Autopsy and Case Reports
type: channel
description: Autopsy and Case Reports (Autops Case Rep) is an Open Access online medical journal published on continuous flow by the Hospital Universitário of the Universidade de São Paulo (HU USP), under the online ISSN 2236-1960. Since 2018, Autopsy and Case Reports publishes using a continuous publication workflow, allowing the immediate posting of articles in their final form on the journal website as soon as they are ready for publication. Accepted articles will be published as Open Access and distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium provided the original work is properly cited. Indexing Bibliographic Databases PubMed Central LILACS SciELO Scopus Indexing Directories Directory of Open Access Journals Redalyc Latindex Sumários.org Diadorim Redib Archiving and preservation All articles published are indexed and deposited in full text version for preservation in PubMed Central® (PMC) (https://www.ncbi.nlm.nih.gov/pmc/journals/2811), SciELO Brasil (https://www.scielo.br/autopsy) and at Revistas USP repository of Universidade de São Paulo (http://www.revistas.usp.br/wp/?p=76).
publisher: Universidade de São Paulo. Hospital Universitário
language: en
publication name: Autopsy and Case Reports
issn: 2236-1960
copyright: Copyright Authors of articles published by Autopsy and Case Report retain the copyright of their work without restrictions, licensing it under the Creative Commons Attribution License - CC-BY, which allows articles to be re-used and re-distributed without restriction, as long as the original work is correctly cited.
items: Mucosal melanoma of hard palate
items: Explant pathology in Biliary Atresia post Kasai procedure: a tale of two livers
items: Gallbladder schistosomiasis
items: Systemic amyloidosis: an aggressive evolution in a patient with relapsing polychondritis and monoclonal gammopathy of undetermined significance (MGUS) undergoing peritoneal dialysis
items: Cytological diagnosis of hyaline-vascular type of Castleman disease
items: Multicystic encephalopathy: an ultimate manifestation of ischemic-hypoxic injury
items: Stealth cryptococcus in an immunocompetent patient
items: Chondroblastic Osteosarcoma of proximal tibia
items: Large atypical parathyroid tumor - a diagnostic conundrum
items: Mönckeberg calcified sclerosis preventing the use of radial artery in myocardial revascularization surgery
items: Anti MDA-5 associated rapidly progressive interstitial lung disease complicated by viral pneumonia - a fatal outcome
items: COVID-19 shed light on Virchow’s law of thrombosis
items: Unravelling the mystery of the central dentinogenic ghost cell tumor- a rare case report and recurrent insights
items: Cholangiocarcinoma in early childhood
items: The need for mandatory autopsy teaching in Forensic Medicine for medical students
items: Laryngeal plasmacytoma in a patient with Down’s syndrome
items: Unilateral testicular metastasis of prostate cancer
items: Traveling together! - Intrathymic thyroid tissue in a patient with Graves’ disease
items: Non-functioning parathyroid cyst presenting as a neck mass
items: Giant intrapulmonary solitary fibrous tumor
items: Bilateral primary ovarian Ewing sarcoma recurring as left submandibular lymphadenopathy diagnosed on cytology
items: Localized cystic kidney disease: a case report unveiling clinical and histopathological challenges
items: A great simulator in clinical practice: mononeuritis multiplex in HIV infection
items: Submandibular and sublingual salivary gland involvement in adenoid cystic carcinoma
items: Clear cell myomelanocytic tumor of ligamentum teres
items: A rare case of Sporadic Creutzfeldt-Jakob disease at a remote mountain hospital in the Indian Himalayan Region
items: Incidental finding of cardiac hydatid cyst during autopsy
items: Emerging infection: streptococcal toxic shock-like syndrome caused by group B Streptococcus (GBS), Streptococcus agalactiae
items: Fatal asphyxia due to large laryngeal granuloma
items: Leiomyoma of maxillary sinus

Mucosal melanoma of hard palate
type: item
description: Melanoma arising in the hard palate is an exceedingly rare entity, comprising a minute fraction of all melanoma cases. The absence of specific clinical signs often leads to delayed diagnosis and subsequent challenges in treatment planning. We discussed the existing literature to elucidate the epidemiology, risk factors, and molecular pathways associated with melanoma of the hard palate. Additionally, we discuss the importance of a multidisciplinary approach involving dermatologists, otolaryngologists, oncologists, and pathologists in diagnosing and managing this condition. A 62-year-old male patient presented with a pigmented lesion on the hard palate mucosa, which was initially asymptomatic but gradually increased in size. Biopsy revealed melanoma, confirmed through immunohistochemical staining. Staging investigations indicated a metastatic disease. Surgery followed by adjuvant therapy was planned; however, he was lost for the follow-up. Melanoma originating from the hard palate mucosa is exceedingly rare, posing diagnostic and therapeutic challenges. Early detection, accurate diagnosis, and prompt multidisciplinary management are crucial for optimal outcomes. This case underscores the importance of comprehensive evaluation and tailored treatment strategies in patients with uncommon mucosal melanomas.
subject: Clinical Case Report
  topic: section
subject: Melanoma, Malignant
  topic: keywords
subject: Palate, Hard
  topic: keywords
subject: Cancer
  topic: keywords
subject: Mucous Membrane
  topic: keywords
creator: Zahed Ali Qamer
creator: Monika Maharjan
creator: Kranthi Kumar Jandrasupalli
creator: Bommisetty Lokesh
creator: Amit Tyagi
creator: Ravi Hari Phulware
rights: Copyright (c) 2024 Zahed Ali Qamer, Monika Maharjan, Kranthi Kumar Jandrasupalli, Bommisetty Lokesh, Amit Tyagi, Ravi Hari Phulware https://creativecommons.org/licenses/by/4.0
date: 2024-11-18
publication date: 2024-11-18
starting page: e2024522
ending page: e2024522
doi: 10.4322/acr.2024.522

