Glomangiopericytoma is a rare neoplasm of the nasal and paranasal sinuses comprising less than 1% of all tumors of the said region. We report of a 59-year-old hypertensive male who presented with epistaxis. CT scan findings showed a mass in the right nasal cavity with extension into the ethmoid and sphenoid sinuses. Histopathologic diagnosis was glomangiopericytoma confirmed with immunohistochemistry studies. Prognosis is favorable with complete resection of tumor and long-term monitoring.
Paranasal Sinus Neoplasms

High-grade B-cell lymphoma with MYC and BCL2 and-or BCL6 rearrangements, also called double-hit lymphoma, is an aggressive mature B-cell lymphoma that carries both MYC and BCL2 and/or BCL6 translocations. This can present as a diagnostic challenge since clinical characteristics, morphology and immunophenotype are not accurate indicators of underlying genetic aberrations in this type of lymphoma. We report a case of a 25-year-old male who presented with a one-year history of cough, gradually increasing abdominal girth and jaundice. Definitive diagnosis was made post-mortem with additional ancillary studies using immunohistochemistry staining and fluorescent in-situ hybridization studies.
Lymphoma ; Lymphoma, B-Cell ; Molecular Diagnostic Techniques

Background and Objectives: Early detection of ovarian neoplasms confer a better outcome and prognosis for patients. Although newer diagnostic modalities have been recently developed, the availability and accessibility of complete blood count parameters specifically, neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) make it a convenient and cost-effective marker to aid as a pre-operative predictor of epithelial ovarian neoplasms. We aim to determine the significance and relationship of preoperative NLR and PLR in predicting a diagnosis of malignant surface epithelial ovarian tumor. Methodology: We gathered surgical pathology reports and complete blood count parameters of service patients with benign and malignant surface epithelial ovarian neoplasms. Diagnostic accuracy of NLR and PLR was determined by using receiver operating curve (ROC) plots. Optimal cutoff points were set using the Youden index. Results: We have included 351 cases of ovarian surface epithelial neoplasms, 209 of which were benign and 142 of which were malignant. The ROC curve for PLR had an area under curve (AUC) of 0.6629 [0.6043, 0.7215]. The optimal cut-off point of was set at 195.99 with the maximal Youden index of 0.295 [9.193, 0.396]. The corresponding sensitivity of this test to determine malignancy at this point was 56.5% [47.8, 64.6] while the specificity was at 73.2% [66.7, 79.1]. The ROC curve for NLR had an AUC of 0.6616 [0.6051, 0.7180]. The optimal cut-off point of was set at 2.60 with the maximal Youden index of 0.316 [0.219, 0.413]. The corresponding sensitivity of this test to determine malignancy at this point was 76.1% [68.2, 82.8] while the specificity was at 55.5% [48.5, 62.4]. Conclusion The utility of CBC parameters such as PLR and NLR are cost-effective tools which may have some diagnostic value but, they cannot be used as a stand-alone predictor of malignancy and must be correlated with other clinical, laboratory and radiologic studies.
Ovarian Neoplasms ; Blood Cell Count ; Lymphocytes ; Neutrophils ; Blood Platelets

