JournalTOCs

Autopsy and Case Reports
Number of Followers: 0

This is an Open Access Journal

Open Access journal
ISSN (Print) 2236-1960
Published by Universidade de São Paulo

[46 journals]

Pleomorphic hyalinizing angiectatic tumor of the vulva: literature review
based on a rare presentation
- Authors: Eveline Cristina da Silva, Rodrigo Fonseca Abreu, Antônio Geraldo Nascimento, Louise De Brot Andrade
  Abstract: Pleomorphic hyalinizing angiectatic tumor (PHAT) of soft tissues is a rare, non-metastatic tumor of unknown etiology and uncertain behavior, which may recur locally. There are few reports on this condition, and due to the rarity of the disease, its lineage has not yet been fully elucidated. The present study aims to report the case of an unusual entity observed for the first time in vulval topography. A female patient, 83 years old, presented with a tumor in the vulvar region that had evolved for approximately 4 months. Magnetic resonance imaging showed an expansive perineal formation of 8.5 × 3.5 cm, and a hemivulvectomy with a flap rotation was performed. The review of the slides revealed a mesenchymal lesion without significant atypia, which was richly vascularized. In the areas of interest, the immunohistochemical (IHC) study demonstrated positivity for CD34, estrogen, and progesterone receptors; it was negative for the other tested markers. Morphological findings associated with the IHC staining panel supported the diagnosis of PHAT. The main morphological features of PHAT are clusters of ectatic vessels of different sizes that show deposits of subendothelial and intraluminal fibrin. Fusiform and pleomorphic cells randomly arranged in leaves or long fascicles intermingle these vessels. It is essential to recognize this entity and consider it among the differential diagnoses of a mesenchymal lesion, given the wide variety of entities that comprise this group of lesions.
  PubDate: 2022-06-23
  DOI: 10.4322/acr.2021.353
  Issue No: Vol. 12 (2022)
Primary retroperitoneal extraovarian granulosa cell tumor
- Authors: Pragya Sharma, Vikram Singh, Niharika Mishra, Manoj Gopinath, Prashant Gupta
  Abstract: Extraovarian granulosa cell tumors (GCTs) develop from ectopic gonadal tissue situated along the embryonal route of the genital ridge. Primary retroperitoneal tumors are extremely rare, with an incidence of 02% -06% and 80-85% probability of malignancy. Only eight such case reports have been published previously. We herein, report a rare case of extraovarian retroperitoneal GCT in a 55-year-old woman who presented with intermittent left lumbar region pain of one-year duration. She had a history of hysterectomy and bilateral salpingo-oophorectomy 8 years ago for uterine leiomyoma. Laparotomy revealed a retroperitoneal mass measuring 8cm x 10cm x 20cm in size, solid cystic with areas of necrosis and hemorrhage. The gross features, classical histopathology, and positive immunostaining of the retroperitoneal mass with inhibin, calretinin, PR, WT1 and immunonegativity for EMA were characteristic of adult-type GCT. Excluding any previous history of primary ovarian GCT in this patient, a de-novo retroperitoneal diagnosis was established.
  PubDate: 2022-06-23
  DOI: 10.4322/acr.2021.355
  Issue No: Vol. 12 (2022)
Pindborg tumor associated with a supernumerary tooth: a case report
- Authors: Hannah Gil de Farias Morais, Weslay Rodrigues da Silva, Ana Cláudia de Macêdo Andrade, Nelmara Sousa e Silva, Mariana Carvalho Xerez, José Wittor de Macêdo Santos, Adriano Rocha Germano, Antônio de Lisboa Lopes Costa
  Abstract: The calcifying epithelial odontogenic tumor is a rare benign neoplasm that accounts for approximately 1% of all odontogenic tumors. Most of the cases occur in the posterior mandible, and a few involve the maxilla. Despite their relatively indolent biological behavior, tumors in the maxilla tend to grow fast. We report the case of a 33-year-old female patient exhibiting swelling in the right maxilla. An isodense area associated with an impacted supernumerary tooth was found on imaging examination. The histopathologic diagnosis was a calcifying epithelial odontogenic tumor. The treatment of choice was surgical removal of the lesion and associated dental elements. The patient has been followed up for 11 months and shows no signs of recurrence. Besides describing this case, we reviewed the literature on the association of calcifying epithelial odontogenic tumors with supernumerary teeth and found two case reports addressing this subject.
  PubDate: 2022-06-23
  DOI: 10.4322/acr.2021.358
  Issue No: Vol. 12 (2022)
Ulcerative colitis after SARS-CoV-2 infection
- Authors: Sofia Kartsoli, Spyridon Vrakas, Dimitrios Kalomoiris, Kassiani Manoloudaki, Vasileios Xourgias
  Abstract: Although severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) affects mainly the respiratory system, the gastrointestinal tract is also considered a site of viral activity. We hereby present the case of a 74-year-old male patient with the diagnosis of new-onset ulcerative colitis. One month earlier, the patient presented fever, running nose, and diarrhea and was tested positive for SARS-CoV-2. Studies with COVID-19 patients revealed significant changes in gut microbiota composition and alterations in immune responses that could lead to chronic inflammation and manifestations of inflammatory bowel disease. We review additional cases of ulcerative colitis presented after SARS-CoV-2 infection and summarize the possible mechanisms that underlie the gastrointestinal abnormalities in COVID-19 patients.
