Frozen-Permanent Section Discrepancy Rate in Oral Cavity and Oropharyngeal Squamous Cell Carcinoma.

Frozen section evaluation of head and neck squamous cell carcinoma (SCC) is critical for margin status and subsequent patient therapy. In this study, we retrospectively reviewed the rate of frozen-permanent section discrepancies in blocks with two frozen section levels compared to ≥ three levels in oral cavity and oropharyngeal SCCs. A search of the cases with both intraoperative frozen sections and corresponding permanent sections for SCCs in the oral cavity and oropharynx was performed. Frozen sections and permanent slides were compared. The nature of discrepancies was assigned to one of the following: change in diagnosis, margin status, or distance of the tumor from the margin. The cause of the discrepancy was designated as one of the following: block sampling, gross sampling, interpretation, or technical error. The pathologist experience, frozen section technical experience, and intraoperative impact of each discrepancy were also evaluated. A total of 654 frozen and corresponding permanent blocks were assessed. For 532 of the frozen section blocks, two levels were cut, while 122 frozen section blocks had ≥ three levels. Thirty-five frozen-permanent section discrepancies were observed (5.4% of all blocks). Among these, 2.5% had a possible or definitive intraoperative impact. The percentage of discrepancies in the ≥ three levels group (5.7%) was slightly higher than the two-level group (5.3%), and this difference was not statistically significant. For the two-level group, the overall block sampling error rate was 4.5%. This was not significantly different from the 4.1% block sampling error rate seen in the ≥ three levels group. The rate of block sampling discrepancy did not show significant differences based on attending or frozen section technical experience. A change in margin distance (closer margin detected on permanent) occurred in 4% of the blocks and involved 16% of the patients. This review of oral cavity and oropharynx SCCs frozen/permanent section discrepancies shows that the error rate is not significantly different depending on the number of levels cut. The results suggest that always performing more than two frozen section levels may not yield a decreased discrepancy rate. A change in margin distance occurred quite frequently, but only in rare cases it had a definitive impact on the intraoperative management. Given the importance of correct intraoperative diagnosis in patient management, additional levels may be warranted depending on the clinical scenario.

Disseminated Mycobacterium chelonae infection with Hughes-Stovin syndrome.

Mycobacterium chelonae usually causes localized cutaneous infections and abscesses but has the potential to cause disseminated infections, especially in immunocompromised hosts. We report a 27-year-old man with Hughes-Stovin syndrome and catastrophic antiphospholipid syndrome who was on chronic immunosuppressant therapy and developed disseminated M. chelonae infection. To the best of our knowledge, this is the first case report of M. chelonae infection in a patient with Hughes-Stovin syndrome.

Death caused by a domestic pig attack.

The primary medico-legal investigation goal in deaths due to animal attacks is distinguishing between animal-related injuries and potential homicidal wounds. We report the case of a 49-year-old male found dead in his farm's pigsty, where a sow and her piglets were present. At the postmortem examination, numerous, severe blunt force injuries were observed on the body, with special regard to the upper extremities where massive injuries involving soft tissues, bones, and regional vessels, tendons, and nerves were present. The death resulted from severe bleeding from massive upper extremities injuries due to a domestic pig attack. Domestic pigs are usually placid but they can become aggressive if disturbed and attack humans producing severe injuries due to trampling, kicking and biting. Knowing the relevant anatomy, pattern of attack, and morphologies of wounds produced by particular animals can distinguish animal attacks from homicides, as well as attempt to identify the type of animal involved in an unwitnessed attack.

The Application of Photogrammetry in the Autopsy Room: A Basic, Practical Workflow.

Photogrammetry is a technique that uses two-dimensional photographs taken from different angles and positions to determine three-dimensional coordinates and distances. Becoming familiar with the photography technique for photogrammetry purposes is the first step to obtaining high-quality results. Ten human cadavers were studied to develop this protocol. Appropriate equipment settings, measurements, and suitable ambient conditions were determined. Finally, the protocol was tested on one cadaver wherein a full postmortem examination was conducted, allowing accurate 3D modeling and measurements of the human body. This straightforward, step-by-step workflow will help users become familiar with this technique. A thorough description of the necessary steps is reported, including equipment, environment requirements, body placement, how to take photographs, and the minimum suggested number of photographs. Numerous graphics show the protocol's main steps to help users understand and reproduce the entire process. Photogrammetry allows the permanent recording and storage of photographic evidence of conditions that existed at the time of autopsy and accurate measurements of the body. The 3D model can have a powerful effect in court, where the findings can be accurately depicted without elicitation of strong emotion that may influence the judge or jurors. The primary disadvantage of photogrammetry for forensic pathology is its time-consuming nature. However, the widespread use of the photogrammetry technique in postmortem rooms would allow in-depth testing to detect and fix potential pitfalls, making this technique more reproducible and verifiable, increasing its admissibility in courts.