Autopsy findings from the first known death from Severe Acute Respiratory Syndrome SARS-CoV-2 in Spain.

The new coronavirus SARS-CoV-2, first identified in Wuhan, China in December, 2019, can cause Severe Acute Respiratory Syndrome (SARS) with massive alveolar damage and progressive respiratory failure. We present the relevant autopsy findings of the first patient known to have died from COVID19 pneumonia in Spain, carried out on the 14th of February, 2020, in our hospital (Hospital Arnau de Vilanova-Lliria, Valencia). Histological examination revealed typical changes of diffuse alveolar damage (DAD) in both the exudative and proliferative phase of acute lung injury. Intra-alveolar multinucleated giant cells, smudge cells and vascular thrombosis were present. The diagnosis was confirmed by reverse real-time PCR assay on a throat swab sample taken during the patient's admission. The positive result was reported fifteen days subsequent to autopsy.

Carcinoma mucoepidermoide de glándula parótida / Mucoepidermoid carcinoma of the parotid gland

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Mid-dermal elastolysis: report of a case and literature review.

Mid-dermal elastolysis (MDE) is an uncommon and probably underdiagnosed disorder of the elastic tissue. Clinical suspicion and histopathological confirmation are essential for the diagnosis. We report the case of a young woman who presented with this disorder after an inflammatory process during pregnancy and we review the main characteristics of this rare entity.

Algunos conceptos básicos de la teoría de colas aplicables en la planificación de un servicio de anatomía patológica / Some basics concepts of queueing theory applicable in the planning of a pathology department

Introducción: Nos planteamos el problema: ¿cuál es el número adecuado de facultativos en un servicio de anatomía patológica (SAP) para responder sin demora al número de solicitudes de estudio que se reciben? Material y métodos: Aplicamos conceptos básicos de teoría de colas y motivamos al lector a introducirse en ellos. Resultados y discusión: Un SAP funciona como un sistema de colas y se ajusta a los modelos de cola infinita con uno (M/M/1) y, todavía mejor, con múltiples recursos (M/M/m). El número de facultativos (m) ha de cumplir: m » velocidad de llegada de biopsias al SAP/velocidad de cierre de biopsias por facultativo Conclusiones: Como sistema de colas, un SAP solo es viable si su capacidad de respuesta es mayor que las necesidades planteadas por la demanda. El modelo de múltiples recursos (facultativos) amortigua mejor los aumentos sostenidos de la demanda (AU)

Introduction: The problem of the optimal number of pathologists required to provide a rapid response to the volume of studies requested is considered. Material and methods: The basic concepts of the queueing theory are applied and recommendations for their use are made. Results and discussion: Pathology departments (PD) work as a queuing system and adapt to infinite queue models with a (M/M1) or, preferably, multiple servers (M/M/m). The number of pathologists (m) must achieve: m » velocity of arrival of biopsies to the PD/velocity of completion of biopsy reports by pathologists. Conclusions: Like a queueing system, a PD is viable only if its capacity of response is greater than the demand. The model of multiple resources (pathologists) better absorbs a sustained growth in demand (AU)

Microsporidia and its relation to Crohn's disease. A retrospective study.

BACKGROUND: The cause of Crohn's Disease (CD) remains unknown. Recently a decrease in the global lymphocyte population in the peripheral blood of CD patients has been reported. This decrease was more evident in γδ T lymphocytes, especially γδ CD8+T subsets. Furthermore, a decrease of IL-7 was also observed in these patients. We propose the hypothesis that microsporidia, an obligate intracellular opportunistic parasite recently related to fungi, in CD patients can take advantage of the lymphocytes and IL-7 deficits to proliferate and to contribute to the pathophysiology of this disease. METHODS AND FINDINGS: In this case-control study, serum samples were collected from 36 CD patients and from 36 healthy individuals (controls), IgE and IgG anti-Encephalitozoon antibodies were determined by ELISA; and forty-four intestinal tissue samples were analyzed through real time Polymerase Chain Reaction (PCR), twenty CD patients, nine with others diseases and 15 healthy subjects. We observed that IgE anti-Encephalitozoon levels were significantly higher in patients with CD: 0.386(±0.256) vs control group, 0.201(±0.147), P<0.001. However, IgG anti-Encephalitozoon values were significantly lower in CD patients: 0.361(±0.256) vs control group, 0.876(±0.380), P<0.001. In the group of CD patients, 6/20 (30%) were positive by real time PCR for microsporidia and, all the patients of the control group were negative by real time PCR. CONCLUSIONS: These results suggest that CD patients are a group at risk for microsporidiasis and, moreover that microsporidia may be involved as a possible etiologic factor of CD.

Sarcoma mieloide de intestino delgado en paciente aleucémico / Myeloid sarcoma of the small intestine in a non-leukemic patient

Paciente varón de 19 años, con sospecha clínica deEnfermedad de Crohn, intervenido quirúrgicamente por uncuadro clínico de oclusión intestinal del segmento distal delyeyuno. El estudio de la pieza quirúrgica mostró una tumoraciónque infiltraba la pared intestinal y grasa mesentéricaadyacente. Histológicamente se evidenció una infiltraciónde la pared intestinal por células poco diferenciadas quedemostraron positividad a la mieloperoxidasa, lo que confirmóel diagnóstico de sarcoma mieloide. No se encontróevidencia de afectación de médula ósea, enfermedad leucémicani síndrome mielodisplásico o mieloproliferativo. Seinstauró tratamiento quimioterápico y tras una serie de complicacionesque se resolvieron favorablemente, el pacientepermanece asintomático a los 24 meses del diagnóstico inicial.El interés del caso estriba no sólo en la rareza de estetipo de tumores y la ubicación intestinal en un paciente sinenfermedad hematológica previa, sino también en la dificultaddel diagnóstico anatomopatológico, dado que un75% de estos casos aleucémicos son erróneamente diagnosticadosde inicio y confundidos con otros tumores malignospobremente diferenciados (AU)

A 19 year-old man with a clinical suspicion of Crohn’sdisease underwent surgery for intestinal occlusion in thedistal jejunum. Macroscopically, a mass infiltrating theintestinal wall and adjacent mesenteric fat was seen. Histologically,the intestinal wall was infiltrated by poorly differentiatedcells which were positive for myeloperoxidase anda diagnosis of myeloid sarcoma was made. No evidence ofbone marrow involvement or myelodysplastic or myeloproliferativedisorders was seen. The patient was treated withchemotherapy and, after several complications which weresuccessfully resolved, is asymptomatic 2 years after theinitial diagnosis. This unusual case of a rare tumour, occurringin the intestine in the absence of previous haematologicalmalignancy, draws attention to the diagnostic difficultiesinvolved; indeed, 75% of nonleukemic cases areinitially misdiagnosed, often being confused with poorlydifferentiated malignant tumours (AU)