Explant pathology in Biliary Atresia post Kasai procedure: a tale of two livers
type: item
description: Biliary atresia (BA) is a progressive inflammatory cholangiopathy of infancy that results in fibrous obliteration of the extrahepatic and intrahepatic bile ducts. In untreated patients, this leads to biliary-type cirrhosis within the first two years of life. Timely diagnosis of BA with a lack of significant hepatic fibrosis is critical and surgical drainage (Kasai procedure) within the first two months of life is the initial treatment modality with the highest success rate. Ultimately, liver transplantation is required due to surgical drainage complications, such as recurrent cholangitis, failure to thrive, and portal hypertension (PHTN). Histopathological findings of hepatectomy specimens after failed and successful Kasai procedures are vastly different depending on the subsequent course of liver disease. Bile flow is inadequate following a failed Kasai procedure with rapid development of biliary cirrhosis. Explants from patients with successful Kasai procedure may show cholestatic (recurrent cholangitis), vascular (obliterative venopathy, regenerative hyperplasia, and PHTN), or an interplay of both cholestatic and vascular abnormalities. Pathologists need to be aware of explant histopathology (post-successful Kasai procedures) with a clinical course dominated by PHTN for precise documentation of vascular abnormalities.
subject: Clinical Case Report
  topic: section
subject: Neonatal cholestasis
  topic: keywords
subject: Biliary atresia
  topic: keywords
subject: Cholangitis
  topic: keywords
subject: Portal hypertension
  topic: keywords
subject: Hepato-porto-enterostomy
  topic: keywords
creator: Sunayana Misra
creator: Sonia Badwal
creator: Shashi Dhawan
creator: Arpita Mittal
creator: Naimish Mehta
creator: Nishant Wadhwa
creator: Arjun Maria
rights: Copyright (c) 2024 Sunayana Misra, Sonia Badwal, Shashi Dhawan, Arpita Mittal, Naimish Mehta, Nishant Wadhwa, Arjun Maria https://creativecommons.org/licenses/by/4.0
date: 2024-10-09
publication date: 2024-10-09
starting page: e2024521
ending page: e2024521
doi: 10.4322/acr.2024.521

Gallbladder schistosomiasis
type: item
description: Schistosomiasis is an infectious disease caused by parasitic flatworms of the genus Schistosoma. The species Schistosoma mansoni is associated with hepatosplenic disease. Schistosomiasis involving the gallbladder alone is highly unusual, with a few cases reported. Herein, we present the case of a woman from a region with endemic schistosomiasis who presented with a painless solid lesion and wall thickening of the gallbladder. She underwent an uneventful laparoscopic cholecystectomy. Microscopic examination of the surgical specimen revealed Schistosoma mansoni eggs associated with granulomatous reaction, leading to the diagnosis of schistosomiasis of the gallbladder, prompting subsequent treatment with praziquantel and follow-up. This case illustrates the importance of suspicion for this diagnosis in endemic areas, as it can be misdiagnosed with malignancy if not examined microscopically. Complications and treatment strategies are poorly characterized for the few cases of schistosomiasis; reporting this case can serve as a helpful reminder of a rare presentation of this disease.
subject: Clinical Case Report
  topic: section
subject: Schistosomiasis
  topic: keywords
subject: Gallbladder Diseases
  topic: keywords
subject: Gallbladder Neoplasms
  topic: keywords
subject: Parasitic Diseases
  topic: keywords
creator: Gabriela Del Angel-Millán
creator: José Jukemura
creator: Júlia Bragion Bicudo
creator: Ricardo Jureidini
creator: André Luís Montagnini
creator: Vanderlei Segatelli
creator: Thiago Costa Ribeiro
creator: Guilherme Naccache Namur
creator: Thiago Nogueira Costa
creator: Lucas Cata Preta Stolzemburg
creator: Emilio Elias Abdo
creator: Ulysses Ribeiro Júnior
creator: Paulo Herman
creator: Estela Regina Ramos Figueira
rights: Copyright (c) 2024 Gabriela Del Angel-Millán, José Jukemura, Júlia Bragion Bicudo, Ricardo Jureidini, André Luís Montagnini, Vanderlei Segatelli, Thiago Costa Ribeiro, Guilherme Naccache Namur, Thiago Nogueira Costa, Lucas Cata Preta Stolzemburg, Emilio Elias Abdo, Ulysses Ribeiro Júnior, Paulo Herman, Estela Regina Ramos Figueira https://creativecommons.org/licenses/by/4.0
date: 2024-10-08
publication date: 2024-10-08
starting page: e2024516
ending page: e2024516
doi: 10.4322/acr.2024.516

