Importance of combined approach of investigations for detection of asymptomatic Hashimoto Thyroiditis in early stage.

INTRODUCTION: Hashimoto's thyroiditis (HT) is the most common cause of goitrous hypothyroidism in iodine sufficient areas. The diagnosis of HT is important because it progresses to hypothyroidism, and also, it is associated with thyroid lymphoma and papillary thyroid carcinoma. Apart from thyroid antibodies, assessment of thyroid function test (TFT) levels, ultrasonography (USG), and cytological analysis can help in early diagnosis and management of HT. AIMS AND OBJECTIVES OF THIS STUDY: To know the age incidence and clinical presentation of HT, its association with thyroid hormone levels and with thyroid antibodies and its correlation with the cytologic grade of HT. MATERIALS AND METHODS: Consecutive convenient method of sampling was adopted at the cytology clinic. Fine-needle aspiration cytology of patients presenting with thyroid enlargement was done using standard technique and aseptic precautions. RESULTS: Out of 875 cases of thyroid cytology, 134 cases were diagnosed as HT over a 4-year period. A strong female preponderance was observed. A significant proportion of them (103/134) presented in the first four decades of life. Majority of cases (60.63%) were hypothyroid, while 15.74% were hyperthyroid and 23.62% were euthyroid. Apart from thyroid enlargement, although a majority of patients presented with symptoms related to the thyroid, a significant number of patients (38.80%) were asymptomatic. CONCLUSIONS: A combined approach of cytological grading of HT along with USG, TFT levels, and thyroid antibodies can detect hypothyroid and subclinical hypothyroid or euthyroid state of HT and provide an appropriate guide to therapy.

An analysis of autopsy cases of non-Hodgkin lymphoma-with special reference to those masquerading as acute febrile illness.

CONTEXT: As in any medical disorder, in non-Hodgkin lymphomas (NHLs) also, precise analysis of causes of death is needed to focus research efforts and improve morbidity and mortality. AIMS: The aim of this study was to review the clinical presentation, mode of death and the immunophenotype of the autopsy cases of NHL. SETTINGS AND DESIGN: Autopsy cases wherein NHL was diagnosed, were selected for study. SUBJECTS AND METHODS: Autopsy cases which were diagnosed as NHL, either antemortem or after autopsy during a 7 years period at a tertiary care referral centre were studied and reviewed. STATISTICAL ANALYSIS USED: Descriptive statistical analysis used. RESULTS: The autopsy findings seen in eight cases of NHL were reviewed. Except one, all cases were above 40 years age. Infective etiology (62%) followed by cardiorespiratory failure (38%) was the cause of death observed in these patients. In three cases, the antemortem diagnosis of NHL was missed as the patients were being treated for acute febrile illness and were referred late to the Tertiary Care Centre. One of these was a case of extra-nodal primary splenic lymphoma. CONCLUSION: As NHL present with nonspecific symptoms, these tumours may not be detected in early stages and hence may not be treated appropriately. These patients have weakened immunity and hence are prone to infection and sepsis which can be a major cause of mortality. This autopsy study experience has shown that NHL can masquerade as acute febrile illness which if not detected early and treated adequately can turn fatal.

Extensive ossification of thymoma in a child.

A case of thymoma with extensive ossification in an 8-year-old female child is presented. The presence of extensive ossification in the stroma of the thymoma is an extremely rare feature. To date, there is a single report of ossifying thymoma in children. This report represents the second known case in a child in the worldwide literature.

Creutzfeldt-Jacob disease: an autopsy case report in tertiary care hospital.

Sporadic Creutzfeldt-Jakob disease (CJD) is the most common prion disease. It is a rare, fatal neurodegenerative disease caused by an infectious protein called prion. The diagnosis can be confirmed only by histological examination of brain tissue. Because of the transmissible nature of the disease, autopsy or brain biopsy cannot be performed at many institutions. Histology shows spongiform changes, neuronal loss, reactive astrocytic proliferation, accumulation of pathologic protein occurring in three general forms: Sporadic, familial, and acquired form, including a variant form of CJD. It clinically presents as predominantly progressive dementia with a rapid onset, myoclonus, cerebellar, pyramidal, extra pyramidal and visual signs. Occurrence of periodical spikes in electro-encephalogram, observation of cortical signal alterations in magnetic resonance imaging (MRI) studies, and detection of protein 14-3-3 in cerebrospinal fluid substantiate diagnosis. Autopsy case is presented of a 50 year old woman with progressive dementia, typical neurological symptoms, MRI findings and confirmation of CJD on histology and immunostaining.

Sudden, unexpected and natural death in young adults of age between 18 and 35 years: a clinicopathological study.

CONTEXT: To identify various causes, risk factors, age and sex distribution associated with sudden and unexpected natural deaths (SUNDs) in young adults of age between 18 and 35 years. MATERIALS AND METHODS: Retrospective analysis of autopsy reports and medical records of all SUNDs that occurred instantaneously or within 24 hours of onset of symptoms in young adults, between 2001 and 2009. RESULT: Of the total 6453 deaths autopsied during 2001-2009, 64 (0.99%) were SUNDs in young adults, chiefly in males between 30 and 35 years of age. Non-cardiac causes significantly predominated (73.4%) over cardiac causes (7.8%). Most of the SUND cases were due to preventable causes, including infections (54.6% cases), cerebrovascular accidents (9.37%) and ischemic cardiac causes (6.25%). Sudden adult death syndrome (SADS) accounted for 18.75% deaths. CONCLUSION: SUND in young adults is preventable. A meticulous post-mortem examination with special attention to the conduction system of heart and detailed toxicological analysis can pinpoint the cause of death in SADS.