Idiopathic Lipoid Pneumonia: An incidental finding in autopsy specimen

Phosphorus is a nonmetallic irritant used in various sectors like rodenticide, firecracker industries, match industries, and fertilizers. Phosphorus poisoning is responsible for deaths among children and adults. Accidental yellow phosphorus poisoning is frequently reported in children, whereas suicidal consumption is not uncommon amongst adults. Herein, we present the case of a 30-year-old female patient who ingested Ratol paste containing yellow phosphorus in an attempt to commit suicide. Her initial chief complaints were nausea, vomiting along with loose motion during hospitalization, followed by a symptomless phase with stable vitals on the 2nd day, and managed conservatively. She took discharge against the medical advice. Later on, she was readmitted in the same hospital, after two days, complaining of generalized weakness, bodily pain, drowsiness, loss of appetite, and breathing difficulties. She developed severe complications due to the intoxication and died. An autopsy was performed. The histopathological and the toxicological examination were carried out. We found characteristic features in different organs due to yellow phosphorus toxicity. We concluded the cause of death as hepatic encephalopathy and multi-organ dysfunction syndrome caused by the yellow phosphorus poisoning.

Atherosclerotic changes in aorta and coronary arteries at autopsy in North Indian population

Background: Cardiovascular disease (CVD) has become a ubiquitous cause of morbidity and a leading contributor to mortality in most countries. It has emerged as a major health burden worldwide with atherosclerosis being the major cause.Methods: 150 random cases of different age groups brought for postmortem examination in the Department of Forensic Medicine PGIMS, Rohtak. Heart was removed and examined after obtaining the consent of next of the kin of the deceased. Gross macroscopic changes were noted and microscopic changes examination was done and reported by preparation of slides in collaboration with Department of Pathology of the Institute.Results: The study group comprised of mostly males (70%) with mean age of 36.90±13.88 years. Almost half of them were in their third and fourth decade of life. 83 cases were found to have atherosclerosis and 25 of them belonged to the age group 40 to 49 years. 82 % of these cases were of male gender. Histopathological grading carried out displayed that Grade III lesions were maximum (27.5%) followed by grade IV lesions (19.0%) and in no section grade VIII lesions were seen.Conclusion: Atherosclerosis has emerged as a new epidemic affecting at a relatively younger age. This study would help in planning of preventive measures directed at the right population. Clinicians could take measures at an early stage to prevent the progression of the disease and will help forensic pathologists in dealing with opinion regarding cause of death.

Disseminated invasive aspergillosis in a prolonged stay in the intensive care unit

Aspergillus is a common cause of invasive mycosis, especially in immunocompromised individuals. We report the case of a 62-year-old male who was hospitalized after suffering severe physical injuries and died after few weeks of hospitalization. A medicolegal autopsy was conducted, and various organs were sent for histopathological examination of which heart, lungs, and kidneys showed extensive involvement by aspergillus. Thus, a diagnosis of disseminated invasive aspergillosis was made on autopsy, which itself is a rare entity. This case report illustrates a prolonged stay in the intensive care unit as a possible risk factor for the development of disseminated aspergillosis.

Correlation of gallstone characteristics with mucosal changes in gall bladder.

Background and aim: Gallstones are known to produce diverse histopathological changes in the gall bladder. Our aim was to correlate various gallstone characteristics (number, size, weight, volume and morphological type) with the type of mucosal response in gall bladder (inflammation, hyperplasia, metaplasia and carcinoma). Methods: The study was conducted on 330 open cholecystectomy specimens with complete gallstones. The stones were assessed for various parameters i.e. number, size, weight, volume and morphological type. For microscopy, sections were obtained from the fundus, body and neck of the gallbladder. Additional sections were taken from abnormal looking areas. Results: Out of the 330 cases, 194 (59%) had mixed stones, 84 (25%) combined, 30 (9%) pigment and 22 (7%) had cholesterol stones. Number of stones varied from a single calculus in 131 (39.6%) cases, double in 29 (8.8%) and multiple in the remaining 170 (51.6%) cases. Cholecystitis, hyperplasia, metaplasia and carcinoma were more commonly seen with mixed and multiple stones. The average weight of calculi in cholecystitis was 2.551 gm, in hyperplasia 3.619 gm, metaplasia 4.549 gm and 17.96 gm in cases with carcinoma. Similarly, average volume of the stone(s) was 2.664 ml in cholecystitis, 3.742 ml in hyperplasia, 4.532 ml in metaplasia and 19.178 ml in carcinoma. The average calculus size (2.147 cm) was found to be maximum in cases with carcinoma, followed by hyperplasia (1.187 cm), metaplasia (1.145 cm) and cholecystitis (1.136 cm). Conclusion: As the weight, volume and size of the stone increases the changes in the gall bladder mucosa changes from cholecystitis, hyperplasia, metaplasia, dysplasia, to carcinoma.