Systemic amyloidosis: an aggressive evolution in a patient with relapsing polychondritis and monoclonal gammopathy of undetermined significance (MGUS) undergoing peritoneal dialysis
type: item
description: Herein, we report the case of primary amyloidosis with multi-organ involvement in a female patient in her 50s. The patient had a history of relapsing polychondritis, chronic kidney disease, and monoclonal gammopathy of undetermined significance (MGUS). The clinical manifestations included neuropathic pain, sensorimotor polyneuropathy, intrahepatic cholestatic liver injury, gastrointestinal symptoms, dysautonomia, and myocardial thickening. Initial histologic evaluations of the abdominal fat pad aspirate and bone marrow biopsy were negative for amyloid deposition. However, due to a high index of suspicion, a second bone marrow biopsy was performed, confirming the presence of the amyloid protein. Given the patient's complex medical history, other types of amyloidosis, such as AA amyloidosis, AL amyloidosis, and ß2-microglobulin amyloidosis, should also be considered as differential diagnoses. The type of amyloid protein was subsequently identified through laser microdissection of amyloid fibrils followed by liquid chromatography–tandem mass spectrometry as AL-lambda (amyloid light-chain) amyloidosis. The patient presented unfavorable evolution, with progressive dysautonomia, being admitted to the ICU, culminating in refractory circulatory shock, and undergoing an empirical broad-spectrum antibiotic therapy. After a few days, she presented pulseless ventricular tachycardia, culminating in her death, before undergoing specific treatment. This article highlights the crucial role of precise identification in guiding appropriate therapeutic strategies for this complex, yet potentially severe, diseases.
subject: Clinical Case Report
  topic: section
subject: Amyloidosis
  topic: keywords
subject: Paraproteinemias
  topic: keywords
subject: Polyneuropathies
  topic: keywords
subject: Autonomic Nervous System Diseases
  topic: keywords
creator: Thiago Cavalcanti Matos
creator: William George Giusti Fischer
creator: Rosa Maria Rodrigues Pereira
creator: Andre Silva Franco
rights: Copyright (c) 2024 Thiago Cavalcanti Matos, William George Giusti Fischer, Rosa Maria Rodrigues Pereira, Andre Silva Franco https://creativecommons.org/licenses/by/4.0
date: 2024-09-27
publication date: 2024-09-27
starting page: e2024518
ending page: e2024518
doi: 10.4322//acr.2024.518

Cytological diagnosis of hyaline-vascular type of Castleman disease
type: item
description: Castleman disease (CD) is a rare, benign lymphoproliferative disorder, mostly involving the mediastinal lymph nodes, but can occur wherever lymphoid tissue is found. With only a few published case reports, there needs to be more literature on its cytological findings. We report the case of a 63-year-old female presenting with left upper cervical swelling. Fine needle aspiration cytology smears showed variably sized lymphoid follicles with diminished germinal centers, prominence of follicular dendritic cells, and capillaries traversing some of the follicles. The possibility of a hyaline-vascular type of Castleman disease was suggested. Histopathology confirmed the cytological diagnosis. The index case is being presented to discuss the cytological features of the CD along with its histological and immunohistochemical correlation.
subject: Clinical Case Report
  topic: section
subject: Hyaline-vascular
  topic: keywords
subject: Castleman Disease
  topic: keywords
subject: fine needle aspiration cytology
  topic: keywords
creator: Deepa Rani
creator: Anupam Varshney
creator: Kanika Rastogi
rights: Copyright (c) 2024 Deepa Rani, Anupam Varshney, Kanika Rastogi https://creativecommons.org/licenses/by/4.0
date: 2024-09-27
publication date: 2024-09-27
starting page: e2024519
ending page: e2024519
doi: 10.4322/acr.2024.519

Multicystic encephalopathy: an ultimate manifestation of ischemic-hypoxic injury
type: item
description: Multicystic encephalopathy is a rare neurological finding characterized by the appearance of multiple cystic or cavitary lesions as the result of repetitive episodes of hypoxic-ischemic injury in neonates and infants. We present a rare case of multicystic encephalopathy in a 3-month-old male, born at 34 weeks with Tetralogy of Fallot and multiple comorbidities. Gross examination of the brain during the autopsy revealed multiple irregular cystic lesions and distortion of the brain parenchyma. This case report highlights the uniqueness of multicystic encephalopathy and offers an extensive review of the existing literature, including etiology, clinical presentation, and histopathologic findings.
subject: Autopsy Case Report
  topic: section
subject: Autopsy
  topic: keywords
subject: Brain
  topic: keywords
subject: Hypoxia, Infant, Newborn
  topic: keywords
creator: Vielka Fernandez Aragones
creator: Amilcar Castellano-Sanchez
creator: Gabriel Chamyan
creator: Darline Santana-Acosta
rights: Copyright (c) 2024 Vielka Fernandez Aragones, Amilcar Castellano-Sanchez, Gabriel Chamyan, Darline Santana-Acosta https://creativecommons.org/licenses/by/4.0
date: 2024-09-27
publication date: 2024-09-27
starting page: e2024517
ending page: e2024517
doi: 10.4322/acr.2024.517