  PubDate: 2022-06-23
  DOI: 10.4322/acr.2021.378
  Issue No: Vol. 12 (2022)
Endobronchial lipoma
- Authors: Lakshitha Anbazhakan, Asad Ullah Khan, Rohit Munagala, Rabih Bechara, Islam Elhelf, Nikhil Patel, Nagla Abdel Karim
  Abstract: Endobronchial lipomas are rare benign lung tumors that can cause bronchial obstruction and parenchymal damage. While an uncommon etiology, they are often misdiagnosed due to a clinical presentation similar to obstructive pulmonary pathologies such as COPD and asthma. Upon review of English-language literature, under 50 cases of endobronchial lipomas were documented in the prior 10 years (2011-2021). There are no clear guidelines regarding the management of this particular entity, but typically interventional debulking is the treatment of choice. Here we present another unique case of endobronchial lipoma along with our diagnostic and therapeutic methodology. The patient underwent bronchoscopic debulking via a cryotherapy probe. Based on the histopathologic analysis, a diagnosis of endobronchial lipoma was made. Endobronchial lipomas must remain in any clinician’s differential when a patient presents with dyspnea. We report the unique location of this lipoma based on our literature review and the importance of investigating endobronchial lesions due to a possible diagnosis of endobronchial lipoma.
  PubDate: 2022-06-23
  DOI: 10.4322/acr.2021.377
  Issue No: Vol. 12 (2022)
Deciduosis in a cesarean scar
- Authors: Toyaja Jadhav, Rohini Doshetty
  Abstract: Deciduosis is the presence of ectopic decidual tissue outside the uterus, pelvic, or abdominal organs usually associated with pregnancy. Cutaneous deciduosis is a highly uncommon manifestation of deciduosis and most commonly is misdiagnosed as a primary malignancy or a metastatic deposit. Typically, it is detected incidentally during operative procedures. It has been rarely documented within a surgical scar; with the incidence of surgically proven deciduosis being approximately 1.6%, and is often difficult to diagnose due to its rarity. Here, we present a case of deciduosis of cesarean scar in a 34-year-old pregnant female.
  PubDate: 2022-06-23
  DOI: 10.4322/acr.2021.383
  Issue No: Vol. 12 (2022)
Loss of an eye to mucormycosis following corticosteroid therapy for
COVID-19
- Authors: Mariana Gonçalves Rodrigues, William Kazunori Sekiguchi, Sérgio Gonçalves, Yuri Reis Casal, Fernando Pereira Frassetto, Vinicius Trindade Gomes da Silva, Marcello Mihailenko Chaves Magri
  Abstract: Mucormycosis is a rare, sometimes severe fungal infection that has emerged as a possible complication of COVID-19. We report a case of a non-diabetic, apparently immunocompetent patient diagnosed with rhino-orbital-cerebral mucormycosis shortly after COVID-19 treatment with dexamethasone. The patient received optimized systemic antifungal therapy and extensive surgical treatment. So far, four months after the last hospital discharge, the patient has been in good general condition. This case is a dramatic reminder that beneficial corticosteroid therapy in general inevitably carries a risk of opportunistic infection, and corticosteroid therapy for COVID-19 risks orbital-rhinocerebral mucormycosis that clinicians should watch for with vigilance.
  PubDate: 2022-06-23
  DOI: 10.4322/acr.2021.345
  Issue No: Vol. 12 (2022)
Fetus in Fetu as a suprarenal mass in a neonate – a rare and
perplexing entity
- Authors: Namratha Ravishankar, Sheeladevi CS, Joxce Pazhayattil
  Abstract: Fetus in fetu (FIF) is a rare entity in which a malformed vertebrate fetus is incorporated within its twin. This entity should be differentiated from a teratoma, which has more malignant potential. We describe a neonate with a heterogeneous calcified suprarenal mass. The aspiration cytology revealed a heterogeneous cell population with spindle cells and small round blue cells. Operative and histopathologic examination showed features consistent with a fetus in fetu. This case report describes a rare entity and discusses its clinical presentation, cytological features on fine-needle aspiration, and the difficulties posed in its differentiation from a teratoma.
