Sudden death due to undetected mediastinal germ cell tumor.

A 32-year old man, apparently asymptomatic, was found dead in his apartment. Autopsy revealed a large necrotic mediastinal mass with liver and occipital brain metastases, the latter having produced acute intraparenchymal and intraventricular hemorrhage with cerebellar tonsillar herniation. Histologically, the mediastinal mass and metastases were consistent with immature extragonadal teratoma, with malignant transformation of the intestinal-type epithelium. Undiagnosed neoplasms as causes of sudden death are quite rare and usually reported in older age groups; however, in one study of autopsies in a 25-to 46-year-old age group, a significant 3.2% was reported. Germ cell tumors of the mediastinum are the most common extragonadal primary site, accounting for approximately 50%-70% of extragonadal germ cell tumors (EGCTs) and primarily affecting 20- to 35-year-old men. EGCTs are usually symptomatic at the time of diagnosis, although a large proportion may be asymptomatic. This case represents one the few reported cases of sudden death as a result of mediastinal EGCT; it also demonstrates the natural course of this disease and underscores the importance of medicolegal autopsies in cases of sudden death.

Adult respiratory distress syndrome in babesiosis.

A patient is described who contracted transfusion-induced babesiosis, and later developed acute respiratory distress syndrome (ARDS) as a fatal complication. ARDS has been reported in patients with Plasmodium falciparum malaria, but to our knowledge has not been observed as a complication of babesiosis.

Aging changes in the human aortic valve in relation to dystrophic calcification.

To elucidate the pathogenesis of aging changes and their relation to age associated calcification, a morphological study of 27 human aortic valves was carried out. Nine valves were obtained from immediate autopsies and 18 valves from routine autopsies done within four hours after death. Calcium deposition was present deep in the zona fibrosa along a zone of lipid accumulation. Fibrocytes in the zona fibrosa showed predominant age associated changes, i.e., a massive accumulation of residual bodies in the cytoplasm probably derived from autophagic vacuoles. Light microscopic lipid accumulation corresponded with both intracellular accumulation of electron dense spherules and membranous vesicles derived from degenerate fibrocytes. Calcium deposition in various stages, including needle shaped hydroxyapatite crystals, was seen in close association with these cellular degradation products rather than collagen or elastic fibers. Dystrophic calcification in the aortic valve appears to result from cellular aging and death followed by petrification of cellular degradation products, which may progress to calcific aortic stenosis.

Effects of shock on the pancreatic acinar cell. Cellular and subcellular effects in humans.

Pancreatic tissues from 22 patients with a wide variety of types of shock were obtained within minutes of somatic death for light and electron microscopy and for cytochemical studies. By light microscopy, it was difficult to ascertain any differences between the shock groups; however, electron microscopy disclosed subcellular alterations that could be correlated well with the type, severity, and duration of shock. Mild cases of shock or shock of short duration showed mild cell damage, while extreme cases of hemorrhagic or septic shock showed cell death and necrosis. No morphological evidence for lysosomal initiation of damage was seen, but it is clear that the pancreas can undergo severe cell injury during shock that could result in release of further damaging enzymes, most probably from zymogen granules rather than from lysosomes.

The application of electron microscopy and cellular biochemistry to the autopsy. Observations on cellular changes in human shock.

A method based on the utilization of electron microscopy, morphometric analysis, tissue culture, and biochemical analysis in the study of human autopsies is described. In this method rapid sampling immediately following somatic death is conducted in order to make meaningful the application of such techniques. In addition to describing the procedure, we present some new findings relating to cellular changes associated with shock. As in cellular pathobiology, it is of utmost importance that ultrastructural changes be correlated with alterations in chemistry and function.