Stealth cryptococcus in an immunocompetent patient
type: item
description: Cryptococcosis occurs primarily in immunocompromised patients. It is difficult to suspect in an immunocompetent patient presenting with a headache. The clinical manifestations of cryptococcosis can be subtle in a patient whose immune system is responding, but inadequate. This is the report of a case of fatal cryptococcosis initially misdiagnosed as a sinus headache on the basis of a telephone call, and then misdiagnosed as aseptic meningitis on the basis of mild findings and negative cerebrospinal fluid cultures. Autopsy revealed unsuspected severe cryptococcal meningoencephalitis. Cerebrospinal fluid nuclear acid amplification (NAA) panels including Cryptococcus should enable the diagnosis of unsuspected cryptococcal meningitis in most cases, but can be false positive, which could be adjudicated by cryptococcal antigen and culture. It will remain important to test for cryptococcal antigen and to maintain a broad differential diagnosis for all patients with meningitis.
subject: Article / Autopsy Case Report
  topic: section
subject: Cryptococcosis
  topic: keywords
subject: Meningitis
  topic: keywords
subject: Headache
  topic: keywords
subject: Immunocompetence
  topic: keywords
subject: Diagnosis, Differential
  topic: keywords
creator: Emily Ryan
creator: Gia Jackson
creator: Larry Nichols
rights: Copyright (c) 2024 Emily Ryan, Gia Jackson, Larry Nichols https://creativecommons.org/licenses/by/4.0
date: 2024-09-27
publication date: 2024-09-27
starting page: e2024520
ending page: e2024520
doi: 10.4322/acr.2024.520

Chondroblastic Osteosarcoma of proximal tibia
type: item
description: Chondroblastic osteosarcoma is a unique form of osteosarcoma defined by malignant cells producing osteoid and cartilaginous matrix.1,2 While osteosarcoma is an uncommon disease, accounting for less than 1% of all cancers, chondroblastic osteosarcoma accounts for 25-30% of osteosarcoma occurrences.2,3 It commonly affects the metaphyseal areas of long bones, particularly the distal femur, proximal tibia, and proximal humerus.2 This discussion aims to evaluate the existing literature on chondroblastic osteosarcoma of the upper tibia, focusing on significant findings, diagnostic problems, treatment methods, and results. Patients with chondroblastic osteosarcoma of the upper tibia typically present with nonspecific symptoms such as localized pain, swelling, and restricted range of motion.3,4 In some circumstances, pathological fractures can occur, causing symptoms to worsen suddenly. However, due to the deep-seated nature of the tumor within the bone, clinical discovery may be delayed, resulting in advanced disease at diagnosis.1,3 Chondroblastic osteosarcoma is diagnosed based on clinical, radiographic, and histological findings. Radiographically, the tumor typically appears as an aggressive lytic lesion with areas of mineralization and cortical damage.4,5 However, identifying chondroblastic osteosarcoma from other bone tumors, such as chondrosarcoma or Ewing sarcoma, can be difficult based only on imaging. Histopathological analysis of a biopsy specimen is required for a definitive diagnosis, which reveals the presence of osteoid and cartilaginous matrix generated by malignant cells.2,3 The cornerstone of treatment for upper tibial chondroblastic osteosarcoma is multimodal therapy, which includes neoadjuvant chemotherapy, surgical resection, and adjuvant therapy.1,2 Neoadjuvant chemotherapy seeks to shrink the tumor, reduce its size, and eliminate micrometastatic illness.3 Surgical excision with wide margins is required to achieve local control and reduce the chance of…
subject: Image in focus
  topic: section
subject: Osteosarcoma
  topic: keywords
subject: Chondrocytes
  topic: keywords
subject: Tibia
  topic: keywords
subject: Chondroblastic
  topic: keywords
subject: Osteoid
  topic: keywords
creator: Ravi Hari Phulware
creator: Kaashvi Gupta
creator: Gaurav Rajendra Shirsath
creator: Mohit Dhingra
rights: Copyright (c) 2024 Ravi Hari Phulware, Kaashvi Gupta, Gaurav Rajendra Shirsath, Mohit Dhingra https://creativecommons.org/licenses/by/4.0
date: 2024-09-12
publication date: 2024-09-12
starting page: e2024515
ending page: e2024515
doi: 10.4322/acr.2024.515

Large atypical parathyroid tumor - a diagnostic conundrum
type: item
description: Atypical parathyroid tumor (APT) is a rare neoplasm of the parathyroid gland, which shows atypical cytological or architectural features and lacks definite diagnosis criteria for malignancy. These cases can cause diagnostic challenges owing to their rarity and similarity with thyroid neoplasm on imaging and fine needle aspiration cytology. Also, differentiating APT from giant parathyroid adenoma or parathyroid carcinoma can be challenging based on clinical, imaging or cytological features. A 49-year-old male presented with clinical features of hyperparathyroidism. On laboratory evaluation, his serum calcium and serum parathyroid hormone was elevated. Imaging studies suggested a possibility of left inferior parathyroid neoplasm, and fine needle aspiration cytology showed features suggestive of parathyroid neoplasm. However, exact categorization of parathyroid tumor was difficult in pre-operative work-up. Possibilities of giant parathyroid adenoma as well as parathyroid carcinoma were considered. A final diagnosis of an atypical parathyroid tumor was made after detailed histopathological evaluation given focal capsular invasion but lack of unequivocal evidence of malignancy in the resected specimen. APT is a rare neoplasm of uncertain malignant potential. Knowledge of the radiological and pathological features will be helpful in accurately identifying the lesion and avoiding misdiagnosis.
subject: Clinical Case Report
  topic: section
subject: Parathyroid adenoma
  topic: keywords
subject: Aspiration, fine Needle
  topic: keywords
subject: hyperparathyroidism
  topic: keywords
subject: Histopathology
  topic: keywords
subject: Parathyroid Carcinoma
  topic: keywords
creator: Saikat Mitra
creator: Shouvanik Satpathy
creator: Devmalya Banerjee
creator: Sugat Sanyal
rights: Copyright (c) 2024 Saikat Mitra, Shouvanik Satpathy, Devmalya Banerjee, Sugat Sanyal https://creativecommons.org/licenses/by/4.0
date: 2024-09-12
publication date: 2024-09-12
starting page: e2024514
ending page: e2024514
doi: 10.4322/acr.2024.514