INTRODUCTION: Complete blood count (CBC) and cell population data (CPD) are hematologic parameters used in several clinical scenarios including infection and neoplastic processes. In the setting of COVID-19 infection, there is relative paucity of data in their use as possible prognostic markers. OBJECTIVE: We aim to evaluate the utility of the baseline CBC and CPD as prognostic markers for in-hospital mortality among COVID-19 patients admitted in Philippine General Hospital from March 2020 to January 2022. METHODOLOGY: This is a case-control study. Expired patients served as cases, and recovered patients served as controls. Data from eligible patients including age, sex, admitting COVID diagnosis with severity, final disposition, baseline CBC and CPD results were collected from the hospital medical records and hematology section of the Department of Laboratories. Statistical analyses were done to determine the prognostic value of these parameters for in-hospital mortality. RESULTS: Among the different CBC and CPD parameters, the study shows total white blood cell (WBC) count, absolute neutrophil count (ANC), absolute eosinophil count (AEC), and neutrophil-lymphocyte ratio (NLR) were statistically significant predictors for in-hospital mortality. For total WBC count, at a cut off 9.9 x 10 9 /L, the sensitivity and specificity is 70.9% and 66.2%, respectively. For ANC, at a cut off of 7.3 x 10 9 /L, the specificity is 76.4% and the specificity is 68.2%. At a cut off of 7.62, the NLR shows a sensitivity of 76.4% and specificity of 70.1%. For AEC, at a cut off of 0.006 x 10 9 /L, the sensitivity is 53.3% and the specificity is 87.3%. AEC predicts towards the direction of survival rather than to the direction of in-hospital mortality. CONCLUSION The total WBC count, ANC, and NLR were statistically significant predictors for in-hospital mortality, while AEC predicts towards the direction of survival. The sensitivities and specificities of the cut off for these parameters were less than ideal. Correlation with clinical and other laboratory parameters is still recommended. For future studies, the authors recommend monitoring CBC and CPD parameters at different time points during the patients’ hospital course.
COVID-19 ; hematology ; blood cell count ; complete blood count ; prognosis

Objective: This study aimed to determine the demographic profiles of admitted COVID-19 patients, the association of coagulation and platelet tests on COVID-19 severity and compare the coagulation and platelet profile across the spectrum of the disease in terms of severity among adult COVID-19 patients admitted to the Philippine General Hospital from March 2020 to December 2022. : Methodology. Medical records of a sample of adult COVID-19 patients admitted to the emergency room of the Philippine General Hospital from March 2020 to December 2022 were reviewed. The demographics, initial COVID-19 diagnosis and initial coagulation and platelet test results were gathered and tabulated. Comparison of the initial coagulation and initial platelet results were made per disease category. Results: Three hundred eighty-five (385) patients were included; 194 were males, and 191 were females. The mean age of all patients was 56.18 years old. There was a total of 30 patients classified as mild and 105 patients are under moderate category. 141 patients were classified as severe, whereas 109 patients were classified as critical. Platelet count test and Activated Partial Thromboplastin Time (APTT) were mostly normal in all disease categories. Prothrombin time was normal in a majority of patients from the mild and severe categories. INR and D-dimer were all elevated mostly in all disease categories. Conclusion Platelet counts and APTT were mostly normal in all disease categories. Prothrombin time and D-dimer had a significant association with disease severity. Platelet count, APTT and INR did not show significant association with disease severity. Prothrombin time, APTT, INR and D-dimer means had significant differences versus disease categories.
Partial Thromboplastin Time ; OVID-19 ; Patient Acuity

Background and Objectives: The use of conventional microscopy still forms the basis for the morphologic evaluation of erythrocytes despite widespread use of automated tests in the hematology laboratory. This requires a considerable length of time and expertise, and have the potential of becoming a source of errors and delay in reporting. Advances in image processing and machine learning in recent years have shown acceptable performance characteristics and have promising applications in the diagnostic laboratory. Use of these newly-developed technologies can address the stated problems and provide an alternative approach in the microscopic analysis of erythrocytes. Methodology: This prospective validation study compared digital image analysis using a machine-learning based image recognition algorithm with conventional microscopy performed by a trained microscopist, which served as the reference standard. Random deidentified anticoagulated peripheral blood samples submitted to the hematology laboratory were assessed. Results: A total of 956 erythrocytes were evaluated after image processing using support vector machine and routine microscopy as classifiers of erythrocytes into three categories: size, central pallor, and shape. The tested software was able to achieve a strong level of agreement compared to conventional microscopy, having kappa values ranging from 0.81 to 0.86. Accuracy for size, central pallor and shape were 89.88%, 93.72% and 87.89%, respectively. Conclusion: The validated image recognition software is an acceptable diagnostic test in determining erythrocyte morphology in peripheral blood smears. Its integration can potentially minimize hands-on time and improve the diagnostic laboratory workflow. Registration Philippine Health Research Registry (PHRR) ID: PHRR191211-002348; University of the Philippines Manila Research Ethics Board (UPMREB): 2019-356-01.
Microscopy