  PubDate: 2022-06-23
  DOI: 10.4322/acr.2021.347
  Issue No: Vol. 12 (2022)
Primary peripheral T-cell lymphoma of the cervix with mononeuritis
multiplex: an unusual case presentation
- Authors: Ratul Seal, Mayur Parkhi, Rajesh Kumar, Suvradeep Mitra
  Abstract: Peripheral neuropathy (PN) is characterized by the injury to the peripheral nervous system of varied etiology. Lymphoma is one of the etiologies of PN, presenting various neurological manifestations. Neuropathy associated with peripheral T-cell lymphoma, not otherwise specified (PTCL, NOS) is unusual and fewer cases are documented in the literature. In addition, PTCL, NOS is extremely rare as primary in the female genital tract, especially uterine cervix, and exhibits aggressive clinical course with poor therapy response. We hereby describe a 47-year-old female who presented with fever and chills for 15 days. Clinical examination revealed left-sided lower motor neuron type of facial nerve palsy with Bell’s phenomenon. Nerve conduction study of all four limbs illustrated asymmetrical axonal neuropathy (motor > sensory), suggesting mononeuritis multiplex. She developed vaginal bleeding during her hospital stay. Pelvic examination and imaging revealed a 4x3cm polypoidal mass on the posterior lip of the cervix, which was excised and diagnosed as extranodal primary PTCL, NOS based on morphology, immunohistochemistry, and in-situ hybridization findings. Besides, the cerebrospinal fluid (CSF) was infiltrated by the lymphoma cells, detected on cell block preparation. The patient succumbed to her illness within one week despite best efforts and the commencement of chemotherapy. No consent was obtainable for nerve biopsy and autopsy. Thus, we report an extremely rare case of primary extranodal PTCL, NOS of the uterine cervix with unusual presentation of mononeuritis multiplex. Further, we discussed the differentials of PTCL, NOS at this extranodal site.
  PubDate: 2022-06-23
  DOI: 10.4322/acr.2021.354
  Issue No: Vol. 12 (2022)
Papillary cystadenoma of the epididymis
- Authors: Olga Lopez, Hisham F. Bahmad, Ruben Delgado, Billy H. Cordon, Robert Poppiti, Lydia Howard
  Abstract: Background: Papillary cystadenoma is a rare benign neoplasm of the epididymis. It may occur sporadically or in association with von Hippel-Lindau disease (VHLD). Papillary cystadenoma of the epididymis (PCE) is a benign mimic of metastatic clear cell renal cell carcinoma (CCRCC) given their histologic similarities.
  Case presentation: Herein, we present the case of a 40-year-old man with a four-year history of microhematuria and a recently detected right paratesticular mass. A testicular sonogram revealed a hypoechoic, hypervascular solid mass in the right epididymal head treated by surgical excision. Histopathological examination demonstrated a 1.1 cm papillary cystadenoma of the epididymis. Genetic testing performed later showed no signs of VHLD. However, heterozygous mutations in three genes - CASR, POT1, and RAD51D - were found which have never been reported in PCE before.
  Conclusions: Papillary cystadenoma of the epididymis should always be considered in the differential diagnosis of epididymal lesions, especially those that are cystic. The mainstay of treatment remains surgical excision, which provides an excellent prognosis.
  PubDate: 2022-06-23
  DOI: 10.4322/acr.2021.374
  Issue No: Vol. 12 (2022)
Fibrous hamartoma of infancy with sarcomatous transformation: an unusual
morphology
- Authors: Gargi Kapatia, Debajyoti Chatterjee, Kirti Gupta, Amita Trehan
  Abstract: Background: Fibrous hamartoma of infancy (FHI) is a rare soft tissue lesion arising as a subcutaneous mass involving the axilla, trunk, and upper arm in infants and children <2yrs. Sarcomatous transformation in FHI is described in anecdotal cases in the literature. Case Report: We describe one such example arising as a mass in the lower back in a 3-month-old infant. On histology, the tumor contained classic triphasic morphology; however, brisk mitotic activity noted at multiple foci was diagnostically challenging to categorize. The tumor was evaluated for ETV6-NTRK3 fusion to exclude other common differentials. Conclusion: While FHI may be frequently encountered in infants, rare sarcomatous transformation are known to occur and merits special attention as it can be misdiagnosed. Also, a close follow-up is warranted as the lesion is known to recur locally.
  PubDate: 2022-06-23
  DOI: 10.4322/acr.2021.380
  Issue No: Vol. 12 (2022)
Embryonal tumor with multilayered rosettes in a teenager
- Authors: Kofi Ulzen-Appiah, Kafui Patrick Akakpo
  Abstract: Background: Embryonal tumor with multilayered rosettes (ETMR), NOS/C19MC- altered, is a rare and recently classified highly aggressive malignant brain tumor in the 2021 World Health Organization (WHO) classification of tumors of the central nervous system 5th edition. They are mostly diagnosed in children before the age of three years. Most of them are located in the supratentorial region. Prior to the reclassification of ETMR as a single entity, three distinct tumors, namely, embryonal tumor with abundant neuropil and true rosettes (ETANTR), ependymoblastoma (EBL) and medulloepithelioma (MEPL) were recognized. Recent studies showed that all the three entities have multilayered rosettes on morphology, sharing a common amplification of the C19MC locus at the chromosome 19q13.42 by fluorescence in situ hybridization, and highly specific immunohistochemical staining for LIN28A rendered their reclassification as a single entity. Report: A 13-year-old girl was rushed to the emergency room unconscious, with no return of spontaneous circulation after cardiopulmonary resuscitation. Autopsy revealed a left cerebellar hemisphere hemorrhagic tumor which histopathological examination revealed a multilayered ependymoblastic rosettes with abundant neuropil. The multilayered rosettes showed reactivity for vimentin but non-reactivity for pan-cytokeratin, the zones with abundant neuropil were reactive for synaptophysin consistent with a diagnosis of embryonal tumor with abundant neuropil and true rosettes now ETMR, NOS (WHO Grade 4) due to the lack of genetic testing for amplification of C19MC. Conclusion: ETMR is a highly aggressive CNS embryonal tumor with extremely poor prognosis. It should be considered in the differential diagnosis of pediatric brain tumors. Multilayered rosettes are a useful clue to histologic diagnosis.