Mönckeberg calcified sclerosis preventing the use of radial artery in myocardial revascularization surgery
type: item
description: Figure 1 A – external and cross-sectional macroscopic view of the radial artery. Note thickening of the arterial wall; B – at histology, massive media calcification is evident (arrows), plus mild intimal fibrotic thickening (asterisks). Note internal elastic lamina (arrowheads), the internal limit of the medial layer (HE stain).: Arteriosclerosis, i.e., “hardening of the arteries”, is currently subdivided into atherosclerosis, Mönckeberg calcified sclerosis (MCS), and arteriolosclerosis. MCS was first described in 1903, characterized by calcific deposits affecting only the tunica media of large and medium-sized muscular arteries without significant luminal stenosis. However, MCS can coexist with classical atherosclerosis, characterized by atheroma plaques in the intima. MCS is rarely seen in patients under the 5th decade of life and is associated with the presence of diabetes mellitus and/or chronic kidney disease. The etiology and pathogenesis of MCS are currently poorly understood.1,2 The use of arterial grafts in myocardial revascularization surgery is associated with a lower rate of adverse cardiac events and a higher rate of patency of the grafts at 5 years of follow-up. Besides the left internal thoracic artery, the right one and the radial artery have been used, particularly when complete revascularization is pursued in patients with multivessel coronary artery disease.3 However, when planning myocardial revascularization, surgeons should be aware that pathological alterations, particularly arteriosclerosis, can affect arterial conduits. Concerning the radial artery, there are previous reports of MCS preventing arterial catheterization and, more importantly, preventing its use as an arterial graft in myocardial revascularization surgery.4,5 A 69-year-old man presented to our hospital with unstable angina. He had systemic hypertension and type II insulin-dependent diabetes mellitus. A previous myocardial infarction occurred 25 years ago, treated with coronary …
subject: Image in focus
  topic: section
subject: Arteriosclerosis
  topic: keywords
subject: Coronary Artery Bypass
  topic: keywords
subject: ; Mönckeberg Medial Calcific Sclerosis
  topic: keywords
subject: Radial Artery
  topic: keywords
creator: Luiz Alberto Benvenuti
rights: Copyright (c) 2024 Luiz Alberto Benvenuti https://creativecommons.org/licenses/by/4.0
date: 2024-09-06
publication date: 2024-09-06
starting page: e2024513
ending page: e2024513
doi: 10.4322/acr.2024.513

Anti MDA-5 associated rapidly progressive interstitial lung disease complicated by viral pneumonia - a fatal outcome
type: item
description: Dermatomyositis is a heterogeneous systemic disease, with 7% to 10% of the individuals presenting the Anti MDA-5 antibody. This subset of patients has clinically amyotropic dermatomyositis, presenting with cutaneous ulcer and rapidly progressive interstitial lung disease. We report the case of a 22-year-old male with a six-month history of low-grade fever associated with myalgia, polyarthralgia, and marked weight loss. He had a history of shortness of breath and high-grade fever 15 days before admission. His clinical features and imaging workup were consistent with acute respiratory distress syndrome. A nasal swab was positive for H1N1 influenza virus infection. During the disease investigation, he succumbed after nine days of admission. The autopsy examination showed diffuse alveolar damage on a background of non-specific interstitial pattern of injury in the lungs. His postmortem muscle biopsy revealed subtle changes of inflammatory myopathy. The brain showed diffuse subarachnoid hemorrhage. Evaluation of postmortem serum sample revealed positivity for Anti MDA-5 and Ro-52 antibodies. This was a case of Anti MDA-5 and Ro-52 associated dermatomyositis with non-specific interstitial pneumonia pattern of lung injury complicated with H1N1 influenza pneumonia, leading to diffuse alveolar damage and subsequent respiratory failure and death. Serum Anti MDA-5 antibodies represent an important biomarker for diagnosing and predicting prognosis for patients with idiopathic inflammatory myopathies, especially clinically amyopathic dermatomyositis. Anti-Ro-52 has been reported in a wide variety of autoimmune diseases, particularly in myositis, scleroderma, and autoimmune liver diseases. Ro-52 autoantibodies are associated with interstitial lung disease (ILD), and their presence should encourage the clinician's curiosity to search for ILD.
subject: Autopsy Case Report
  topic: section
subject: Dermatomyositis
  topic: keywords
subject: Idiopathic Interstitial Pneumonias
  topic: keywords
subject: Influenza A Virus
  topic: keywords
subject: H1N1 Subtype
  topic: keywords
subject: Lung Diseases
  topic: keywords
subject: Interstitial Respiratory Distress Syndrome
  topic: keywords
creator: Saikat Mitra
creator: Nithye Parvathy
creator: Mandeep Garg
creator: Shritik Devkota
creator: Sandeep Bansal
creator: Inderpaul Singh Sehgal
creator: Kirti Gupta
rights: Copyright (c) 2024 Saikat Mitra, Nithye Parvathy, Mandeep Garg, Shritik Devkota, Sandeep Bansal, Inderpaul Singh Sehgal, Kirti Gupta https://creativecommons.org/licenses/by/4.0
date: 2024-08-30
publication date: 2024-08-30
starting page: e2024511
ending page: e2024511
doi: 10.4322/acr.2024.511