Profile of Erythroblastopenia in Childhood.

Bone marrows of hospitalized children with anaemia were examined to study the incidence and profile of erythroblastopenia in childhood. Forty children aged between 7 months to 12 years with anaemia, reticulocytopenia and isolated erythroblastopenia on Bone marrow aspiration were evaluated during 2 years duration. Depending on duration of illness and their recovery the disease was categorized into acute, subacute and chronic erythroblastopenia. The disease was found to be associated with PEM and nutritional anaemia (55%), gastroenteritis (12.5%) and respiratory tract infections (12.5%) amongst others.

Fetus-in-fetu presenting as acute intestinal obstruction.

Fetus-in-fetu is a rare condition in which a fetiform calcified mass is often present in the abdomen of its host; a newborn or infant. We present the case of a three-month-old male baby with acute intestinal obstruction and abdominal mass. X-ray abdomen and ultrasonogram revealed a cystic mass with calcification. On laparotomy, a well encapsulated retroperitoneal mass causing high intestinal obstruction was identified. Total excision of the mass was done. Diagnosis of fetus-in-fetu was confirmed on histopathology. Postoperative recovery was uneventful.

HER-2/neu expression in lesions of uterine cervix: Is it reliable and consistent.

This study was conducted to evaluate the expression of HER-2/neu oncogene in the lesions of the uterine cervix and to determine its correlation with histological type of malignancy, grade and clinical stage of presentation. One hundred cervical specimens were included in this study. These comprised cases with diagnosis of benign epithelial lesions, squamous cell carcinoma, adenocarcinoma, carcinoma cervix with glandular differentiation and cervical intraepithelial neoplasia. HER-2/neu immunostaining was performed by streptovidin-biotin peroxidase method. Higher expression of HER-2/neu was noted in malignant lesions as compared to benign lesions. Intensity of staining also correlated with clinical stage of presentation, lymph node metastasis and presence of parametrial extension. The over-expression of HER-2 oncoprotein is associated with poor prognosis, metastatic potential and aggressive biological behavior.

A rare presentation of invasive rhino-orbital mucormycosis in an immunocompetent young girl: a case report.

A 18 year young, healthy, immunocompetent girl presented with proptosis of left eye, referred to eye OPD, suspected clinico-radiologically as malignancy. This presentation with suspicion of malignancy resulted into extensive surgical debridement with removal of left eye, which was diagnosed as mucormycosis on histopathological examination. Her eye could have been saved if the mucormycosis was highly suspected initially, because of the good general health and immunocompetency led to misdirected thought.

Is fine needle aspiration cytology (FNAC) useful in skin adnexal masses? A study on 5 cases of pilomatixoma.

Superficial cutaneous/subcutaneous nodules, caused by a variety of inflammatory, benign and malignant pathology of diverse origin, are tempting lesion for fine needle aspiration cytology (FNAC). Amongst these, adnexal tumor show considerable overlap, both in clinical manifestation as well as in histopathology. Archieval records of clinical findings, FNAC smears and reports pertaining to 5 histologically proved cases of pilomatricoma (PMX) were analyzed. Different cytological findings were graded + to +++. Pre FNAC clinical diagnoses were sebaceous cyst, tuberculous lymphadenopathy, dermatofibroma, reactive lymphadenopathy and lipoma. PMX was diagnosed on FNAC in 3 cases on finding groups of basaloid cells, ghost epithelial cells, pink fibrillary material and calcium deposits. Other cases were diagnosed as epidermal inclusion cyst with the differential diagnosis of well differentiated squamous cell carcinoma and skin appendageal tumor of undetermined origin in one case each. In all the cases, FNAC established epithelial nature of the lesion, excluding clinically mimicking inflammatory/neoplastic lesions of other origin. FNAC should be followed by excision biopsy to accurately type the epithelial neoplasm.