  PubDate: 2022-06-22
  DOI: 10.4322/acr.2021.373
  Issue No: Vol. 12 (2022)
Dual pathogen valvular endocarditis in a case of severe aortic aneurysm
- Authors: Meghna Yadav, Rohit Tewari, Tathagata Chatterjee
  Abstract: Infective endocarditis (IE) is the heart valve or endocardium infection. We report a rare case of polymicrobial endocarditis, namely invasive Aspergillus spp and Acinetobacter baumannii, in a 36-year-old male with a medical history of degenerative disease of the aorta with abdominal aortic and ascending aortic aneurysms with a fulminant clinical course and fatal outcome. The treatment was challenging due to multiple comorbidities. The autopsy revealed dual pathogen endocarditis due to Acinetobacter baumannii sepsis and invasive Aspergillus spp mycosis. This report emphasizes that polymicrobial endocarditis (PE) is an infrequent finding with a poor prognosis requiring high clinical suspicion.
  PubDate: 2022-06-22
  DOI: 10.4322/acr.2021.381
  Issue No: Vol. 12 (2022)
Sudden death of an egg donor during oocyte retrieval due to ovarian
hyperstimulation syndrome
- Authors: Swati Tyagi, Asit Ranjan Mridha, Chittaranjan Behera
  Abstract: Ovarian Hyperstimulation Syndrome (OHSS) is uncommon among oocyte donors during in vitro fertilization (IVF) procedure and is rarely associated with death. We report a case of a 23-year-old oocyte donor who suddenly died on the operation table during oocyte retrieval. She had no risk factors in her menstrual history, laboratory, or clinical parameters. The antagonist cycle, triggered with the GnRH agonist protocol, was carried out. The cause of death at autopsy was attributed to respiratory failure due to acute massive pulmonary edema, which developed due to the complication of OHSS. Only a few autopsy cases associated with OHSS have been published, but, as far as we know, no clinical or autopsy cases of sudden death caused by OHSS have been reported.
  PubDate: 2022-06-22
  DOI: 10.4322/acr.2021.385
  Issue No: Vol. 12 (2022)
Congenital Rubella Syndrome as a possible cause for persistent
thrombocytopenia in early infancy: The Forgotten Culprit
- Authors: Jogender Kumar, Venkataseshan Sundaram, Kirti Gupta, Anmol Bhatia, Gurwinder Kaur, Sourabh Dutta
  Abstract: We present a case of a late preterm intrauterine growth-restricted neonate with isolated and persistent severe thrombocytopenia. At birth, the neonate did not have a complete clinical spectrum of congenital rubella syndrome (CRS) but later developed peculiar findings that helped clinch the diagnosis. The neonate also had interstitial pneumonia and died secondary to superimposed acute viral infection leading to acute respiratory distress syndrome. The serology was positive for IgM antibodies against the rubella virus. The constellation of clinical manifestations of congenital rubella in the presence of positive IgM antibody against rubella and consistent histopathology confirmed the diagnosis of CRS.
  PubDate: 2022-06-22
  DOI: 10.4322/acr.2021.386
  Issue No: Vol. 12 (2022)
Epidermoid cyst in an intrapancreatic accessory spleen with abnormally
high CEA level in cyst fluid: a case report
- Authors: Chun-hai Lo, Po-man Tsang, Shui-ying Cheng, Cheuk-nam Ling, Cheuk-lam Ho
  Abstract: Epidermoid cyst in an intrapancreatic accessory spleen is a rare benign lesion that is difficult to diagnose preoperatively. Cyst fluid analysis for biochemistry markers has been widely used to aid the diagnosis of pancreatic cysts. A high cyst fluid carcinoembryonic antigen (CEA) level (>800 ng/mL) is said to be useful in distinguishing intraductal papillary mucinous neoplasm (IPMN) and mucinous cystic neoplasm (MCN) from other non-mucinous cysts. We herein report a case of epidermoid cyst in an intrapancreatic accessory spleen with abnormally high CEA level (3582 ng/mL) in the cyst fluid, suggesting a potential pitfall in using cyst fluid CEA level as an indicator of mucinous neoplasms.