COVID-19 shed light on Virchow’s law of thrombosis
type: item
description: Virchow’s law of thrombosis states that thrombosis in a vessel occurs as a combination of the following: (i) injury to the vessel wall, (ii) stasis of blood flow, and (iii) blood hypercoagulability. Injury to the wall includes infection/inflammation and/or injury to the resident cells of the wall. We postulate that in COVID-19, the SARS-CoV-2 virus directly infects the alveolar type II cell or directly or indirectly infects/injures the pericyte, promoting inflammation and interaction with endothelial cells, thereby causing a cascade of events leading to our observation that thrombosis occurred within the walls of the pulmonary vessels and not in the lumen of the vascular circulation.
subject: Short Communication
  topic: section
subject: Blood vessels
  topic: keywords
subject: COVID-19
  topic: keywords
subject: Thrombosis
  topic: keywords
creator: Hubert Daisley
creator: Oneka Acco
creator: Martina Daisley
creator: Dennecia George
creator: Lilly Paul
creator: Arlene Rampersad
creator: Johann Daisley
rights: Copyright (c) 2024 Hubert Daisley, Oneka Acco, Martina Daisley, Dennecia George, Lilly Paul, Arlene Rampersad, Johann Daisley https://creativecommons.org/licenses/by/4.0
date: 2024-08-28
publication date: 2024-08-28
starting page: e2024512
ending page: e2024512
doi: 10.4322/acr.2024.512

Unravelling the mystery of the central dentinogenic ghost cell tumor- a rare case report and recurrent insights
type: item
description: Dentinogenic ghost cell tumor (DGCT) is a rare benign neoplasm form of calcifying odontogenic cyst (COC) characterized by ghost cells. Although benign, it presents an aggressive behavior. DGCT accounts for 2% to 14% of all COCs and less than 0.5% of all odontogenic tumors. It is a benign odontogenic tumor despite its local invasion and the likelihood of recurrence. To detect recurrence, central DGCT patients must be monitored long-term. We present the case of a 51-year-old male who reported pain in the right upper back tooth region. On examination, a soft to firm, bright red swelling was present in the buccal vestibule and gingival margin of the maxillary right first and second molar, which extended up to the palate. Histopathological analysis confirmed the diagnosis of a DGCT, which occurred in a previously treated calcifying odontogenic cyst. The case is reported here, along with a review of the literature update of such recurred instances in the past.
subject: Clinical Case Report and Review
  topic: section
subject: Maxillary Neoplasms
  topic: keywords
subject: Odontogenic Cyst, Calcifying
  topic: keywords
subject: Odontogenic Tumors
  topic: keywords
creator: Jagveer Yadav
creator: Mala Kamboj
creator: Anju Devi
creator: Anjali Narwal
creator: Deepti Chhikara
creator: Bhawna Saini
rights: Copyright (c) 2024 Jagveer Yadav, Mala Kamboj, Anju Devi, Anjali Narwal, Deepti Chhikara, Bhawna Saini https://creativecommons.org/licenses/by/4.0
date: 2024-08-15
publication date: 2024-08-15
starting page: e2024510
ending page: e2024510
doi: 10.4322/acr.2024.510

