending page: C38
doi: 10.21276/apalm.3737

Histopathological diagnosis of lymph node biopsies and subtyping of lymphomas based on immunohistochemistry at a tertiary care centre in South Kerala
type: item
description: Background: Lymph node enlargement is a clinical sign with uncertain definitive diagnosis since the causes are many. In view of the wide spectrum of the possible differential diagnoses, it is imperative for the clinicians and pathologist to have a knowledge of the common causes of lymphadenopathy in their locality. Aim: To study the spectrum of histopathological diagnosis of lymph node biopsies received at a tertiary care centre in South Kerala and to find out the proportion of neoplastic and non-neoplastic lesions and to subtype lymphoma based on immunohistochemistry. Method: This work involved all the lymph node biopsies received in the department during the study period (138 cases) and their histological analysis. In all cases of lymphoproliferative disorders, immunohistochemistry was done. Results and Discussion: The male to female ratio was 1.1:1 with a slight male preponderance. The most common site biopsied was the cervical lymph node. Non-neoplastic lesions were more common and comprised 71% of all biopsies. Overall, the most common lesion was reactive lymphadenopathy. Tuberculous lymphadenitis was the next common lesion with highest incidence in individuals aged 30-39 years showing a female preponderance. Among neoplastic lesions, metastasis to lymph node showed a slight predominance over lymphoproliferative disorders. Metastasis from adenocarcinoma was the most common. All metastatic lesions were in the age group more than 30 years with a male preponderance. Non-Hodgkin’s lymphoma was more common than Hodgkin’s Lymphoma. Follicular lymphoma was the commonest among NHL. Among the 17 cases of NHL, 15 of the cases could be subtyped with the available basic IHC panel, rest 2 cases could not be precisely subtyped. All 3 cases of Hodgkin’s Lymphoma were males with Classic Hodgkin’s Disease- Mixed Cellularity type. Conclusion: In the present study of 138 lymph node biopsies, non-neoplastic lesions were more frequent than neoplastic lesions, with reactive lymphade…
subject: Original Article
  topic: section
subject: lymph node
  topic: keywords
subject: reactive change
  topic: keywords
subject: tuberculosis
  topic: keywords
subject: hodgkin’s lymphoma
  topic: keywords
subject: non hodgkin’s lymphoma
  topic: keywords
subject: metastasis
  topic: keywords
creator: Anu Jose Markose
creator: Siji Mathew
creator: Suma S
creator: Rema Priyadarshini
rights: Copyright (c) 2026 Anu Jose Markose, Siji Mathew, Suma S, Rema Priyadarshini https://creativecommons.org/licenses/by/4.0
date: 2026-01-05
publication date: 2026-01-05
starting page: A41
ending page: A48
doi: 10.21276/apalm.3693

Proximal-Type Epithelioid Sarcoma with Unusual Morphology: A Diagnostic Challenge with Detailed Immunohistochemical Workup
type: item
description: Background:An uncommon and aggressive soft tissue sarcoma, Epithelioid sarcoma (ES) has a significant risk of recurrence and metastasis. The proximal variant overlaps with other epithelioid malignancies, it can be diagnostically challenging particularly in young patients. Case Presentation:We report a single-patient case of a 14-year-old male with a painful deep-seated calf mass. Trucut biopsy showed deceptively bland epithelioid–rhabdoid cells with lymphocytic admixture. After Immunohistochemistry (IHC), lesion was reported as a polygonal cell neoplasm on biopsy. Wide local excision was performed, morphology showed myxoid matrix making it more difficult to diagnose and extended IHC demonstrated PanCK and EMA positivity with complete loss of INI1, while S100, GFAP, CD34, Desmin, SALL4, and CD138 were negative, confirming proximal-type epithelioid sarcoma. Conclusion:This case emphasizes that proximal-type epithelioid sarcoma may present with deceptively bland histology and unusual myxoid stromal changes. Definitive diagnosis requires extended immunohistochemical panel, particularly assessment of INI1 loss.
subject: Case Report / Case Series
  topic: section
subject: epithelioid sarcoma
  topic: keywords
subject: proximal type
  topic: keywords
subject: ini1 loss
  topic: keywords
subject: unusual morphology
  topic: keywords
creator: Suguna Badiginchala
creator: Aruna kumari Prayaga
creator: Rukmangadha Nandyala
creator: Manilal.B
rights: Copyright (c) 2026 Suguna Badiginchala, Aruna kumari Prayaga, Rukmangadha Nandyala, Manilal.B https://creativecommons.org/licenses/by/4.0
date: 2026-01-05
publication date: 2026-01-05
starting page: C39
ending page: C43
doi: 10.21276/apalm.3739

