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INTRODUCTION Myeloid neoplasm with blasts showing mast cell (MC)-differentiation and MC-component less than 10% of all nucleated cells but not fulfilling the criteria for systemic mastocytosis with associated hematological neoplasm (SM-AHN) or myelomastocytic leukemia (MML) has not been described in the literature. Herein, we report a study of diverse myeloid malignancies with blasts showing MC-differentiation but not meeting the criteria for SM-AHN or MML. We also evaluated the utility of flow-cytometric immunophenotyping (FCI) in the characterization of immature-MCs (iMCs). METHODS We identified nine patients of myeloid neoplasms and studied their morphological, FCI, immunohistochemistry, cytogenetic and molecular characteristics. We also compared the immunophenotypic features of MCs from patient samples with control samples. RESULTS The study included patients with newly-diagnosed acute myeloid leukemia (n = 4), chronic myelomonocytic leukemia (n = 1), and chronic myeloid leukemia on follow-up (n = 4) showing MC differentiation in leukemic-blasts. These patients had mildly increased MCs (range, 0.5%-3%) in bone-marrow morphology, including immature-forms and did not meet the criteria for either SM-AHN or MML. On FCI, iMCs were positive for bright-CD117, heterogeneous-CD34, dim-to-negative-HLADR, and moderate-CD203c expression. Expression-levels of CD123 and CD38 were higher (p

Introduction: Metastasis to bone marrow by solid malignancies is a rare event and it upgrades the tumor thereby worsening the prognosis. This is caused by an impaired response to therapy and other manifestation resulting from decreased hematopoiesis. The common malignancies to metastasize in male and female are carcinoma prostate and carcinoma breast, respectively. It is noted that metastasis from small round cell tumor (SRCT) predominates in children. Here, we present a series of cases of bone marrow metastasis by solid organ malignancies over a period of 5 years. Objectives: The aim of this study was to investigate the clinical and hematological characteristics of patients with BM metastases of solid tumors diagnosed by bone marrow (BM) aspiration. Materials & methods: In this study, we reviewed 3520 bone marrow aspirates in our hospital from January 2013 to December 2017. Patients diagnosed with solid malignancies metastasizing to bone marrow were selected. Results: We found a total of 26 cases of solid malignancies with metastasis to bone marrow. The age of the patients ranged from 2–88 years (mean age of 46 years). Most of the patients were adults (19/26), of which 77.7% were males. Seven of the 26 patients were in the pediatric age group, with an age range of 2-11 years. Various malignancies metastasizing to marrow were evaluated and clinical and hematological correlation was done. The common presenting sign & symptoms were fever, anorexia and bodyache and organomegaly. Anemia was the most common hematological finding at the time of admission. Carcinoma prostate was the most common metastatic tumor in adults and small round cell tumor in children. Conclusion: BM is one of the important and infrequent sites of metastasis of solid tumors. Detection of bone marrow metastasis has significant clinical implication with impact on therapeutic decisions and is associated with poor prognosis. Aspiration of the BM provides an easy and quick way of detecting involvement, however, biopsy with immunohistochemical and/or molecular techniques may be needed in case of microscopical tumor burden.

Advances in molecular immunology have unveiled some of the complexity of the mechanisms regulating cellular immune responses and led to the successful targeting of immune checkpoints in attempts to enhance antitumor T cell responses. Surgery, chemotherapy, and radiation therapy have been the mainstay of treatment in urologic malignancies. Immune checkpoint molecules such as cytotoxic T-lymphocyte associated protein-4, programmed cell death protein-1, and programmed death-ligand 1 have been shown to play central roles in evading cancer immunity. Thus these molecules have been targeted by inhibitors for the management of cancers forming the basis of immunotherapy. Immunotherapy is now among the first line therapeutic options for metastatic renal cell carcinomas. In advanced bladder cancer, immunotherapy is the standard of care in the second line and the first line for cisplatin ineligible patients. There continues to be ongoing research to identify the role if any of immunotherapy in testicular, prostatic, and penile cancers. The ideal biomarker for response to immunotherapy is still elusive. Although programmed death-ligand 1 immunohistochemical testing has been widely used across the globe as a biomarker for immunotherapy, companion diagnostic tests have inherent issues with testing and reporting and cannot have universal applicability. Additional biomarkers including, tumor mutational burden, deficient mismatch repair, high microsatellite instability, and immune gene expression profiling are being evaluated in various clinical trials. This review appraises the data of immunotherapy in the management of urologic malignancies.

Uterine leiomyosarcoma (ULMS) is a rare malignancy of the female genital tract and carries an extremely poor 5-year survival rate. It is known to metastasize early and to distant sites owing to a high propensity for hematogeneous spread. Lung, peritoneum, liver, and bone are relatively common sites of metastasis. Patient age, tumor size, FIGO stage, and grade of the tumor are important criteria for predicting metastasis. The incidence of ULMS is increasing, probably due to the use of improved imaging techniques and as a result of cancer patients' prolonged life expectancy. An early well thought diagnosis is only made possible if even in otherwise seemingly unsuspected cases, the histopathology slides are extensively screened and the treating clinician is alerted timely. We hereby report a case of an elderly female who underwent hysterectomy for resection of multiple fibroids in the uterus and later presented with distant metastasis to brain with the erosion of overlying skull bone, chest wall, and lungs. Microscopic features along with an extensive immunohistochemistry panel were used to ascertain tumor origin.