Large granular lymphocytic leukemia (LGL) affects adults and is rare in children, etiology being unknown. We describe a case of a fourteen year old boy who presented with symptomatic anemia with lymphocytosis and atypical lymphocytes. Bone marrow revealed hypocellularity with marked erythroid hypoplasia, lymphocytosis and increased eosinophils. Immunohistochemistry confirmed the diagnosis of LGL.

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Background : Gallbladder (GB) cancer ranks among the first five common cancers in females in Delhi, India. The incidence rate of GB carcinoma is higher in North India compared to South India. Methods : A population based case-control study on 333 GB incident cases was carried out in Delhi to identify the risk factors. Cases were matched with two controls based on age (± 5 years), sex and marital status (in case of females) Results : Smoking and alcohol consumption increase the risk of GB cancer. The risk among those who smoke cigarette (OR=3.05, CI=1.33-6.98) was higher than that seen among bidi smokers (OR=2.25, CI=1.38-3.69). History of typhoid in the past and cholelithiasis increased the risk of GB cancer. Post menopausal women had a significant risk of GB cancer than the menstruating women. Consumption of urad dhal, moong dhal, milk, cottage cheese and butter also increased the risk of GB cancer. Conclusion : Smoking, alcohol consumption, typhoid in the past, cholelithiasis and certain dietary items are the some of the most important risk factors for gallbladder cancer.

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Pediatric Hodgkin's lymphoma is currently one of the most curable childhood malignancies. Therapy is stratified based on disease stage and the presence of adverse prognostic factors. Optimal treatment strategy in pediatric remains controversial, especially in case of advanced disease. Risk-adapted combined modality therapy is the standard of care in favourable and unfavourable early disease. Chemotherapy-alone protocols are advocated by some groups, and show similar outcome, although isolated reports favour additional involved-field radiotherapy. Interim and post-therapy positron emission tomography (PET) is emerging as a tool to avoid radiation or to intensify therapy. Responseadapted therapy is a most effective new approach in order to decrease treatment related long-term toxicity while maintening high cure rates.

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Primary non-Hodgkin's lymphoma (NHL) of the oral region is rare. Oral manifestations are present in 3-5% of cases of NHL and oral lesions are rarely the initial manifestation. We describe a 40 year old male who presented with a mass lesion primarily involving the tongue and was diagnosed as diffuse large B cell lymphoma. The patient was treated with CHOP chemotherapy with complete disappearance of lesion after first cycle. Pertinent literature is being reviewed.

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Second malignancies or co-existing malignancies like ovarian, endometrial, lung carcinomas, soft tissue sarcomas have been reported to be associated with breast carcinoma. The commonest cause of bone pain in a patient of breast cancer is metastasis to bone. We present a rare case of multiple myeloma mimicking bony metastasis in a patient of breast carcinoma.

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Allogeneic bone marrow transplantation from an HLA-identical donor is currently the only means of curing thalassemia . Transplant outcome depends upon the presence of risk factors (hepatomegaly, portal fibrosis and poor quality of chelation). patients are defined to have class I - if no risk factor, class II with one or two and class III - if all three risk factors are present. For patients under 16 years of age, for class I, class II and III the probabilities of survival are approximately 95%, >80% and 60-70%, respectively. The risk of transplant related morbidity& mortality is low when transplant is done at an early age. Currently, busulfan, cyclophospahmide and antithymocyte globulin based combination is used for conditioning. More than 200 patients with sickle cell disease (SCD) have undergone allogeneic SCT with long term survival in >80% of patients. Results are better if donor is an HLA-identical sibling and if transplant is done early in the course of disease. Presently, experience with reduced intensity SCT and matched unrelated donor transplant is limited to recommend their routine use.

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Objectives : For young patients receiving cancer chemotherapy, the major concern is gonadal dysfunction with impaired reproductive capacity. The impact of such therapy in patients with lymphoma was focus of this study. Methods : Semen analysis and serum FSH and LH levels were determined pretreatment, immediately after completion of therapy and at follow-up in 60 patients of lymphoma receiving chemotherapy. Results : Pretreatment infertility was present in 13.2% of patients. After completion of treatment, 76.9% developed azoospermia. However, after a mean follow up of 56.66 months, percentage of normospermic patients declined to 43.3%, recovery being better in patients of age less than 30 years. Conclusion : The effects of chemotherapy on testicular activity were significant with combination containing cyclophosphamide and procarbazine. Recovery in spermatogenesis and FSH levels to normal was seen in patients receiving cyclophosphamide, vincristine and prednisolone but was least when procarbazine was added to this. 90% patients continued to have azoospermia at 5 years in the group which received cyclophosphamide in combination with procarbazine.

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