Immunohistochemical study of the expression of epidermal growth factor receptor in benign prostatic hypertrophy, prostatic intraepithelial neoplasia and prostatic carcinoma.

The present study provides an analysis of immunohistochemical expression and localization of epidermal growth factor receptor (EGFR) in formalin fixed paraffin embedded specimens of prostate. Thirty-five cases each of benign prostatic hypertrophy (BPH) and prostatic carcinoma and 30 cases of prostatic intraepithelial neoplasia (PIN) were taken up for study. Streptavidin biotin peroxidase method was employed for immunohistochemical staining. EGFR positivity was observed in all the cases (100%) of BPH and PIN and in only 10 cases (28.5%) of prostatic carcinoma. In both BPH and PIN the basal cells revealed significantly higher intensity and percentage cell positivity than the luminal cells. Intensity and percentage of positively stained basal cells in BPH was higher than PIN basal cells but the difference was not statistically significant. The intensity and percentage cell positivity of BPH basal cells and PIN basal and luminal cells were significantly greater than the epithelial cells of prostatic carcinoma. Presently, the significance of variable expression of EGFR in various types of prostatic lesions is unknown.

Proptosis in a young child.

We encountered an extremely unusual presentation of proptosis in a 7-yr-old boy due to psammomatoid juvenile ossifying fibroma of frontoethmoidal region. The tumor also led to development of mucocele in the frontal sinus not yet fully developed as on opposite side.

Grading of marrow fibrosis in chronic myeloid leukemia--a comprehensive approach.

In the course of Chronic myeloid leukemia (CML), appearance of increased number of blasts may herald evolution of accelerated phase as well as onset of marrow fibrosis (MF) thereby necessitating the need to perform trephine biopsy for correct diagnosis and appropriate treatment. In the existing grading systems of MF, a comprehensive view has not been taken of the variability of density and area occupied by reticulin and collagen fibres. To overcome this shortcoming, we quantitated the reticulin and collagen content of marrow, its pattern of distribution and percentage area occupied by each type of fibres in every individual case. We performed 50 bone marrow (BM) trephine biopsies in patients of CML in order to assess the incidence and degree of MF. Various grades of MF were correlated with peripheral smear including blast count, bone marrow aspirate and LAP score of the case. A positive correlation was found between increasing grades of MF and number of megakaryocytes in the BM.

Ileal atresia with segmental defect of intestinal musculature.

An unusual case of segmental defect of ileal musculature with terminal ileal atresia and ventricular septal defect is reported. Clinically the patient was diagnosed as ileal atresia. On exploration, there was type I atresia at ileocaecal junction with attendant ileal dilatation and an adjoining 5 cm x 4 cm segment resembling segmental dilatation of ileum, about 15 cm proximal to ileocaecal junction. Pathological examination of segmentally dilated ileum revealed focal absence of circular and longitudinal muscle coat without any evidence of necrosis or inflammation. The possible etiology and its relationship with congenital segmental dilatation of intestine is discussed.

Mesoblastic nephroma of infancy.

This report presents features of mesoblastic nephroma, a rare benign tumor of kidney observed in perinatal period of life and highlights the role of imaging investigations in the proper management of this tumor. Awareness of this tumor may facilitate prevention and management of severe obstetric and neonatal complications and inadvertent and vigorous therapy compatible with that of Wilms' tumor can be avoided.

Mesenchymal hamartoma of the liver--a case report.

Mesenchymal hamartoma of the liver is a rare benign tumor of infancy and childhood. A case of mesenchymal hamartoma of liver seen in a 37 day old child is reported and the available literature on the subject is briefly reviewed.

Non-gestational choriocarcinoma in small intestine.

Choriocarcinoma most commonly arises from intrauterine gestational trophoblastic tissue; non gestational choriocarcinoma is rare. We report a 22-year-old married woman with non-gestational choriocarcinoma in the small intestine. Partial resection of the jejunum and ileum was done, followed by chemotherapy. She was well one year later.