  PubDate: 2022-06-22
  DOI: 10.4322/acr.2021.369
  Issue No: Vol. 12 (2022)
Solid papillary carcinoma of the breast
- Authors: Toyaja Jadhav, Shashi Shekhar Prasad, Bhupesh Guleria, Manvir Singh Tevatia, Prerna Guleria
  Abstract: Solid Papillary Carcinoma (SPC) of the breast is a rare tumor with an incidence of less than 1%, mainly affecting elderly females. It is morphologically characterized by well-defined nodules with low-grade nuclear features associated with fibrovascular cores and shows neuroendocrine differentiation. SPC can be in-situ or invasive but has a favorable prognosis. It is a morphological mimicker of some pre-malignant conditions leading to its frequent misdiagnosis. An appropriate immunohistochemical (IHC) panel workup helps in distinguishing this tumor from its various morphological mimics. In this report, we present one such case of SPC with a small focus of invasion, reviewing the literature.
  PubDate: 2022-06-22
  DOI: 10.4322/acr.2021.352
  Issue No: Vol. 12 (2022)
Invasive cystic hypersecretory carcinoma of the breast
- Authors: Srilata Chitti, Sunayana Misra, Arvind Ahuja, Nikhil Gupta, Raghav Yelamanchi
  Abstract: Cystic hypersecretory carcinoma (CHC) of the breast is a rare variant of ductal carcinoma, characterized by variably sized cysts lined by micropapillary fronds to proliferative pseudostratified columnar epithelium. It includes a spectrum of morphological features ranging from clearly benign cystic hypersecretory hyperplasia (CHH), CHH with atypia to invasive CHC. Only 20 cases of invasive CHC have been reported to date. We report a case of a 49-year-old female who presented with a palpable breast lump and nipple discharge. Gross examination showed variable-sized cysts lined by solid grey white tumors. On microscopic examination, cysts were lined by micropapillary fronds with eosinophilic colloid-like secretion with a focus of invasion. A diagnosis of invasive CHC was made. Since there are limited case reports, our understanding of its biological behavior, prognostic factors, and genetic basis is limited.
  PubDate: 2022-06-22
  Issue No: Vol. 12 (2022)
Myoid differentiation in dermatofibrosarcoma protuberans and its
fibrosarcomatous variant: 10 years’ experience in a tertiary hospital
- Authors: Chun-hai Lo, Po-man Tsang, Shui-ying Cheng
  Abstract: Dermatofibrosarcoma protuberans (DFSP) is a relatively rare, locally aggressive, and dermal-based fibroblastic tumor. There are several histological variants, in which the usual emphasis is on fibrosarcomatous DFSP, as it acquires metastatic potential. Myoid differentiation in DFSP is rare, and more often found in fibrosarcomatous DFSP. Myoid differentiation is defined as tumor cells with brightly eosinophilic cytoplasm, well-defined cytoplasmic margins, and vesicular nuclei. In this study, we aim at characterizing the immunostaining pattern regarding myoid differentiation in DFSP, and discuss the potential pitfall in making the diagnosis. A total of ten cases of DFSP were found in the past ten years in our hospital. Two of them show focal myoid differentiation, including the only case of fibrosarcomatous DFSP. Around 5% of the tumor area in the traditional DFSP case shows myoid differentiation, while around 10% of the tumor area in fibrosarcomatous DFSP shows myoid differentiation. The myoid areas show positive staining, albeit patchy to focal, for smooth muscle markers, including smooth muscle actin, muscle-specific actin, caldesmon, and calponin. Staining for CD34, in those areas, is weak or negative. This may create diagnostic difficulty with smooth muscle tumors or myofibroblastic lesions, especially in a small biopsy sample. In difficult cases, the detection of COL1A1-PDGFB fusion by fluorescence in situ hybridization is helpful, as this is a characteristic chromosomal translocation found in the large majority of DFSP.
  PubDate: 2022-06-21
  DOI: 10.4322/acr.2021.368
  Issue No: Vol. 12 (2022)
Sebaceous breast carcinoma
- Authors: Natália Nobre de Alencar, Diego Agra de Souza, Alexandre Alves Lourenço, Raimunda Ribeiro da Silva
  Abstract: Breast sebaceous carcinoma is one of the rarest breast neoplasms, with less than 30 cases reported worldwide. Due to the rarity, the new WHO classification of breast tumors grouped these tumors among the ductal carcinoma. A detailed description of these cases is relevant due to the insufficient knowledge about the prognosis of this neoplasm. We report the clinical, histological, and immunohistochemical characteristics of a case of sebaceous carcinoma of the breast in an 81-year-old woman with a right breast nodule. The tumor was composed of nests of a varying mixture of sebaceous cells with abundant slightly vacuolated cytoplasm, surrounded by smaller oval-to-fusiform cells with eosinophilic cytoplasm without vacuolization. No lymph node metastases were present. The immunohistochemical reactions were positive for GATA3, EMA, CD15, and GCDFP15 (focal staining), and negative for RE, RP, and HER-2. The tumor was classified as triple-negative. Morphologically, the differential diagnoses included skin sebaceous carcinoma, lipid-rich carcinoma, apocrine carcinoma, and glycogen-rich clear cell carcinoma. Most of the previously reported cases were positive for RE and RP, which generally was associated with a better prognosis. However, some cases presented a more aggressive behavior with distant and lymph node metastases.
