Ramadas Naik

An Autopsy Case of Sudden Unexplained Death Caused by Malaria

Abstract:  Sudden unexplained deaths, especially those unwitnessed can lead to forensic issues and would necessitate the need for a meticulous and complete postmortem examination including ancillary investigations to discover the cause of death. We herein report a case of sudden unexplained death caused by malaria in an apparently healthy individual. This fatal case is presented to remind the forensic pathologist of the possibility of malaria as a cause of sudden unexplained death in malaria‐endemic regions. In the present case, histopathological examination demonstrated the presence of parasitized red blood cells with malarial pigment in the blood capillaries in the brain, myocardium, pericardium, lungs, kidneys, liver, and the spleen. Cerebral malaria with acute renal insufficiency or pulmonary edema with an acute respiratory distress syndrome might have been the cause of death.

Megakaryocytic alterations in thrombocytopenia: a bone marrow aspiration study.

CONTEXT Dysplastic changes are well documented in myelodysplastic syndromes (MDS). However, they are also observed in non-MDS hematological conditions. AIMS To evaluate the megakaryocytic alterations in the bone marrow aspirations in cases of non-MDS related thrombocytopenia. SETTING AND DESIGN A prospective study of 144 bone marrow aspirates was conducted in the department of pathology, Kasturba Medical College, Mangalore. The aspirates were studied to assess the number and morphology of the megakaryocytes in non-MDS related thrombocytopenia and evaluate their significance when compared to changes in MDS. MATERIALS AND METHODS The bone marrow aspiration smears were stained with Leishman stain and examined under light microscope. STATISTICAL ANALYSIS USED Fishers exact test. A P value less than 0.05 was considered significant. Sensitivity and specificity was calculated for those features which were significant in the relevant hematological disorders. RESULTS The sensitivity of immature megakaryocytes, dysplastic forms and micromegakaryocytes in cases of immune thrombocytopenic purpura was 100%, 89% and 42% respectively. The specificity of emperipolesis was 74%. In cases of infection-associated thrombocytopenia, immature megakaryocytes had a sensitivity of 100% and cytoplasmic vacuolization were 86% specific. The sensitivity of the dysplastic forms in megaloblastic anemia was 75%. However, no platelet budding was observed. The presence of micromegakaryocyte had a specificity of 83% in MDS, and was statistically significant when compared to cases of non-MDS conditions (P 0.05). CONCLUSIONS Careful understanding of the morphological changes of megakaryocytes in bone marrow aspirates can improve the diagnostic accuracy for a wide range of hematological disorders thereby enabling proper therapeutic interventions.

Cytologic diagnosis of small cell anaplastic hepatoblastoma: a case report.

BACKGROUND Small cell anaplastic hepatoblastoma (HB) is the least common subtype of HB. There are few articles in the literature describing the cytologic characteristics of this rare subtype. CASE A 5-year-old girl present with a progressively enlarging abdominal mass. Ultrasound examination revealed the mass to be arising within the right lobe of the liver. Fine needle aspiration (FNA) of the mass revealed primitive cells with a high nuclear/cytoplasmic ratio and hyperchromatic, ovoid nuclei in poorly cohesive clusters as well as dispersed singly. These cells closely resembled those of small round cell tumors of childhood. CONCLUSION The cytologic differential diagnosis of undifferentiated HB must include small round cell tumors of childhood. With knowledge of the typical cytomorphologic appearance of HB in association with clinical and radiologic information, one can offer a reliable preoperative diagnosis on FNA.

Cytodiagnosis of Extramedullary Plasmacytomas

OBJECTIVE Extramedullary plasmacytoma (EMP) constitutes approximately 4% of all plasma cell neoplasms. It may present as the sole manifestation of plasma cell neoplasm, as a solitary plasmacytoma of the bone or as a consequence of multiple myeloma. This study was done to determine the role of fine needle aspiration cytology (FNAC) in the diagnosis of EMP. STUDY DESIGN In our study 8 cases of EMP at various sites were diagnosed on FNAC. In 3 patients EMP was the initial presentation of plasma cell neoplasm. In the remaining 5 patients the tumors occurred during the course of treatment for multiple myeloma. RESULTS The lesions were located at various anatomic sites, including lymph node, scalp, breast, jaw, rib, clavicle and soft tissue swelling in the retrosternal region. The smears prepared from the aspirates in all cases revealed numerous plasma cells at various stages of maturation, leading to a diagnosis of EMP. Radiologic and bone marrow findings also substantiated the diagnosis of multiple myeloma in all but 1 case. CONCLUSION FNAC offers a rapid, reliable and accurate diagnosis of EMP and thus allows initiation of appropriate treatment.