Malakoplakia in a Transplant Kidney: A Rare Case Report
type: item
description: Malakoplakia is a rare inflammatory condition, commonly associated with immunosuppression. It usually affects the urinary bladder. Involvement of renal parenchyma is uncommon. This is a case report of a 49 year old renal transplant recipient with persistent graft dysfunction following an episode of urinary tract infection. Creatinine level was high and urine analysis showed pus cells and E.Coli organisms. Renal allograft biopsy was performed to rule out rejection and interstitial nephritis. The biopsy showed interstitial inflammation with histiocytes showing Michaelis-Gutmann bodies which were highlighted by Perls Prussian blue stain. Hence, the diagnosis of Malakoplakia was made. Treatment with prolonged antibiotics led to significant improvement in the creatinine value and graft function. This is a rare case which involves the renal parenchymal tissue following transplantation and correct diagnosis is required for graft survival and good prognosis.
subject: Case Report / Case Series
  topic: section
subject: malakoplakia
  topic: keywords
subject: renal transplant
  topic: keywords
subject: renal biopsy
  topic: keywords
subject: michaelis-gutmann bodies
  topic: keywords
creator: Praveen Shankar Balasubramanian
creator: Veenaa Venkatesh
rights: Copyright (c) 2026 Praveen Shankar Balasubramanian, Veenaa Venkatesh https://creativecommons.org/licenses/by/4.0
date: 2026-01-05
publication date: 2026-01-05
starting page: C44
ending page: C46
doi: 10.21276/apalm.3742

Left Atrial Myxoma: An Enigma in Itself – Two Case Reports
type: item
description: Background: Cardiac myxomas are rare primary cardiac tumours with variable clinical presentation.Case Presentation: We report two cases of left atrial myxoma, a 40-year-old female with dyspnoea and syncopal episodes, and a 16-year-old male with atypical chest pain and a prior neurological event. Routine laboratory parameters and ECG were unremarkable in both cases, while transthoracic echocardiography and CECT chest identified left atrial masses. Both patients underwent surgical excision. Histopathology revealed classic myxoma morphology with nests and cords of lepidic cells in a myxoid matrix. The older patient developed postoperative sepsis and expired, whereas the adolescent recovered uneventfully.Conclusion: These two case reports highlight the broad age spectrum and diverse clinical manifestations of left atrial myxoma, reinforcing the importance of timely imaging and histopathological confirmation.
subject: Case Report / Case Series
  topic: section
subject: left atrial myxoma
  topic: keywords
subject: case report
  topic: keywords
subject: echocardiography
  topic: keywords
subject: cardiac tumour
  topic: keywords
subject: histopathology
  topic: keywords
creator: Fiza Chopra
creator: Neha Singh
creator: Rupinder Kaur
creator: Sanjukta
rights: Copyright (c) 2026 Fiza Chopra, Neha Singh, Rupinder Kaur, Sanjukta https://creativecommons.org/licenses/by/4.0
date: 2026-01-05
publication date: 2026-01-05
starting page: C47
ending page: C51
doi: 10.21276/apalm.3724