  PubDate: 2022-06-21
  DOI: 10.4322/acr.2021.365
  Issue No: Vol. 12 (2022)
The hospital autopsy: the importance in keeping autopsy an option
- Authors: Rachel Scarl, Bryce Parkinson, Vidya Arole, Tanner Hardy, Patricia Allenby
  Abstract: Autopsy has been one of the most powerful diagnostic tools in medicine for over a century. Despite its importance in establishing cause of death and elucidating pathophysiology of disease, rates of hospital autopsies continue to decline. In this study we aim to determine if physicians believe autopsies are essential to patient care through discussion of autopsy with families. At the same time, we analyzed whether families are more willing to consent to autopsy if physicians are involved in autopsy discussion at the time of death, and what may be the reasons for not wanting an autopsy. Our results showed a doubling in autopsy consent when autopsy was discussed by the physician. Additionally, the biggest reason for families not consenting to autopsy was because they believed they already knew what caused death. The emergence of Coronavirus 2019 (COVID-19) has re-established the value of autopsy, as seen by increased autopsy rates in the past year. This study demonstrates that physician conversation with families on autopsy leads to an increased chance of autopsy consent.
  PubDate: 2022-06-20
  DOI: 10.4322/acr.2021.333
  Issue No: Vol. 12 (2022)
Pathology of pulmonary tuberculosis: has the tiger changed it’s
stripes'
- Authors: Heena Maulek Desai, Pradeep Vaideeswar, Manish Gaikwad, Gayathri Prashant Amonkar
  Abstract: Background: India accounts for the highest number of TB cases globally (almost one-fifth of the global burden and almost two-thirds of the cases in South East Asia. Furthermore, the development of drug resistance of varying levels such as multi-drug resistant TB (MDR-TB), extensively-drug resistance TB (XDR-TB) and total-drug resistant TB (TDR-TB) has been on the increase, and now India also features in the 27 high-MDRTB-burden countries. Almost parallel to these developments, in the last few years, we have been encountering less common morphological forms of pulmonary TB (PTB) at autopsies. With these less common manifestations of the disease, we undertook this study to examine the changing trends in the morphological pattern of pulmonary TB over the recent years.
  Methods: In this 3-year retrospective study, adult autopsy cases of PTB (that significantly contributed to the final cause of death) were studied in detail. HIV-positive cases were excluded from the study. The clinical details, gross appearances of the pulmonary lesions, microscopic pattern and Ziehl-Neelsen (ZN) staining were studied. Extrapulmonary involvement and causes of death were documented.
  Results: Pulmonary tuberculosis as a cause of death at autopsy was seen in 130 adult patients over 3 years. The age range was between 12 to 70 years. Anti-tuberculous therapy had been administered in 33 of them, but only one patient had taken complete therapy. Dyspnea was the commonest respiratory symptom seen in 51 cases (39.2%). Tuberculous bronchopneumonia was the commonest lesion (45.3%), miliary lesions (including localized miliary) accounted for 26% while fibrocavitary lesions (including the ones not involving apex) were seen in 13% cases. Other morphologies included nodular forms of TB (13%), localized miliary lesions (11.9%), and fibrocavitary lesions, not necessarily involving the apex (11.7% of all fibrocavitary cases), and predominant pleuritis with underlying lung involvement by TB in 1 case. Many cases of TB bronchopneumonia had a bronchocentric pattern of distribution (14.7%). On microscopy, caseating granulomas were seen in 93% cases, only caseation necrosis was seen in 4.6% cases, and necrotizing granulomas with abscess-like reaction in 11.5% cases. ZN staining was positive in 92 cases (70.7%). All the extrapulmonary lesions showed caseating granulomas histologically. The final cause of death was found to be primarily tuberculous in 106 cases (81.5%), whereas in 24 cases (19.5%) pulmonary TB was attributed to the secondary cause of death.
  Conclusion: The typical apical involvement of secondary TB was not seen in most of our cases. This could indicate a difference in the morphology and the pattern of lung involvement in recent years. The difference in gross morphology does not affect the pattern of involvement of the lung. In our study, we have observed both; a change in morphology, i.e., more cases of TB bronchopneumonia, and a change in the pattern of involvement like nodular forms, localized miliary forms, and fibrocavitary lesions not necessarily involving the apex. We postulate that this less common manifestation of pulmonary TB is closely related to the development of multi-drug and microbial resistance posing serious medical challenges.
