Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Dr Bhanu K Bhakhri

"The Journal of Clinical and Diagnostic Research (JCDR) has been in operation since almost a decade. It has contributed a huge number of peer reviewed articles, across a spectrum of medical disciplines, to the medical literature.
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Super Speciality Paediatric Hospital and Post Graduate Teaching Institute, Noida
On Sep 2018




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On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



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Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
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I wish JCDR a great success and I hope that journal will soar higher with the passing time."



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Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




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Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




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" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
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Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011

Important Notice

Case report
Year : 2010 | Month : October | Volume : 4 | Issue : 5 | Page : 3221 - 3224

Cytological Diagnosis In A Case Of Histoid Leprosy

CHUFAL S S*, MANNAN R**, SINGH M***, YADAV S****

*M.D, Department Of Pathology, M.L.N. Medical College, Allahabad,U.P, India; **M.D, Department Of Pathology, M.L.N Medical College, Allahabad,U.P, India; ***M.D, Department Of Pathology, M.L.N Medical College, Allahabad, UP, India; ****M.D, Department Of Dermatology, M.L.N Medical College, Allahabad, UP, India.

Correspondence Address :
Sanjay Singh Chufal,
Sri Sai Kripa, Lohariyasal Talla,
P.O- Kathgharia, Haldwani,
Dist- Nainital, Uttarakhand, India.
Phone- 9639621696
E mail- ratna_chufal@rediffmail.com

Abstract

Histoid leprosy, a variant of lepromatous Leprosy, usually develops due to resistance to dapsone monotherapy. It also can arise denovo. The clinical presentation of Histoid leprosy can mimic other inflammatory and some neoplastic conditions, especially if it arises denovo. FNA cytology can be performed as an outdoor procedure and can provide a quick and reliable diagnosis in such cases. A 35 year old male presented with multiple nodules all over the body. There was no previous history of Leprosy or antileprotic treatment. The clinical differential diagnoses were Post Kala azar dermal Lehishmaniasis (PKDL), Histoid Hansen’s leprosy and Cutaneous metastasis. FNA with a 23G needle showed numerous histiocytes which were filled with intracellular and extracellular negative bacillary images. These bacilli were arranged parallel to each other rather than in a random manner, which differentiated it from Atypical mycobacterial cutaneous infection, although a rare condition, without the aid of special stains and other ancillary investigations. Ziehl Neelsen’s staining for acid fast bacilli was positive. The arrangement of the negative bacillary images was important in distinguishing it from Atypical Mycobacterial infection, as FNA smears can be similar in both the cases and the treatment for both the entities is different. Subsequent histopathology confirmed the diagnosis and the patient responded to the treatment.

Keywords

Histoid Leprosy, Negative Bacillary images, Atypical Mycobacterial infection

Introduction

Hansen’s disease (Leprosy) is a chronic slowly progressive infection which is caused by Mycobacterium Leprae, affecting the skin and the peripheral nerves, resulting in disabling deformities. .The prevalence of leprosy in India is reported to be 0.7 per 10,000 Population (1). The disease manifests itself in two forms, namely lepromatous leprosy and tuberculoid leprosy, lying at the two ends of a long spectrum of disease. Histoid Leprosy is a variant of Lepromatous Leprosy, which mostly develops due to resistance to dapsone monotherapy, although it can also arise denovo(2). The incidence of histoid hansen’s disease has been described to be 2.79 – 3.60 % in Leprosy patients (3) The cases of denovo histoid patients are on the rise in India (4).Here, we report a case of 35 year old patient who had multiple subcutaneous nodules all over the body including face, without any previous history of leprosy or antileprotic treatment, causing a diagnostic dilemma clinically. FNA cytology was performed and a provisional diagnosis of Histoid Leprosy was given, which was later confirmed by histology. On the FNA smears, the arrangement of negative bacillary images within the histiocytes is important to differentiate histoid hansen’s disease from cutaneous atypical mycobacterial infections.

Case Report

A 35 year old male presented with multiple, skin coloured, subcutaneous juicy nodules and ulcers all over the body, including the face. [Table/Fig1] The clinicaldifferential diagnoses were Histoid Hansen’s disease, Post Kala azar dermal Leishmaniasis and cutaneous metastasis. There was no previous history of leprosy or anti leprotic treatment. The lesions started as a single ulcerated growth over the inner aspect of the thigh, with gradual eruption of these lesions all over the body.