Cholangiocarcinoma in early childhood
type: item
description: To the Editor: Cholangiocarcinoma (CCA) is a rare malignancy of the biliary tract, comprising 3% of all gastrointestinal cancers.1 Typically diagnosed in the seventh decade of life, it seldom occurs in the pediatric age group, making cases in pediatric patients notable.2 CCA in children and adolescents is frequently associated with underlying risk factors. In contrast, only 30% of adults exhibit them.3 We report the youngest presentation of a sporadic case of CCA in a 5-year-old boy with an unremarkable medical history. A 5-year-old boy presented with a 15-day history of progressive abdominal distension and vomiting. Notably, there was no weight loss, fever, or jaundice. Clinical examination revealed a distended abdomen with dilated veins and marked hepatosplenomegaly. Laboratory findings included a hemoglobin of 12.5 g/dL (13-18 g/dl), a white blood cell count of 14,810/μL (4000-11500/uL), and a platelet count of 341,000/μL (331000/uL). The biochemical profile revealed a total serum bilirubin level of 0.6 mg/dL (0.2-1.2 mg/dL), serum aspartate aminotransferase of 37 U/L (up to 35 U/L), serum alanine transaminase of 11 U/L (up to 55 U/L), albumin of 3 g/dl (3.5-5.2 g/dL), and an INR of 1.1. Tests for human immunodeficiency virus, hepatitis B surface antigen, and hepatitis C virus were negative. The abdominal and pelvic contrast-enhanced computed tomography revealed an enlarged liver with multiple scattered, well-defined hypodense lesions, the largest in segment VI of 3.3x3.0cm. The spleen was enlarged, without focal lesions. Multiple paraaortic and mesenteric lymph nodes were enlarged, and the abdomen had moderate free fluid. Serum carbohydrate antigen 19-9 (CA 19-9) was l136 U/mL (RR: 0-37 IU/mL), and alpha-fetoprotein was 2.19 IU/mL (RR: 0-8 IU/mL). An ultrasound-guided liver biopsy revealed a neoplasm characterized by tumor cells with eosinophilic cytoplasm, vesicular nuclear chromatin, and prominent nucleoli arranged in a glandular pattern, cords, and nests. Imm…
subject: Letters to the Editor
  topic: section
subject: Pediatric Cancer
  topic: keywords
subject: Cholangiocarcinoma
  topic: keywords
subject: Jaundice
  topic: keywords
subject: Ascites
  topic: keywords
subject: Malignancy
  topic: keywords
subject: Pediatric Oncology
  topic: keywords
creator: Amrit Kaur
creator: Prakruthi S. Kaushik
creator: Suma Mysore Narayana
creator: Arun Kumar Ajjapanahalli Rajanna
creator: Aruna Kumari Bandagadde Sreenivasa Bhat
creator: Lingegowda Appaji
rights: Copyright (c) 2024 Amrit Kaur, Prakruthi S. Kaushik, Suma Mysore Narayana, Arun Kumar Ajjapanahalli Rajanna, Aruna Kumari Bandagadde Sreenivasa Bhat, Lingegowda Appaji https://creativecommons.org/licenses/by/4.0
date: 2024-08-06
publication date: 2024-08-06
starting page: e2024504
ending page: e2024504
doi: 10.4322/acr.2024.504

The need for mandatory autopsy teaching in Forensic Medicine for medical students
type: item
description: The effectiveness of the autopsy as an educational tool in forensic medicine courses has been widely acknowledged, and medical students were expected to attend regularly. Nevertheless, the use of autopsies for teaching has dramatically declined in recent years and worldwide despite their high-value benefits. This study aims to understand the importance and relevance of attending autopsies during forensic teaching sessions and identify any challenges that may impede attendance. A self-administered online questionnaire that assesses the knowledge, attitudes, and practices related to autopsies attendance was distributed to fourth-year medical students at the National Defence University of Malaysia and Universiti Sains Islam Malaysia. A total of 99 respondents were involved in this study. Our findings indicate that most respondents (over 85%) demonstrated good knowledge of forensic medicine. Pearson's statistical test revealed a significant correlation between the knowledge and students' attitudes toward autopsy. This study demonstrates the need to strategically integrate autopsy attendance into medical curricula to encourage constructive attitudes and practices among medical students. Students gain the most benefits from frequently attending autopsies. Passionate educators can conduct preparatory sessions to set expectations and address concerns, encourage students to process their experiences, and reinforce learning outcomes in the mortuary setting. Mandatory autopsy teaching should be integrated into the curriculum to ensure medical students have the necessary skills and knowledge to become competent doctors.
subject: Original Article
  topic: section
subject: autopsy
  topic: keywords
subject: education
  topic: keywords
subject: forensic medicine
  topic: keywords
subject: undergraduate
  topic: keywords
subject: teaching
  topic: keywords
creator: Nurul Kharmila Abdullah
creator: Nur Arina Ahmad
creator: Shalinawati Binti Ramli
creator: Nadiawati Abdul Razak
rights: Copyright (c) 2024 Nurul Kharmila Abdullah, Nur Arina Ahmad, Shalinawati Binti Ramli, Nadiawati Abdul Razak https://creativecommons.org/licenses/by/4.0
date: 2024-08-06
publication date: 2024-08-06
starting page: e2024509
ending page: e2024509
doi: 10.4322/acr.2024.509

Laryngeal plasmacytoma in a patient with Down’s syndrome
type: item
description: Extramedullary plasmacytoma is a rare localized plasma cell neoplasm typically found in soft tissues outside the bone marrow. Predominantly occurring in the head and neck region, particularly in the sinonasal and nasopharyngeal areas, it presents a diagnostic challenge due to its uncommon nature. Herein, we report a 38-year-old female patient with Down’s syndrome with a 2-year complaint of intermittent dysphonia, hoarseness, and progressive respiratory distress, including dyspnea, fatigue, and biphasic stridor. Examination via flexible laryngoscopy revealed a white lesion, prompting direct microscopic laryngeal surgery to excise a 1x1 cm mass. Histological findings confirmed the diagnosis as solitary extramedullary plasmacytoma. Notably, this represented the first documented case of laryngeal solitary extramedullary plasmacytoma in a patient with Down’s syndrome. This case underscores the importance of considering tumor development in the larynx among individuals with Down’s syndrome, highlighting the necessity for tailored management strategies to address such occurrences effectively. Increasing awareness of this association can aid in early detection and appropriate treatment of tumors in this population.
subject: Clinical Case Report
  topic: section
subject: Extramedullary plasmacytoma
  topic: keywords
subject: laryngeal neoplasms
  topic: keywords
subject: larynx
  topic: keywords
creator: Hassan Hodroj
creator: Zahraa Saker
creator: Zahraa Al Najjar
creator: Hassane Choukr
creator: Mohamad Reda Noureddine El Moussaoui
rights: Copyright (c) 2024 Hassan Hodroj, Zahraa Saker, Zahraa Al Najjar, Hassane Choukr, Mohamad Reda Noureddine El Moussaoui https://creativecommons.org/licenses/by/4.0
date: 2024-08-02
publication date: 2024-08-02
starting page: e2024508
ending page: e2024508
doi: 10.4322/acr.2024.508