  PubDate: 2022-06-20
  DOI: 10.4322/acr.2021.370
  Issue No: Vol. 12 (2022)
Cytomegalovirus pneumonia presenting as pulmonary nodules
- Authors: Janet Basinger, Meghan E. Kapp
  Abstract: Cytomegalovirus (CMV) pneumonia is a well-known cause of morbidity and mortality in patients with a history of allogenic hematopoietic stem cell transplant. Radiographically, CMV pneumonia most commonly presents as bilateral ground glass opacities; however, the presentation is non-specific and can be variable, including presenting as areas of air-space consolidation or pulmonary nodules. We report a case of a 70-year-old man who presented with rapidly progressive bilateral pulmonary nodules approximately two months after receiving a bone marrow transplant. No infectious etiology was identified for the pulmonary nodules, and a bronchoscopy was unable to be performed due to a rapid decline in the patient’s overall condition and respiratory status. The patient died shortly after the decision was made to transition to palliative care and a limited autopsy was performed to explore the pulmonary findings. Corresponding to premortem imaging were the postmortem gross findings of numerous bilateral pulmonary nodules and a large mass-like area of consolidation in the right upper lobe. Microscopic examination of the nodules demonstrated a necrotizing pneumonia with few foci of viral cytopathologic change consistent with CMV, which was confirmed by immunohistochemistry. While CMV is a common infectious agent in the immunocompromised population, CMV pneumonia continues to be a challenging entity due to difficulty in diagnosis and treatment. Rapidly enlarging pulmonary nodules in an immunosuppressed patient is highly suggestive of an infectious process and careful histologic examination for viral cytopathologic change is essential.
  PubDate: 2022-06-20
  DOI: 10.4322/acr.2021.362
  Issue No: Vol. 12 (2022)
Hypoxic hepatitis as a complication of newly diagnosed type 1 diabetes in
a teenager
- Authors: Kamil Buczkowski, Irena Ożóg-Zabolska, Jacek Gulczyński, Ewa Iżycka-Świeszewska
  Abstract: Hypoxic hepatitis is a rare complication of type 1 diabetes with unknown prevalence in Pediatrics. We present a case report of an 11-year-old boy admitted to the ER in the spring of 2020 (the beginning of the COVID19 pandemic in Poland) due to nausea, abdominal pain, and weight loss. A diagnosis of type 1 diabetes accompanied by severe ketoacidosis (pH 6.9, blood glucose 632mg/dl, ketone bodies in urine – 150mg/dl) was made. The hyperglycemia, ketoacidosis, and water-electrolyte disturbances were treated in the Pediatric Intensive Care Unit. On day 4, the boy developed fulminant septic shock with high aminotransferases (AST 9026 U/l, ALT 3559 U/l). CT scan revealed hepatic enlargement and steatosis. Acute viral hepatitis was suspected. The levels of anti-CMV IgM and IgG antibodies were slightly elevated. At autopsy, the liver was enlarged, with petechial bleedings on the surface. The liver parenchyma was congested, with signs of steatosis. Microscopically, there was extensive centrilobular necrosis, acute passive sinusoidal congestion, and steatosis of hepatocytes. There were no signs of CMV infection. Based on the entire clinicopathological picture, the patient was diagnosed with hypoxic hepatitis, complicated by septic shock and multiple organ failure.
  PubDate: 2022-06-20
  DOI: 10.4322/acr.2021.372
  Issue No: Vol. 12 (2022)
The importance of autopsies despite the declining number amidst the
COVID-19 pandemic
- Authors: Monika Bhatt, Mani MovaseghiGargari, Momal T Chand
  PubDate: 2022-06-20
  DOI: 10.4322/acr.2021.371
  Issue No: Vol. 12 (2022)
A gastric ulcer: double trouble
- Authors: Pauline Verhaegh, Hajo Flink, Alette Daniels-Gooszen, Clément Huysentruyt, Erik Schoon
  PubDate: 2022-06-20
  DOI: 10.4322/acr.2021.376
  Issue No: Vol. 12 (2022)
Peutz-Jeghers syndrome: revisited
- Authors: Vitorino Modesto dos Santos, Lister Arruda Modesto dos Santos, Laura Campos Modesto
  PubDate: 2022-06-20
  DOI: 10.4322/acr.2021.384
  Issue No: Vol. 12 (2022)
Type A aortic dissection
- Authors: Gabriele Gaggero, Luca Valle, Jacopo Ferro, Davide Taietti
  PubDate: 2022-06-20
  DOI: 10.4322/acr.2021.346
  Issue No: Vol. 12 (2022)
Extraventricular neurocytoma
- Authors: Gabriele Gaggero, Luca Valle, Jacopo Ferro, Davide Taietti, Bruno Spina
  PubDate: 2022-06-20
  DOI: 10.4322/acr.2021.348
  Issue No: Vol. 12 (2022)
Porencephalic cyst in adult
- Authors: Stefano Tambuzzi, Guendalina Gentile, Riccardo Zoja
  PubDate: 2022-06-20
  DOI: 10.4322/acr.2021.351
  Issue No: Vol. 12 (2022)
Neuro-toxoplasmosis and fatal necrotizing cerebellitis
- Authors: Gabriele Gaggero, Michela Campora, Beatrice Dose, Davide Taietti, Antonio Vena, Emanuele Delfino
  PubDate: 2022-06-20
  DOI: 10.4322/acr.2021.363
  Issue No: Vol. 12 (2022)
Primary hepatic angiosarcoma in an elderly patient
- Authors: Mayur Parkhi, Aravind Sekar
  PubDate: 2022-06-20
  DOI: 10.4322/acr.2021.364
  Issue No: Vol. 12 (2022)
Pilomatricoma in the neck of an adult male
- Authors: Kofi Ulzen-Appiah
  PubDate: 2022-06-20
  DOI: 10.4322/acr.2021.379
  Issue No: Vol. 12 (2022)
ERRATUM: Partial retraction of “Dyskeratosis congenita” [Autops Case
Rep 10(3) (2020) e2020203]
- Authors: Autopsy; Case Reports
  Abstract: Due to a desktop publishing error, the partial retraction notice “Partial retraction of “Dyskeratosis congenita” [Autops Case Rep 10(3) (2020) e2020203]” (
  DOI https://doi.org/10.4322/acr.2021.341), published in Autops. Case Rep. 11, 2021, was published with an error.