(Table/Fig 1): Clinical picture of the patient showing multiple subcutaneous nodules all over the body

Three consecutive night peripheral blood smears showed no evidence of haemoparasites including microfilarae. The patient’s serological tests for VDRL and HIV were negative, Mantoux’s test was negative, the aldehyde test for Leishmaniasis was negative and other ancillary investigations like Chest X- ray, USG abdomen and careful physical and clinical examinations were unremarkable. FNA with a 23G needle, with multiple punctures from four different lesions yielded blood mixed material. The smears which were prepared by staining with May Grunwald’s Giemsa, showed numerous foamy histiocytes which were filled with intracellular and extracellular negative bacillary images.[Table/Fig.2] These histiocytes were admixed with few spindle shaped cell clusters. The negative bacillary images were arranged in a parallel disposition, rather than in a random manner within the histiocytes.[Table/Fig.3]. This arrangement of bacilli ruled out the other rare cutaneous infection which is caused by Atypical mycobacteria, having a similar picture cytologically.

(Table/Fig 2): Cytological smears showing histiocytes with negative bacillary images intracellularly extracellulary. (MGG 100x)

(Table/Fig 3): Cytological smears showing parallel disposition of negative bacillary images with in Histiocytes.(MGG 400x)

Ziehl Neelsen’s staining for acid fast bacilli showed numerous solid staining bacilli in clumps within the histiocytes, as well as lying extracellularly. [Table/Fig.4]. Taking into account the clinical presentation and the cytological findings, especially the arrangement of the negative bacillary images in the parallel disposition and the presence of acid fast bacilli, a diagnosis of histoid hansen’s disease was given. Subsequently, a punch biopsy of the lesion was done and histopathology revealed numerous spindle shaped macrophages which were arranged in a storiform pattern beneath an ulcerated epidermis with a Grenz zone in between. These spindle cells were also arranged around the skin adnexa, as if compressing them. [Table/Fig.5].Thus, a diagnosis of Histoid Leprosy was confirmed and the patient responded to the treatment.

(Table/Fig 4): Extracellular and intracellular Acid Fast Bacilli. (ZN 1000x)

(Table/Fig 5): Histological section showing spindle shaped macrophages around skin adnexa.(H&E 400x)

Discussion

Although Leprosy is a common problem in India, in recent years, its incidence has declined and the pure histoid forms are not so common, although the incidence of denovo histoid patients is increasing (4). Histoid Leprosy occurs predominantly in male patients who take irregular treatment for Leprosy (3) or it arises denovo in Lepromatous Leprosy patients (2). It also has been described in patients who develop de novo Histoid Leprosy during the course of the DEC treatment for filariasis (5),(6) . The patient failed to give any history of leprosy or antileprotic or antifilarial therapy. Three consecutive night peripheral blood smears showed no evidence of haemoparasites including microfilarae. Histologically it mimics Dermatofibromas, whereas clinically it may resemble Post Kala azar dermal Leishmaniasis (PKDL) and in some cases, nodular syphilis (7), eruptive Keratoacanthomas or cutaneous metastasis (3). However, the patient’s serological tests for VDRL and HIV were negative, the aldehyde test for Leishmaniasis was negative and other ancillary investigations like Chest X- ray, USG abdomen and careful physical and clinical examinations showed no evidence of malignancy. FNA from four different sites was performed, as it is important to perform multiple punctures to yield cellular material (8). The smears showed numerous spindle to oval histiocytes which were filled with numerous negative bacillary images, as well as those which were lying extracellulary [Table/Fig 2, 3]. Such a picture can be seen in Cutaneous Atypical Mycobacterial Infections, although rarely (9). The arrangement of the negative bacillary images was important in distinguishing it from Atypical mycobacterial infections, although described in lymph nodes (10),(11).These bacilli were arranged in a parallel disposition, whereas in Atypical mycobacterial infections, they are arranged randomly(12)/[Table/Fig3]. As the patient had no past history of leprosy or antileprotic treatment and as both forms of infections can be seen in immunocompromised patients in a tropical country like India, it was important to distinguish such a de novo histoid Leprosy patient, as the treatment for both these conditions was different. Strong Acid Fast bacilli positivity on cytology and the characteristic histology confirmed the diagnosis. Thus, it can be concluded that FNA is a rapid and cost effective way of detecting mycobacteria, as well as in differentiating Histoid Leprosy patients from cutaneous Atypical mycobacterial infections which can present with similar clinical pictures, without the aid of special stains and other specific tests (13).The case highlights the role of cytology as a quick , easy and a minimally invasive outdoor procedure to rule out other conditions, relieve the patient’s anxiety and to help the clinician to start the appropriate treatment at the earliest(14). As the bacillary load in such Histoid patients is very high, they can be potential reservoirs of infection (4). Other investigations like histopathology may not be acceptable to the patient, cultures and PCR can be time consuming, and the slit smear technique stained with Ziehl Neelson’s stain is limited to the determination of the presence or absence of Acid Fast bacilli(8).

