Autopsy findings in sudden death in adults: a study of 150 cases

Background: World Health Organization (WHO) defines sudden death as “deaths within 24 hours from the onset of the symptoms”. It is also defined as death, which is sudden, unexpected, clinically unexplained. Aims of the study was to classify underlying causes of sudden death, to find out risk factors, associated diseases and triggers of sudden deaths in the autopsy specimens received in the Department of Pathology, Government Medical College, South Gujarat.Methods: A review of autopsies of sudden deaths performed between January 2018 to August 2018 in age group 15-45 years at Department of Pathology, Government Medical College, South Gujarat were done.Results: A total of 150 cases were studied for sudden deaths during the study. The age ranged from 15 to 45 years. Maximum deaths occurred in the age group between 35-45 years. Males (n=120) were affected more than females (n=30). The cause of deaths in 84 cases (56%) were attributed to cardiac causes and the remaining cases (44%) were due to noncardiac causes like pulmonary diseases (17.3%) followed by hepatobiliary diseases (5.4%), cerebrovascular (2%) and others like suicide by ingestion of poisoning, hanging and asphyxia (9.3%). Major cardiac cause for sudden deaths was Coronary Artery Disease (CAD) (95.2%).Conclusions: Sudden deaths were common in young adults and most are attributed to a cardiac cause. This study highlights the serious health concern in our society and a necessity to create awareness among the population at risk so that sudden deaths can be averted and life expectancy can be improved.

Parasites found in surgical pathology: the institutional experience

Background: Parasitic infestation has a worldwide prevalence and it affects almost all age groups and both the sexes. The incidence of these infections is slowly rising in today’s era. Parasites are mainly found in stool samples but due to increase in a immunocompromised state now a days, tissue parasitaemia has increased globally necessitating more such type of studies. Parasite found in surgical pathology either incidentally or in clinically suspicious cases not only improves morbidity but also saves clinician’s time and patient’s money.Methods: A retrospective-cross sectional study is done based on histomorphological and cytomorphological evaluation of 25 cases diagnosed at The Department of pathology, New Civil Hospital Surat from January 2015 to January 2017.Results: Most common parasite seen was Echinococcus presenting as hydatid cyst in liver followed by filariasis. Most common age group affected was 0-20 years of age. Most common intestinal parasite found in our study was Entamoeba histolytica. Patients presented with variety of symptoms.Conclusions: Distribution of parasite in tissue section in relation to frequency, age, sex, various system involvements and its correlation with clinical symptoms are analyzed in our study.

A rare case of multilocular cystic renal neoplasm of low malignant potential diagnosed on intra-operative fine needle aspiration cytology

Multi-locular Cystic Renal Cell Carcinoma (MCRCC) is now considered as Multilocular cystic renal neoplasm of low malignant potential (MCRNLMP) in World health organisation classification (WHO) 2016. It is usually seen in elderly people where it can mimic most of the time as benign cystic lesion. Authors are reporting a case of MCRNLMP in a 70 year male diagnosed intraoperative with the help of Fine Needle Aspiration Cytology (FNAC). Radiological and other clinical findings are in favour of cystic renal lesion. And it is very important to differentiate it from conventional renal cell carcinoma which requires radical nephrectomy. So, radiological finding and FNAC is instrumental in diagnosing this rare case which require different mode of surgical management.

A rare case report of multifocal origin of dermatofibrosarcoma protuberans diagnosed on cytology.

Dermatofibrosarcoma protuberans (DFSP) is a relatively uncommon soft tissue neoplasm of cutaneous fibrous tissue with low to intermediate grade malignancy. Most of this tumour is focal origin; however the sequential occurrence of the two masses over breast and inguinal region in our case probably represents multifocal origin rather than metastases. To the best of our knowledge case of DFSP having multifocal origin as was our case, have rarely been documented in the literature.

Thrombocytopenia in malaria: Correlation with various prevalent species.

Background: Most of the patients suffering from malaria shows reduced Red cell count, leukopenia and varying degree of thrombocytopenia but it is rarely associated with haemorrhagic manifestations. Aims & Objective: This study was undertaken to correlate the incidence and severity of thrombocytopenia with the prevalent species of malaria. Material and Methods: Total 1480 Patients were included in this study after positive identification on PSMP. Platelet count was done by haematology analyser (Sysmax Kx 21). Results: Incidence of thrombocytopenia was seen in 83.80% and 74% cases of P. falciparum and P. vivax malaria respectively. Severe thrombocytopenia in P. falciparum was found in 7.70% cases while in P. vivax 3.67% cases. No difference was observed in incidence of thrombocytopenia in both age groups in relation to both prevalent species. In paediatric age group, significant leukopenia was found in 22.22% Cases of P. falciparum in comparison to P. vivax (14.96%). Hb less than 10 mg/dl was found in 66.11% cases in P. Falciparum while in P. vivax it was found in 40.13% cases. In adults leukopenia was found in 27.46% Cases of P. falciparum in comparison to P. vivax 22.61% cases. Hb less than 10 mg/dl was found in 41.28% cases in P. falciparum while in P. vivax it was found in 28.57% cases. Conclusion: Severe thrombocytopenia is commonly associated with P. falciparum malaria however severe thrombocytopenia also observed in P. Vivax malaria. In both species of malaria significant number paediatric patients present with low Hb level compared to adults. In P. vivax malaria significant number of adult patients presented with leukopenia as compared to paediatric patients.