  Where the text reads:
  Gitto L, Stoppacher R, Richardson TE, Serinelli S. Dyskeratosis congenita. Autops Case Rep [Internet]. 2021;11:e2021341. https://doi.org/10.4322/acr.2021.341
  It should read:
  Gitto L, Stoppacher R, Richardson TE, Serinelli S. Dyskeratosis congenita. Autops Case Rep [Internet]. 2020 Jul-Sep;10(3):e2020203. https://doi.org/10.4322/acr.2020.203
  The publisher apologizes for the errors.
  PubDate: 2022-06-20
  Issue No: Vol. 12 (2022)
ERRATUM: Fatal hemorrhage from peripheral varicose vein rupture
- Authors: Autopsy; Case Reports
  Abstract: Due to copyediting error the article “Fatal hemorrhage from peripheral varicose vein rupture” (
  DOI https://doi.org/10.4322/acr.2021.330), published in Autops. Case Rep, 11, 2021, was published with an error in the author's name in How to cite.
  On How to cite, where the text reads:
  How to cite: Gentile G, Tambuzzi S, Boracchi M, Gobbo A, Bailo P, Zoia R. Fatal hemorrhage from peripheral varicose vein rupture. Autops Case Rep [Internet]. 2021;11:e2021330. https://doi.org/10.4322/acr.2021.330
  It should read:
  How to cite: Gentile G, Tambuzzi S, Boracchi M, Del Gobbo A, Bailo P, Zoia R. Fatal hemorrhage from peripheral varicose vein rupture. Autops Case Rep [Internet]. 2021;11:e2021330. https://doi.org/10.4322/acr.2021.330
  The publisher apologizes for the errors.
  PubDate: 2022-06-20
  Issue No: Vol. 12 (2022)
ERRATUM: [Article Partial Retraction] Dyskeratosis congenita
- Authors: Autopsy; Case Reports
  Abstract: Due to a desktop publishing error, the retraction notice added to article “Dyskeratosis congenita” (
  DOI https://doi.org/10.4322/acr.2020.203), published in Autops. Case Rep. 10 (3); 2020, was published with an error. On the retraction notice, where the text reads: Gitto L, Stoppacher R, Richardson TE, Serinelli S. Dyskeratosis congenita. Autops Case Rep [Internet]. 2021;11:e2021341. https://doi.org/10.4322/acr.2021.341 It should read: Gitto L, Stoppacher R, Richardson TE, Serinelli S. Dyskeratosis congenita. Autops Case Rep [Internet]. 2020 Jul-Sep;10(3):e2020203. https://doi.org/10.4322/acr.2020.203 The publisher apologizes for the errors.
  PubDate: 2022-06-20
  Issue No: Vol. 12 (2022)
Fatal adult-onset diaphragmatic hernia in the context of the COVID-19
pandemic
- Authors: Ajith Antony, Sheryl Suares, André Victor Fernandes
  Abstract: Late-presenting or “Adult-Onset” Diaphragmatic Hernia is uncommon, especially in individuals with no history of trauma. The non-traumatic diaphragmatic hernia may be a Congenital Diaphragmatic Hernia [CDH] lately manifested as a sequela to an iatrogenic intervention or prolonged infections. We aim to explore the genetic correlations in “adult-onset” CDH, with an insight into the indirect contribution of the COVID-19 pandemic towards the fatal outcome.In this report, we present a case of an adult female who died from the complications of an undiagnosed adult-onset diaphragmatic hernia, deemed completely preventable, if not for the global COVID-19 pandemic. There was no prior history of physical trauma or medical history of any relevance.Early diagnosis and rapid surgical intervention remain the keystone management for successfully treating individuals affected by this entity. The decedent in question presented with symptoms demanding hospital stay for investigations that would have aided in timely diagnosis and prevented death. However, the excessive fear of COVID-19 prevented the patient from undergoing hospitalization and follow-up, delaying the diagnosis and leading to death.
  PubDate: 2022-03-28
  DOI: 10.4322/acr.2021.366
  Issue No: Vol. 12 (2022)