Perinatal and Fetal Autopsies in Neuropathology: How I do it

Fetal and perinatal autopsies are useful to identify the accurate cause of death and in the process recognize disorders which may require counselling for future pregnancies. Abnormalities of the CNS are an important cause of fetal loss and perinatal deaths. Most of these are structural abnormalities of the CNS, however a smaller portion show changes pertaining to prematurity, infections and even congenital tumors. In this review we evaluate CNS abnormalities of the fetus and the newborn as detected in autopsy series. We also describe our experience in a tertiary care hospital with a specialized neonatology unit over the last 8 years and discuss some of the newer methods like virtual autopsy.

A prospective study to assess the predictive factors of radiation-induced oral mucositis in head-and-neck carcinoma and its impact on treatment outcome: Long-term results and lessons learned

Background: Radiation-induced oral mucositis (RIOM) is one of the major dose-limiting toxicities in head-and-neck cancer patients. It is due to normal tissue damage by radiation. It is a potential hazard to treatment delivery as it threatens to alter the therapeutic ratio. The radiation oncologist must find a way to balance between tumor control and sparing of normal mucosa to validate the age-old principle of cancer treatment. The onus lies on them to find the contributory factors to curb them accordingly. Objective: The objective of the study was as follows: (1) To find out the factors associated with RIOM in head-neck squamous cell cancer (HNSCC) and (2) to assess the impact of the RIOM on treatment outcome. Materials and Methods: This was a single-institutional, prospective, non-randomized, and open-label study. All cases were treated after informed consent and tumor board approval. This was an observational study with standard treatment according to the stage of the disease. Results: Tumor site, poor oral hygiene, modality of radiation, addiction, and fractionation appeared to be the significant predictive factors of RIOM in HNSCC. Conclusion: This study helps to identify the contributory factors and gives a comprehensive understanding of the same. More multi-institutional subsite-specific studies are warranted to validate the same.

Thoracopagus: Autoptic and radiologic study of 2 cases

Conjoined twins are a very rare complication of monozygotic twinning, most common being thoracopagus. Here we report about two cases of thoracopagus male twins illustrating the autopsy details of one case and the prenatal magnetic resonance imaging (MRI) details of another case. While the first case was misdiagnosed as separate twins on antenatal USG, only to be later confirmed as thoracopagus twins after birth, the antenatal MRI done in the second case helped in accurate detection of thoracopagus twins. Bilateral peripheral cortical cysts with dysplasia was noted in one of the twins of the first case, which has not been reported earlier in conjoint thoracopagii. Early prenatal diagnosis of conjoined twins is essential for better counselling of parents regarding post natal surgical management or termination of pregnancy. Importance of prenatal MRI for accurate detection of these cases is thereby highlighted.

Glomerulocystic disease, a rare cause of renal cysts in infants: A series of three cases

Glomerulocystic kidney disease (GCKD) is an uncommon type of cystic renal disease affecting children. It has both sporadic and familial occurrence and is characterized by cortical microcysts associated with dilatation of Bowman's spaces. In some instances, GCKD is an early manifestation of autosomal dominant polycystic kidney disease. Here, we present three cases of GCKD, two in infants and one in a perinatal postmortem. The first one is a case of GCKD with unilateral involvement, diagnosed on surgical biopsy. GCKD is a morphological expression of several hereditary and nonhereditary disorders that differ vastly in their management and long-term outcome. Hence, accurate morphological diagnosis of this entity is important for prognostication and genetic counseling.

A study of spectrum of pulmonary pathology and expression of thyroid transcription factor-1 during neonatal period

Context: Neonatal period is the single most hazardous period of life. The major causes of neonatal death are prematurity and respiratory distress syndrome. We report a series of neonatal autopsies in our Neonatal Intensive Care Unit with special emphasis on pulmonary pathology. The spectrum of pathological changes in the lungs and thyroid transcription factor-1 (TTF-1) expression was studied in detail with reference to its spatial distribution. Aims: This study aims to analyze the causes of neonatal death with special attention to pulmonary pathology along with associated histopathological changes in lungs. We also evaluated the expression of TTF-1 at different levels of the airway. Materials and Methods: After taking consent and anthropometric measurements, autopsy was performed. Weights of all organs were taken, and histological sections were examined under hematoxylin and eosin stain. TTF-1 immunostaining was done on lung sections. Localization of TTF-1 was evaluated at the intrapulmonary level of terminal bronchioles (TBs), distal bronchioles, and alveoli. Results: We performed a series of 25 autopsies in neonates. In our series, most of the neonates were preterm (64%), had low birth weight (44%), and died within the first 7 days of life (80%). Majority (60%) of the neonates died due to pulmonary causes, followed by septicemia (24%), congenital anomalies (12%), and birth injury (4%). Among the respiratory causes, hyaline membrane disease (HMD) was diagnosed in maximum number of cases (32%), followed by pneumonia (12%) and pulmonary hemorrhage (12%). The TTF-1 expression in TBs, distal airways, and alveoli was significantly reduced or absent in cases of HMD compared to the control group. Conclusions: In this study, we observed that HMD is the most common cause of perinatal death among respiratory disorders, and in this disease, the expression of TTF-1 is significantly reduced in TBs, distal airways, and alveoli compared to the control group.

Emerging Plasmodium falciparum in an endemic area in Calcutta.

Calcutta is now intensely malarious. Malarial infections are detected in every month. In an endemic area in central Calcutta a year-long study from August 1996 to July 1997 reveals that 31.47% of all cases are due to Plasmodium falciparum infection. A competition is going on between P vivax and P falciparum to gain upperhand. An equilibrium is there in the month of January (1997), when P vivax and P falciparum cases constitute 51.13% and 49.43% respectively. The highest and lowest percentage of P falciparum infection is in December 1996 (67.98%) and in May 1997 (0.89%) which is just reverse in the case of P vivax in December 1996 (33.60%) and in May 1997 (99.10%). Three imported cases of P malariae have been detected but the patients cannot be traced. Six cases of mixed infections have been found.