Improved diagnosis of tuberculosis in lymph node cytology by bleach method for detection of acid fast bacilli in comparison to conventional ziehl neelsen staining method.

Background: Extra pulmonary tuberculosis (TB) is prevalent in developing countries and its diagnosis is often delayed, thus increasing the morbidity and mortality. Bleach method is cost effective, sensitive and safe method for demonstration of Acid fast bacilli (AFB) and is very valuable in diagnosing a case of tuberculous lymphadenitis. This simple procedure would benefit the patients to receive an early and specific treatment. Aims & Objective: The aim of our study was early diagnosis of tuberculosis in lymph node Fine needle aspiration cytology (FNAC) by bleach method for detection of AFB in comparison to conventional Ziehl–Neelsen (ZN) method. Material and Methods: Total 115 cases clinically suspected as tuberculous lymphadenitis in one year duration were included in study. All the aspirates by FNAC were processed for routine cytology, ZN staining and bleach method. The significance of the bleach method over the ZN method was analyzed using the χ2 (chi-square) test. Results: Among the 115 aspirates, 59.13% (68/115) were indicative of TB on cytology, 27.83% (32/115) were positive for AFB on conventional ZN method and the smear positivity increased to 61.74% (71/115) on bleach method. Conclusion: The implementation of the bleach method clearly improves microscopic detection of AFB over ZN method. The bleach method can be easily performed and reduce chances of laboratory acquired infections.

Study of metastasis in lymph node by fine needle aspiration cytology: our institutional experience.

Background: Fine needle aspiration cytology (FNAC) is a reliable as well as an inexpensive diagnostic method. It is suitable for the developing countries for the diagnosis of lymphadenopathy at any approachable site. Fine needle aspiration cytology not only confirms the presence of metastatic disease but also, in most cases, gives the clue regarding the origin of the primary tumor, prognosis as well in the management of patient for staging purposes. The aim of the study was to detect and diagnose metastasis in lymph nodes. Methods: A study was done of all metastatic lymph node lesions reported in Department of Pathology, Govt. Medical College, Surat from May 2011 to April 2012. Results: A total of 2355 cases of fine needle aspiration cytology were carried out of which 580 cases were of lymph node. Cytology results were positive for metastasis in 157 specimens (27.06%). The most common site was cervical lymph nodes. Maximum numbers of cases of metastatic tumors were in 41-50 yrs age group. There were 115 males and 42 females with a male predominance (Male:Female= 2.8:1). The most common malignancy was squamous cells carcinoma, seen in 118 cases (75.15%), followed by metastatic mammary carcinoma (13 cases, 8.29%). In 26 cases out of 580 cases, histopathological confirmation was done and diagnostic accuracy of FNAC was 100%. Conclusions: Fine needle aspiration cytology of lymphadenopathy is a useful tool in diagnosing metastatic lesions with good certainty.

Characteristic and trends of malaria in Surat district of Gujarat: a hospital based study.

Background: Malaria is a major health problem and infects many individuals despite of various efforts to control it. The present study was aimed to observe characteristics of malaria, seasonal variation and prevalence of malaria in our region. Methods: This retrospective study was conducted in our institute from period of January 2012 to December 2012. All the fever cases undergone investigations for malarial parasites were included in present study for defined time period. All the laboratory data of the patients having fever were retrieved from the Pathology Laboratory of our institute. Results: out of total 32674 reports studied 4907(15.01%) were positive for malaria with overall Slide positivity rate and slide falciparum rate were 15.01% and 38.29% respectively. Incidence of malaria occurs throughout year with increased incidence of P. falciparum in monsoon. Conclusion: In the present study incidence of malaria was higher in monsoon in comparison to other seasons. But throughout the year no declining trends in incidence of malaria was observed. P. vivax malaria was more commonly observed in our study but incidence of P. falciparum increased in monsoon.

Vasoocclusion by sickled RBCs in 5 autopsy cases of sudden death.

Mortality in sickle cell disease is high at young age group. So it is necessary to find out the cause of death in young patients with sickle cell disease. We are presenting 5 cases of sudden death in young adults with undiagnosed sickle cell disease. The provocative factors for those terminal events were vasoocclusive crisis. In our patients crisis was secondary to fever (infection), conductive arrhythmia, cardiovascular collapse, post partum shock and hemorrhage. On microscopic examination of viscera, not a single patient showed signs of chronic organ damage, sequestration crisis or acute chest syndrome, which are the common causes of death in sickle cell disease.

Relationship of oral cancer with age, sex, site distribution and habits.

Many studies are carried out regarding age incidence, tobacco smoking and sites of oral cancer, but in Gujarat tobacco chewing in form of Gutkha is more common than smoking and start during preteen years. Tobacco chewing causing chronic inflammation, submucous fibrosis and oral cancer. This study was conducted on 504 patients to find out if there is increasing incidence of oral cancer in lower age group and its relation with sex as well which site was commonly affected. There was statistically significant increase in oral cancer in lower age group, and anatomically anterior part of oral cavity showed involvement in 61.32% of cases. Though males were affected more but female cases were 25%. So tobacco chewing has got detrimental effect on oral cavity.

Left shoulder region metastasis from hepatocellular carcinoma as an initial presentation--a case report.

Hepatocellular carcinoma metastasis as a soft tissue mass is rare; we came across a 65 years old female who presented with a left shoulder region mass. There was no previous history of any liver disease and liver function tests were normal. Histologically, it turned out to be a metastasis from hepatocellular carcinoma.