Joo-Young Na

An autopsy case of sudden unexpected death due to a glial cyst of the pineal gland.

Pineal cysts are usually asymptomatic; however, they may rarely cause symptoms such as chronic headache, paroxysmal headache with gaze paresis, postural syncope, loss of consciousness, and sudden death. A 30-year-old woman with no specific medical history except chronic headache was found collapsed in a public toilet per se. Postmortem examination revealed no external injuries or internal diseases except a cystic lesion of the pineal gland. Histologic examination showed an internal cyst surrounded by glial tissues and pineal parenchyma that was diagnosed as a glial cyst of the pineal gland. Although the pineal cyst cannot be confirmed as the cause of death, it was considered, as no other cause was evident. Herein, we report a pineal cyst considered as an assumed cause of death.

Point-of-care hemoglobin testing for postmortem diagnosis of anemia

An autopsy involves examination of a body using invasive methods such as dissection, and includes various tests using samples procured during dissection. During medicolegal autopsies, the blood carboxyhemoglobin concentration is commonly measured using the AVOXimeter® 4000 as a point-of-care test. When evaluating the body following hypovolemic shock, characteristics such as reduced livor mortis or an anemic appearance of the viscera can be identified, but these observations arequite subjective. Thus, a more objective test is required for the postmortem diagnosis of anemia. In the present study, the AVOXimeter® 4000 was used to investigate the utility of point-of-care hemoglobin testing. Hemoglobin tests were performed in 93 autopsy cases. The AVOXimeter® 4000 and the BC-2800 Auto Hematology Analyzer were used to test identical samples in 29 of these cases. The results of hemoglobin tests performed with these two devices were statistically similar (r = 0.969). The results of hemoglobin tests using postmortem blood were compared with antemortem test results from medical records from 31 cases, and these results were similar. In 13 of 17 cases of death from internal hemorrhage, hemoglobin levels were lower in the cardiac blood than in blood from the affected body cavity, likely due to compensatory changes induced by antemortem hemorrhage. It is concluded that blood hemoglobin testing may be useful as a point-of-care test for diagnosing postmortem anemia.

A heart of stone: an autopsy case of massive myocardial calcification

A case of massive calcification of the myocardium is presented that was diagnosed by postmortem computed tomography (PMCT) and confirmed by conventional autopsy. There are two types of pathologic calcification, dystrophic and metastatic. Massive calcification of the myocardium is associated with variable clinical outcomes, including sudden unexpected death. A 53-year-old man was found after he collapsed beside a walkway. He was transferred to hospital and died approximately two months later. To investigate the cause of death, PMCT and conventional autopsy were performed, which revealed massive calcification of the myocardium, a very rare finding at autopsy. Massive myocardial calcification was one of the possible causes of his collapse. PMCT may be a useful diagnostic tool for detecting massive calcification of the myocardium following sudden cardiac death.

Forensic application of microRNA-706 as a biomarker for drowning pattern identification

Forensic research using microRNA has been used so far only for the identification of body fluids, but its use in understanding biological processes in post-mortem pathology has not been studied before. Therefore, we performed experiments in mice to compare between freshwater and saltwater drowning models, and miRNA expression was analyzed in the brain through a forward bioinformatics screening approach. In this study, we identified eight specific microRNAs whose expression increased in freshwater and decreased in saltwater. Among them, miR-706 - targeting HCN1 - was identified as a potent biomarker for the drowning pattern identification. A higher expression of miR-706 was detected in the freshwater drowning compared to the control and saltwater drowning group (p<0.05, and p<0.01, respectively). HCN1 mRNA expression, a suggested candidate target for miR-706, was lower in the freshwater (p<0.01) than in the saltwater drowning group, and showed statistical difference between freshwater and saltwater drowning (p<0.01). miR-706 was specifically expressed in the hippocampal neurons as detected by in situ hybridization. Our data suggest that a specific microRNA may provide clues to understanding some crime scene investigations and pathobiological processes in the dead body.

A mass lesion in the skull after radiotherapy for medulloblastoma

A 14-year-old boy underwent craniotomy and mass removal 3 years earlier for a medulloblastoma in the cerebellar vermis (Fig. 1a,b). After the operation, he had a total dose of 54 Gy of radiotherapy and chemotherapy for 1 year. Three years following the initial radiotherapy, a mass-like lesion in the frontal bone was incidentally detected. The lesion revealed a 2.1 cm lobulated osteolytic lesion on CT scan (Fig. 2a) and iso-signal intensity on T1-weighted MRI and high signal intensity with nodulelike foci on T2-weighted MRI. Radiologic appearances suggested a bone marrow lesion such as metastatic bone tumor. Intraoperatively, the lesion was located in the left frontal bone. Frontal craniectomy and mass removal was performed with a provisional diagnosis of metastatic bone tumor. After the operation, the patient was discharged without any complications.