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.

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.

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).

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.

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.

Basal cell carcinoma, the most common human malignancy, has a rare incidence of metastases ranging from 0.0028-0.55%. We report a case of a 74-year-old female with a 10-year history of an enlarging anterior thigh nodule. Wide resection and inguinal lymph node dissection revealed an infiltrative basal cell carcinoma with lymph node metastasis due to the presence of basaloid cells, limited peripheral palisading, loose stroma, extensive spread, perineural invasion and immunoreactivity to p40, BerEP4, and GATA3.

BACKGROUND AND OBJECTIVE

Blood collection errors are one of the most common causes of laboratory sample rejection in the pre-analytical phase of the testing process. This study aims to determine the frequency and identify the preanalytical factors that lead to rejection of samples meant for the hematology laboratory.

This cross-sectional, retrospective study analyzed blood samples received and rejected by the Hematology Division of the University of the Philippines – Philippine General Hospital from 2018 to 2022. Data were extracted from the Division's annual reports and sample rejection logbooks. The causes and frequency of sample rejections, as well as the hospital locations of the patients involved were presented using frequency tables.

Out of 1,072,366 blood samples received during the study period, 61,935 (5.78%) were rejected. The most common cause of rejection was clotted blood samples for both routine hematology (86.31%) and coagulation (44.43%). Clotted samples were the predominant cause of sample rejection across most age groups, with the exception of the neonatal and infancy groups, where inadequate sample quantity was the primary issue. The highest rejection rate was seen in the emergency department (65.71%) and intensive care units (9.68%).

The rejection rate in our institution was higher than reported in previous global studies. The main causes of rejection were identified as clotted blood samples and inadequate blood volume for routine hematology and coagulation testing. Notably, the highest rejection rates for hematology-related requests occurred in critical areas, including the emergency department, intensive care units, and obstetrics and gynecology.

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: 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

Background and Objective: Blood collection errors are one of the most common causes of laboratory sample rejection in the pre-analytical phase of the testing process. This study aims to determine the frequency and identify the preanalytical factors that lead to rejection of samples meant for the hematology laboratory. Methods: This cross-sectional, retrospective study analyzed blood samples received and rejected by the Hematology Division of the University of the Philippines – Philippine General Hospital from 2018 to 2022. Data were extracted from the Division's annual reports and sample rejection logbooks. The causes and frequency of sample rejections, as well as the hospital locations of the patients involved were presented using frequency tables. Results: Out of 1,072,366 blood samples received during the study period, 61,935 (5.78%) were rejected. The most common cause of rejection was clotted blood samples for both routine hematology (86.31%) and coagulation (44.43%). Clotted samples were the predominant cause of sample rejection across most age groups, with the exception of the neonatal and infancy groups, where inadequate sample quantity was the primary issue. The highest rejection rate was seen in the emergency department (65.71%) and intensive care units (9.68%). Conclusion The rejection rate in our institution was higher than reported in previous global studies. The main causes of rejection were identified as clotted blood samples and inadequate blood volume for routine hematology and coagulation testing. Notably, the highest rejection rates for hematology-related requests occurred in critical areas, including the emergency department, intensive care units, and obstetrics and gynecology.
pre-analytical phase

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

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