Pulmonary Amyloidosis: Diverse Clinical and Histopathological Manifestations - A Series of Five Cases
type: item
description: Pulmonary amyloidosis, a rare condition caused by the abnormal deposition of protein fibrils, most often the AL (light chain) type, within the lung, frequently presents a diagnostic challenge. Its clinical manifestations often resemble more prevalent lung diseases like cancer or infections. A crucial step is to differentiate between disease limited to the respiratory system and widespread systemic involvement, as this guides the appropriate treatment. This report provides a retrospective analysis of five histologically confirmed cases of pulmonary amyloidosis, detailing their presenting clinical features, radiological findings, microscopic tissue characteristics, immunohistochemical analysis, and results from systemic evaluations. Our patient group, comprising three males and two females aged between 38 and 67 years, presented with varied initial symptoms: three had lung masses, one exhibited pleural effusion with concurrent liver disease, and another was being treated for tuberculosis. Microscopic examination revealed discrete amyloid nodules in three cases, diffuse interstitial deposition in one, and a pleural based accumulation in another. Immunohistochemical studies confirmed AL-type amyloid in three cases, AA-type in one, while the specific amyloid type remained undetermined in a fifth case. A confirmed diagnosis of systemic amyloidosis was made in only one patient. In one instance, nodular pulmonary amyloidosis occurred alongside fungal colonization. Pulmonary amyloidosis often poses a diagnostic conundrum in lung pathology. While localized nodular forms generally follow a benign clinical course, diffuse patterns necessitate a thorough systemic evaluation, even when serological indicators are negative. Advanced techniques like mass spectrometry and extensive imaging are becoming more vital for accurate subtyping and informed treatment decisions.
subject: Case Report / Case Series
  topic: section
subject: pulmonary amyloidosis
  topic: keywords
subject: localized amyloidosis
  topic: keywords
subject: systemic amyloidosis
  topic: keywords
subject: congo red staining
  topic: keywords
subject: immunohistochemistry
  topic: keywords
subject: lung pathology
  topic: keywords
subject: case series
  topic: keywords
subject: amyloid subtyping
  topic: keywords
creator: Richa Bhartiya
creator: Pallavi Mehra
creator: Vishal Tayade
creator: Navin K. Bariar
creator: Mansi Karwa
creator: Pritisha Choudhury
rights: Copyright (c) 2026 Richa Bhartiya, Pallavi Mehra, Vishal Tayade, Navin K. Bariar, Mansi Karwa, Pritisha Choudhury https://creativecommons.org/licenses/by/4.0
date: 2026-01-05
publication date: 2026-01-05
starting page: C52
ending page: C57
doi: 10.21276/apalm.3683

Beyond the Matrix: A Rare Case of Pilomatrix Carcinoma with Histologic Insights
type: item
description: Pilomatrix carcinoma is rare entity which arises from matrical cells of hair follicle and misdiagnosed quite often. A 27 years female with presented with a swelling on right side of nape of neck for approximately 3 years which was painless, slowly progressive, soft to firm in consistency. Previously misdiagnosed as squamous cell carcinoma, the lesion recurred and was excised again in our institution and was diagnosed here as Pilomatrix carcinoma with regional lymph node metastasis. Since she had metastasis, the patient is currently undergoing radiotherapy. Considering the rarity of this carcinoma it was noteworthy to report this case as correct diagnosis aids patient’s treatment protocol and improves prognosis.
subject: Case Report / Case Series
  topic: section
subject: pilomatrixoma
  topic: keywords
subject: pilomatrix carcinoma
  topic: keywords
subject: matrical cells
  topic: keywords
subject: skin adnexal tumor
  topic: keywords
creator: Nidhi Priya Barla
creator: Prima Shuchita Lakra
creator: Rahul Kumar Bharti
creator: Amiy Arnav
creator: Sanjeet Kumar Singh
creator: Monalisa Katyare
rights: Copyright (c) 2026 Nidhi Priya Barla, Prima Shuchita Lakra, Rahul Kumar Bharti, Amiy Arnav, Sanjeet Kumar Singh, Monalisa Katyare https://creativecommons.org/licenses/by/4.0
date: 2026-01-05
publication date: 2026-01-05
starting page: C58
ending page: C61
doi: 10.21276/apalm.3745

Sarcomatoid carcinoma of prostate: A rare variant
type: item
description: Sarcomatoid carcinoma of the prostate is an extremely rare aggressive variant of prostatic adenocarcinoma, which causes diagnostic and therapeutic challenges due to its mixed histological features. It represents less than 0.1% of prostate cancer cases.
subject: Case Report / Case Series
  topic: section
subject: carcinoma
  topic: keywords
subject: prostate
  topic: keywords
subject: adenocarcinoma
  topic: keywords
subject: aggressive
  topic: keywords
creator: Archana N Rijhsinghani
rights: Copyright (c) 2026 Archana N Rijhsinghani https://creativecommons.org/licenses/by/4.0
date: 2026-01-05
publication date: 2026-01-05
starting page: C62
ending page: C64
doi: 10.21276/apalm.3629