Diaphragmatic pathology: a cause of clinically unexplained death in the perinatal/paediatric age group.

Sudden unexpected death in infancy and childhood requires a 'full' post-mortem investigation. Guidance from the Royal College of Pathologists recommends sampling of all the major organs. However, the diaphragm does not feature in this or in most lists of routine histology. Our aim is to emphasize the importance of sampling the diaphragm for histological examination during autopsy. We describe three autopsy cases of clinically unexplained death in the perinatal and paediatric age group that showed significant pathology of the diaphragm. In Case 1, a previously healthy five-year-old girl collapsed suddenly and died four days later. In Case 2, an eight-month-old infant had repeated episodes of respiratory arrest that culminated in death. Autopsy demonstrated a predominantly diaphragmatic myositis. In Case 3 a female neonate had a respiratory arrest three days after birth and died less than a month later. Autopsy showed multiple large calcified necrotic fibres in the diaphragm. The diaphragm is seldom sampled at autopsy. In the first two cases a predominantly diaphragmatic myositis was either the direct or underlying cause of death. In the third case long-standing diaphragmatic pathology of uncertain cause may have contributed to the original respiratory arrest. Had the diaphragm not been examined histologically, the cause of death would have remained unascertained in these cases. In cases of sudden death in infancy and childhood, failure to reach a diagnosis may lead to undue suspicion falling upon the child's carers. This underscores the need for full histology at post-mortem in child deaths, including diaphragmatic sampling.

[Teratoma of the thyroid gland in an infant]. / Teratom stitaste zlezde kod odojceta.

Stridor is the major clinical sign of upper airways obstruction in children and is usually caused by various inflammatory and structural lesions of the pharynx, larynx and subglottic trachea. Rarely, this obstruction can be produced by growth of a tumour. We present a three-month-old infant with upper airways obstruction caused by thyroid teratoma. Teratomas represent 3-5% of all tumours in childhood. The main sites of these tumours are the gonads, the sacrococcygeal region and the anterior mediastinum. The neck is one of the least common sites, accounting for only about 5% of all teratomas. As opposed to adults in whom prognosis depends primarily on histologic type of the tumour, the most important prognostic factors in children are the age of the patient, localization and histologic type of the tumour. In about 30% of cases neck teratomas are associated with polyhydramnios which can be easily detected by routine ultrasound examination in pregnancy. Surgery is the treatment of choice in young children and usually no further radio- or chemotherapy is needed. Clinical diagnosis, histologic features, prognosis, management, follow-up and prenatal detection of thyroid teratoma in children are discussed in the paper.

[Diverticulum of the stomach]. / Divertikulum zeluca.

Gastric diverticula are very rare and usually asymptomatic diseases. Clinical symptoms may include haemorrhage, mild discomfort and pain in upper abdomen. They are most frequently diagnosed incidentally during X-Ray examinations. In symptomatic diverticulum of gastric fundus was diagnosed roentgenographically and endoscopically and was successfully cured surgically.

[Whipple's disease. Case report]. / Morbus Whipple. Povodom jednog slucaja.

This is a case report on a 42 years old patient suffering from Whipple's disease. The patient had characteristic symptoms: high temperature, frequent bowel movement, melanoderma, arthralgia and enlarged lymph nodes. After detailed clinical researches, x-ray and endoscopic examination, bacteriology examination of faeces, absorptional tests, the diagnosis was made thanks to pathohistologic analysis of biopsy samples of the small intestine by light and electron microscopy. The differential diagnostic similarity with AIDS, especially at the early phase of the illness, required excluding HTLV III. We examined the aetiophathogenesis of the illness and discussed the clinical and laboratory presentation of the patient considering contemporary ideas regarding this disease.

[Mixed mesodermal tumors of the uterus. Clinico-pathologic characteristics of 23 patients]. / Mesoviti mezodermni tumori uterusa klinicko-patoloske osobenosti 23 bolesnika.

The clinical and pathological features, histogenesis and treatment of 23 cases of mixed mesodermal tumours of the uterus (15 benign and 8 malignant) in woman aged from 27 to 78 years (mean 51.25) are reviewed. The tumours manifested by non-specific symptoms, most often uterine bleeding, arising suspicion of malignancy in only two cases. Unlike malignant mixed mesodermal tumours, differentiation of adenofibromas from low-grade adenosarcomas was often very difficult, and needed careful pathohistological analysis of extirpated tissues, including all available histochemical, immunohistochemical and EM procedures. Two cases of adenofibromas recurred as adenosarcomas after four months and five years respectively. Poor prognosis of malignant variants of mixed mesodermal tumours and their difficult differentiation from adenofibromas require close collaboration of pathologists and gynaecologists, implicating hysterectomy as proposed treatment and permanent clinical monitoring.