Gastric Signet Ring Cell Carcinoma (GSRCC) is an increasingly recognized subtype of gastric cancer, particularly prevalent in South Asian populations and regions within India. This carcinoma is distinguished by its abundant cytoplasmic mucinous cells and aggressive clinical behavior, often affecting younger individuals and leading to a poor prognosis due to its advanced‐stage presentation and resistance to standard treatments. A critical factor in its progression is the tumor's uniquely immunosuppressive and stromal‐rich microenvironment, characterized by dysfunctional immune infiltrates, activation of cancer‐associated fibroblasts, extracellular matrix remodeling, and complement cascade dysfunction. Recent research has highlighted the significance of key biomarkers, including MSMB, AGR2, CLDN18.2, and notably GRIN2D, which play roles in tumor angiogenesis, immune evasion, and metabolic reprogramming. The interaction of these elements contributes to therapeutic resistance and immune escape, thereby reducing the effectiveness of chemotherapy and checkpoint inhibitor immunotherapies. Innovative strategies that integrate stromal‐targeting agents, complement modulators, anti‐CLDN18.2 antibodies, and novel GRIN2D‐targeted therapies, along with precision molecular profiling, offer potential for enhancing patient outcomes. Tailored approaches that incorporate early detection and dynamic biomarker monitoring may ultimately transform GSRCC management toward personalized, evidence‐based therapies and prevention.

Background Blastoid mantle cell lymphoma (B-MCL) is a rare aggressive lymphoma. It is characterized by blastoid morphology with high proliferation and inconsistent immunohistochemistry (IHC), making it a diagnostic challenge for the pathologist. Methods This is a retrospective analytical cohort study. We reviewed biopsy confirmed cases of B-MCL diagnosed over a period of 10 years (January 2012 to December 2022). The clinical presentation, histopathological and IHC findings, treatment received, and survival outcomes were studied. Randomly selected cases of classic MCL (n=12), diagnosed during the same period served as controls. Results A total of 12 cases were studied. Four cases were transformed from previously diagnosed MCL; 8 cases arose de novo. Mean age was 61.17 years and the male: female ratio was 5:1. Half of the cases showed extra nodal extension and 81.8% had bone marrow involvement. Gastrointestinal tract was the most common site of extra nodal involvement. Histopathological examination showed diffuse involvement of the lymph node with medium sized cells. On immunohistochemistry, one of the cases showed loss of CD5 expression while the other had aberrant CD10 expression. Mean Ki-67 index was 58.09% in the cases and 16.33% in controls and was statistically significant ( p =0.005). The median overall survival (OS) for cases was 2 years vs 8 years in controls. The p53 over expression (>30% nuclear positivity) was seen in 66.6% cases (4/6). Conclusion There are several factors that contribute to the aggressiveness of B-MCL, and new treatment approaches might be required to improve patient outcomes.

Background Blastoid mantle cell lymphoma (B-MCL) is a rare aggressive lymphoma. It is characterized by blastoid morphology with high proliferation and inconsistent immunohistochemistry (IHC), making it a diagnostic challenge for the pathologist. Methods This is a retrospective analytical cohort study. We reviewed biopsy confirmed cases of B-MCL diagnosed over a period of 10 years (January 2012 to December 2022). The clinical presentation, histopathological and IHC findings, treatment received, and survival outcomes were studied. Randomly selected cases of classic MCL (n=12), diagnosed during the same period served as controls. Results A total of 12 cases were studied. Four cases were transformed from previously diagnosed MCL; 8 cases arose de novo. Mean age was 61.17 years and the male: female ratio was 5:1. Half of the cases showed extra nodal extension and 81.8% had bone marrow involvement. Gastrointestinal tract was the most common site of extra nodal involvement. Histopathological examination showed diffuse involvement of the lymph node with medium sized cells. On immunohistochemistry, one of the cases showed loss of CD5 expression while the other had aberrant CD10 expression. Mean Ki-67 index was 58.09% in the cases and 16.33% in controls and was statistically significant ( p =0.005). The median overall survival (OS) for cases was 2 years vs 8 years in controls. The p53 over expression (>30% nuclear positivity) was seen in 66.6% cases (4/6). Conclusion There are several factors that contribute to the aggressiveness of B-MCL, and new treatment approaches might be required to improve patient outcomes.

