An Uncommon Primary Tracheal Tumor Masquerading as Chronic Obstructive Pulmonary Disease: Diagnosed at Autopsy.

Primary tracheal tumors are rare neoplasms and often are hard to diagnose early due to the non-specific clinical presentations. Prolonged symptomatic treatment for these can often lead to missing out the diagnosis and can prove fatal. A 35-year-old male presented with gradually increasing breathlessness and dysphagia to solids and was being treated with bronchodilators and antibiotics. Chest computed tomography (CT) revealed an intratracheal mass in the lower part of the trachea and the patient was referred to our institution in view of a primary tracheal tumor where he expired within 10 min of admission. On autopsy, the gross findings and histological examination revealed a diagnosis of adenoid cystic carcinoma in the trachea. To conclude, primary tracheal tumors, even though rare, should be suspected in cases of refractory chronic obstructive pulmonary disease and chest CT and bronchoscopy must be done to aid correct diagnosis.

Creutzfeldt-Jacob disease: An autopsy case report in tertiary care hospital.

Sporadic Creutzfeldt-Jakob disease (CJD) is the most common prion disease. It is a rare, fatal neurodegenerative disease caused by an infectious protein called prion. The diagnosis can be confirmed only by histological examination of brain tissue. Because of the transmissible nature of the disease, autopsy or brain biopsy cannot be performed at many institutions. Histology shows spongiform changes, neuronal loss, reactive astrocytic proliferation, accumulation of pathologic protein occurring in three general forms: Sporadic, familial, and acquired form, including a variant form of CJD. It clinically presents as predominantly progressive dementia with a rapid onset, myoclonus, cerebellar, pyramidal, extra pyramidal and visual signs. Occurrence of periodical spikes in electro-encephalogram, observation of cortical signal alterations in magnetic resonance imaging (MRI) studies, and detection of protein 14-3-3 in cerebrospinal fluid substantiate diagnosis. Autopsy case is presented of a 50 year old woman with progressive dementia, typical neurological symptoms, MRI findings and confirmation of CJD on histology and immunostaining.

Sudden, unexpected and natural death in young adults of age between 18 and 35 years: A clinicopathological study.

Context: To identify various causes, risk factors, age and sex distribution associated with sudden and unexpected natural deaths (SUNDs) in young adults of age between 18 and 35 years. Materials and Methods: Retrospective analysis of autopsy reports and medical records of all SUNDs that occurred instantaneously or within 24 hours of onset of symptoms in young adults, between 2001 and 2009. Result: Of the total 6453 deaths autopsied during 2001-2009, 64 (0.99%) were SUNDs in young adults, chiefly in males between 30 and 35 years of age. Non-cardiac causes significantly predominated (73.4%) over cardiac causes (7.8%). Most of the SUND cases were due to preventable causes, including infections (54.6% cases), cerebrovascular accidents (9.37%) and ischemic cardiac causes (6.25%). Sudden adult death syndrome (SADS) accounted for 18.75% deaths. Conclusion: SUND in young adults is preventable. A meticulous post-mortem examination with special attention to the conduction system of heart and detailed toxicological analysis can pinpoint the cause of death in SADS.

Fatal thyrotoxic periodic paralysis with normokalemia.

We present a 10-year-old girl who presented to our emergency services with difficulty in breathing of 2-days duration and progressive weakness of a month's duration. In a previous admission elsewhere, she had not been detected to have hyperthyroidism or electrolyte abnormalities. On admission, the child was in hypercapnic respiratory failure with tachycardia and hepatomegaly. A small goiter as well as signs of thyrotoxicosis were present. Laboratory investigations showed anemia, mildly elevated liver enzymes and serum potassium of 4.8mEq/L. Despite intubation and ventilation and other supportive management including propranolol, the patient could not be saved. Post-mortem biopsy of the thyroid showed diffuse hyperplasia of the follicles and muscles showed evidence of thyroid myopathy.