Background: Diffuse large B-cell lymphoma (DLBCL) is the most common type of non-Hodgkin lymphoma (NHL). Classification of DLBCL is often based on the cell of origin (COO), distinguishing between germinal center B-cell (GCB) and non-GCB subtypes. Although not yet recognized as a distinct entity by the World Health Organization (WHO), double expressor lymphoma (DEL), characterized by the co-expression of c-MYC and BCL2, carries an unfavorable prognosis for a subgroup of DLBCL patients. Another entity is the so-called high-grade B-cell lymphoma with MYC and BCL2 and/or BCL6 rearrangements (double-hit/triple-hit lymphomas) diagnosed through fluorescent in-situ hybridization (FISH) analysis. Objective: This study aimed to determine the clinicopathologic profile and survival outcomes of Filipino DLBCL patients at the Philippine General Hospital (2016-2021), comparing double-hit versus non-double-hit and doubleexpressor versus non-double-expressor lymphomas, and assessing concordance between FISH-measured double-hit and IHC-measured double-expressor statuses. Methods: This is a single-arm, retrospective cohort study involving all surgical pathology cases signed out, with the aid of immunohistochemistry (IHC) studies, as NHL DLBCL, GCB, or non-GCB subtype, from 2016 to 2021. A second panel of IHC studies and FISH analysis using tissue microarray was subsequently done. Most cases exhibited a nonGCB subtype and were classified as DEL on second IHC panel. Five out of eleven DEL cases were reclassified as double hit lymphoma (DHL). Results: Clinically, most patients with these lymphomas present at age 60 years and below, exhibit B symptoms, with elevated serum lactate dehydrogenase (LDH) levels, at least stage III-IV disease at diagnosis, and possess a high International Prognostic Index (IPI) score, collectively indicating a poor prognosis. Conclusion Survival outcomes for patients with DLBCL ranges from three to 37 months. All cases of mortality were associated with DEL, contrasting with DHL cases which had variable outcomes. Due to limited sampling, statistical significance of the results cannot be determined. A comprehensive evaluation is essential to the diagnosis of DLBCL and DHL to include a complete immunohistochemistry panel and molecular testing, notably with FISH studies.
lymphoma ; lymphoma, large B-cell, diffuse ; cytogenetics ; immunohistochemistry

Objective. To determine the efficacy of rTMS in decreasing body mass index (BMI) versus sham stimulation among obese Filipino patients. Methodology. This was a single-center, randomized, sham-controlled, single-blind, parallel group trial. Participants were 15-65 years old with BMI ≥30 kg/m2 and weight stable for 6 weeks. Participants were randomized to receive real rTMS or sham stimulation. Each underwent 4 sessions of stimulation over 2 weeks. Anthropometrics, total caloric intake (TCI), and VAS score for appetite were taken at baseline, 2, 4, 6, and 12 weeks. Results. A total of 31 patients were randomized with 15 to the treatment and 14 to sham stimulation completing treatment, with 2 lost to follow-up. A significant decrease in BMI was noted after 4 weeks from the start of rTMS in the treatment group, (0.6±0.6, p-value=0.001), with weight change of -1.3±1.3 kg (p-value=0.009), but was no longer observed at 6 weeks onwards. No severe adverse effects were noted. Conclusion. rTMS to the DLPFC effectively decreased BMI (0.6±0.6) and weight (-1.3±1.3 kg) from baseline to 4 weeks. At 6-12 weeks after rTMS however, there was no longer a significant difference, indicating that 4 sessions of rTMS may not be enough to produce a prolonged effect on weight loss.
weight loss ; obesity ; Transcranial Magnetic Stimulation