Postmortem diagnosis of acute haemorrhagic pancreatitis

Forensic pathologists can help in the investigation of sudden unexpected deaths in co-operation with the officials responsible for the maintenance of law and order to administer justice. Sudden unexpected deaths form the subject of medicolegal investigation if they occur in apparently healthy individuals, wherein an autopsy would shed light regarding the cause of death. A 4 year retrospective review of autopsy files at the Department of Forensic Medicine, Kasturba Medical College, Mangalore, South India was undertaken for cases of sudden unexpected deaths due to acute haemorrhagic pancreatitis occurring between May 2004 and April 2008. A total of seven cases of acute haemorrhagic pancreatitis diagnosed at autopsy as the cause of sudden unexpected death during the study period are discussed herein.

Microwave histoprocessing versus conventional histoprocessing

The aim of the study is to compare the histologic quality of the microwave histoprocessing with that of conventional method and to determine its positive impact on turnaround times and reduction of costs of tissue processing. One hundred and eighty-five paired tissue sections from different organs were taken. Each tissue sections were of size of 15 mm x 10 mm x 3 mm and divided into two; one set as experimental group and the other as control group. The tissues in the experimental group were further divided into six groups and processed by vacuum-microwave method according to six protocols from I to VI. Other tissues in the control group were processed by the conventional method and compared. Overall, the quality of microscopic tissue from both the methods was identical. Microwave processing shortened the time of processing without compromising the overall quality of the histologic section and was cost-effective.

Bone marrow biopsy in non-Hodgkin lymphoma: A morphological study

CONTEXT Bone marrow (BM) biopsy is an integral part of staging work-up for non-Hodgkin lymphoma (NHL). AIMS To study the characteristics of BM involvement in NHL with respect to incidence, histologic pattern and morphology of infiltration and its discordance with the histology of primary anatomic site. SETTINGS AND DESIGN Forty-nine cases of NHL in which BM biopsy was performed for staging were included in this study, the primary site being classified according to the WHO classification for NHL. MATERIALS AND METHODS A prospective study of 49 cases was conducted. Bilateral BM biopsy was obtained from the posterior superior iliac spine. The biopsies were fixed in 10% buffered formalin solution and decalcified using 10% formal - formic acid for 4 - 6 h followed by routine processing. The serial sections were stained by hematoxylin and eosin and reticulin stains. RESULTS BM biopsy showed involvement by lymphoma in 27 cases (55.10%). Unilateral positivity was found in four cases (14.81% cases). The overall incidence of marrow involvement by NHL was 55.1%. The incidence of involvement was higher in T-cell lymphomas when compared with B-cell lymphomas and predominant pattern of involvement was mixed. Diffuse large B-cell lymphomas had the lowest incidence in all the B-cell lymphomas. A discordant histology between BM and primary anatomic site was found in 29.63% (8/27) of the cases, where it was seen more in follicular lymphomas and diffuse large B-cell lymphomas. CONCLUSIONS Critical examination of BM biopsies can increase the diagnostic accuracy, thereby contributing to the prognosis and appropriate treatment modalities.

Morphometric evaluation of endometrial blood vessels.

Five hundred endometrial specimens were studied to document the changes in blood vessels in various phases of menstrual cycle, menstrual disturbances and in unexplained infertility. Sixty-three cases were taken as control and 437 cases as study group which included cases of dysfunctional uterine bleeding (DUB), endometrial polyps, fibroids, adenomyosis, infertility and atrophic endometrium. Using light microscopy, the vascular morphology was studied. The blood vessels were concentrated more in basal layer in the proliferative phase and in functional layer in the secretory phase. Cases of complex hyperplasia and pill endometrium had significantly higher vessel concentration. Congestion and dilatation of blood vessels were significantly higher in cases of DUB. The present study showed a positive correlation between endometrial angiogenesis and menstrual disorders. The alteration in blood vessel morphology has significant role in prognosis and in various anti-angiogenic therapies.

Bilateral angiosarcoma breast diagnosed by fine needle aspiration cytology

Concurrent or synchronous angiosarcoma (AS) of breast is a rarity. Specific recognition of this neoplasm in cytological specimens is difficult and conclusive diagnosis in the absence of ancillary methods is achieved only uncommonly. Herein, we present a case of bilateral AS of breasts in a 32-year-old lady diagnosed by fine needle aspiration (FNA) cytology, thus enabling a definitive surgical approach. This case report emphasizes that when aspiration smears show vasoformative features consisting of microacini, arborizing microtissue fragments and intracytoplasmic lumen against a bloody background, diagnosis can be made conclusively by FNA with immunohistochemical confirmation.

Bilateral calcified stylohyoid ligament: an incidental autopsy finding with medicolegal significance.

Eagles syndrome occurs due to elongation of the styloid process or calcification of the stylohyoid ligament, which then may produce a pain sensation due to pressure exerted on various structures in the head and neck region. A case report of calcified stylohyoid ligament found incidentally at autopsy and further confirmed by computed tomography scan and histopathology is herein discussed with associated medicolegal significance.