Key Message

• FNA cytology is a simple, safe and a least traumatic procedure which can provide a quick and reliable diagnosis in cases with histoid leprosy.
• FNA helps in ruling out other probable clinical differential diagnoses in de novo histoid patients, so that treatment can be started at the earliest, as such patients can form potential reservoirs of infection.
• Cutaneous Atypical mycobacterial infection should also be considered in clinical differential diagnoses in such de novo histoid patients, as FNA smears can be similar in both the cases.
• The arrangement of negative bacillary images within the cytoplasm of the histiocytes is important in distinguishing the de novo histoid patients from atypical mycobacterial infections without the aid of special stains or other specific tests.

References

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Park K, Park’s Textbook of Preventive and Social Medicine, 20thedn. Jabalpur, India: Banarsidas Bhanot Publishers; 2009;234-236
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Sehgal VN, Agarwal A, Srivastava G,Sharma N. Int. J Dermatology Evolution of histoid leprosy (de novo) in Lepromatous (multibacillary) Leprosy .2005; Vol 44(7): 576 -578.
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Annigeri SR, Metgud SC, Patil JR, Lepromatous Leprosy of Histoid type. Indian J .Med .Microbiology 2007; 25(1): 70 – 71.
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Kaur I, Dogra S, De D, Saikia UN, Histoid Leprosy: A retrospective study of 40 cases from India, Br J Dermatol 2009 Feb; 160(2): 305-10.
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Sehgal VN, Srivastava G. Histoid Leprosy: A Prospective diagnostic study in 38 patients .Dermatologica 1988; 177(4): 212 –7.
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Agarwal K, Jain VK, Daya S, Histoid Leprosy with filariasis Indian. J Dermatology, Venerol Leprol; 68 (6):345- 6.
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Pandhi D, Reddy BSN, Khurana N, Agarwal S. Nodular syphilis mimicking histoid Leprosy. J Eur Acad. Dermatol Venerol .2005 Mar; 19 (2):256 -7.
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Prasad PVS, George RV, Kaviarasan PK, Viswanathan P, Tipoo R, Anandhi E. Fine needle aspiration cytology in Leprosy I J.D.V.L,2008;74(4):352-56.
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Ho MH, Ho CK, Chang Ly, Atypical mycobacterial cutaneous infection in Hongkong: 10 year retrospective study, Hongkong Medical Journal 2006 Feb;12 (1):21-6.
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Cavett JR 3rd, McAfee R, Ramzy I, Hansen’sDisease (Leprosy). Diagnosis by aspiration biopsy of lymph nodes. ActaCytol 1986; 30(2): 189-193.
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Ang GAT, Janda WM, Novak RM, Gerardo L, Negative images of mycobacteria in aspiration biopsy smears from the lymph node of a patient with AIDS: Report of a case and review of the Literature, Diagnostic Cytopathology 1993;9(3): 325-28.
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Gray W, McKee GT, Diagnostic Cytopathology 2ndedn.Edinburg, UK: Elssevier Science Limited; 2003;678-680
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Basu D, Nilkund J. Detecting mycobacteria in Romanowasky stained cytologic smears. A case report. Acta cytol. 2003; 47(5):774-6.
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Mehdi G, Maheshwari V, Gaur S, Sharma R, Histoid Leprosy: Diagnosis by Fine needle aspiration cytology. Acta Cytol. 2003; 47(3):529-31.

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