Background: Ulceroproliferative lesions involving the eyelids can be due to several causes, chief among them being squamous cell carcinoma (SCC). It is imperative to distinguish it from various mimics owing to the limited surgical therapy that can be offered at the site. Inverted follicular keratosis (IFK) is a rare benign epidermal tumor that arises from the infundibular portion of the hair follicle. The endophytic growth pattern and histological features closely mimic SCC especially in small or superficial biopsies, making accurate diagnosis challenging. Case Presentation: A 76-year-old male patient who presented with a nodular ulcerative lesion on the right lower eyelid that gradually increased in size over a span of 20 years. The lesion was excised through pentagonal full-thickness resection with 2-mm margins. Primary closure was achieved with the aid of lateral canthotomy to reduce tension. The postoperative course was uneventful. Wound healing was complete with normal eyelid closure and no ectropion. Histopathological examination revealed features characteristic of IFK, including an endophytic proliferation of basaloid and squamous cells, numerous squamous eddies, keratin-filled cysts, and absence of cellular atypia or mitotic activity. p53 immunohistochemistry showed wild-type expression, supporting the benign nature of the lesion. Conclusions: IFK can clinically and histologically resemble SCC, particularly in limited biopsy samples. Surgical excision with appropriate margin clearance and functional eyelid reconstruction ensures both curative and functional outcomes. Awareness of this benign entity and recognition of its distinguishing histopathological features are crucial to avoid overtreatment and to ensure appropriate patient management. Complete excision remains the treatment of choice and has excellent prognosis.

Malaria is one of the most common parasitic diseases causing a significant burden on health care, especially in India. Light microscopy, the gold standard for malaria diagnosis is time-consuming especially in a setup where the caseload is high and parasite index is low. Knowledge of abnormal scattergrams by the malarial parasite is very essential to suspect malaria and screen those cases thoroughly on a peripheral smear for accurate diagnosis. A timely and accurate diagnosis is crucial to the prognosis of this disease. Herein, we report a case of a 40-year-old male from Punjab who presented to the emergency with fever and an altered sensorium. Analyzer showed characteristic pseudo eosinophilia with greying of neutrophil eosinophil zone with double eosinophil cluster. According to flagging rules because of eosinophilia, peripheral blood film (PBF) was made and examined, which revealed Plasmodium falciparum gametocytes.

Background: Cancer of the thyroid gland is the most common endocrine malignant neoplasm, and papillary thyroid carcinoma (PTC) accounts for majority of the cases. PTC cases are identified by its distinct histopathological features. Due to lack of definable criteria and overlapping features seen in other diseases of thyroid giving rise to false positive cases and errors in diagnosis may reflect drastically on the prognosis and treatment outcome. Objective: To analyse the frequency of PTC microscopic criteria in a series of benign lesions of thyroid and PTC cases and to build an optimal cut off score which could help us differentiate between these cases. Materials and Methods: The study included 86 thyroid lesions, 43 benign and 43 PTC cases. Histopathological parameters analysed included colloid, papillae, nuclear crowding, nuclear grooving, nuclear enlargement, oval nucleus, nuclear clearing. Results: The above mentioned parameters could differentiate between benign and PTC cases. Based on sensitivity and specificity, the cut off derived for every parameter is as follows: colloid 1%, nuclear crowding >25%, nuclear grooving >5%, nuclear enlargement >50%, ovoid nucleus >25%, nuclear clearing>50%. The scoring system was built based on these parameters. The score proposed helped us to classify benign and PTC cases. PTC cases scored a total score of >7 indicating that seven can be considered as cut off value to differentiate between benign and PTC cases. Conclusion: Definite distinction between benign and PTC cases was possible when all the parameters were clubbed together with an important role in cases with diagnostic dilemma.