Unilateral testicular metastasis of prostate cancer
type: item
description: Prostatic adenocarcinoma is the most common type of cancer in men, with subsequent lesions most commonly occurring in the lymph nodes, bones, and lungs.1,2 We discuss the clinical case of a 59-year-old man who presented after radical prostatectomy for prostate cancer with a unilateral metastasis in the right testis. Metastases to the testis are uncommon, occurring in less than 4% of cases.2,3 This kind of metastasis is usually unilateral, manifesting as a palpable testicular mass, and rarely involves both the testis and the epididymis.1,2 Secondary neoplasms of the testis are found in around 2.5% of autopsies, including nonneoplastic fatalities.2 Most secondary testicular metastases develop from distant primary locations, the most prevalent of which are the lung, prostate, and gastrointestinal tract.2 Testicular metastases can occur in up to 4% of all prostate cancer cases and are frequently discovered by chance following orchiectomy therapy for advanced disease.4 In general, advanced prostate cancer metastases to the pelvic lymph nodes, bones, lungs, and liver are common; however, few of these patients have clinically evident testicular metastasis.4,5 Secondary neoplasms of the testis are uncommon, with a reported rate of 0.02-2.5%, except leukemia and lymphoma infiltration.2,3 The prostate is the most common site of testicular metastases (15%), followed by the lung, melanomas, skin, colon, and kidney.1,2 However, most testicular metastases of prostate cancer were discovered after examining a significant number of testes from patients who had tumors removed during therapeutic orchiectomies.2,4 Lung cancer (43%), malignant melanoma (20%), pancreatic cancer (10%), and prostate cancer (10%) are among cancers that can spread to the testes.4,5 However, the great majority of metastases are lesions detected by chance following an autopsy or bilateral orchiectomy for Prostatic Cancer hormonal treatment.3 A testicular tumor revealing clinical recurrence is highly unusual. B…
subject: Image in focus
  topic: section
subject: Neoplasm Metastasis
  topic: keywords
subject: Prostate-Specific Antigen
  topic: keywords
subject: Prostatic Neoplasms
  topic: keywords
subject: Testicular Neoplasms
  topic: keywords
subject: Testis
  topic: keywords
creator: Ravi Hari Phulware
creator: Gayathri K S
creator: Gaurav Rajendra Shirsath
creator: Amit Gupta
rights: Copyright (c) 2024 Ravi Hari Phulware, Gayathri K S, Gaurav Rajendra Shirsath, Amit Gupta https://creativecommons.org/licenses/by/4.0
date: 2024-07-30
publication date: 2024-07-30
starting page: e2024507
ending page: e2024507
doi: 10.4322/acr.2024.507

Traveling together! - Intrathymic thyroid tissue in a patient with Graves’ disease
type: item
description: Ectopic thyroid tissue is rare in the general population and more prevalent in people who have existing thyroid disease. Common anatomical sites of ectopic thyroid tissue include the lateral cervical region, thyroglossal duct, mediastinum, lingual, sublingual, and submandibular region. Intrathymic ectopic thyroid tissue is exceedingly rare. The purpose of this report is to describe one such case in a 52-year-old African-American female with Graves’ disease. The patient presented for a physical exam and follow-up. During the exam, an incidental mediastinal mass was discovered, which was evaluated by imaging studies and subsequently was resected. Histologically, the mass was composed of variable-sized thyroid follicles lined by a monolayer of cuboidal to columnar follicular epithelial cells and filled with eosinophilic colloid, surrounded by a rim of unremarkable compressed thymic tissue.
subject: Clinical Case Report and Review
  topic: section
subject: Ectopic thyroid
  topic: keywords
subject: Intrathymic thyroid
  topic: keywords
subject: Thoracic intrathymic thyroid
  topic: keywords
subject: Benign thymic nodule
  topic: keywords
subject: Mediastinal mass, Graves’ disease
  topic: keywords
creator: Hugh Ellis McCormick
creator: Sidrah Khawar
creator: Ameer Hamza
rights: Copyright (c) 2024 Hugh Ellis McCormick, Sidrah Khawar, Ameer Hamza https://creativecommons.org/licenses/by/4.0
date: 2024-07-30
publication date: 2024-07-30
starting page: e2024506
ending page: e2024506
doi: 10.4322/acr.2024.506

Non-functioning parathyroid cyst presenting as a neck mass
type: item
description: Parathyroid cyst (PC) is an uncommon cause of neck mass and accounts for 0.8- 3.41% of parathyroid lesions. Females are more commonly affected than males (F:M- 2.5:1).1 Nearly 90% of PCs are non-functional, while the remaining are functional and secrete parathormone. Although functional PCs usually manifest cystic degeneration of a parathyroid adenoma, simple functional cysts of the parathyroid gland presenting features of hyperparathyroidism have also been documented.2 PC mainly develops in the inferior parathyroid glands, like the index case. The presentation may vary from asymptomatic neck mass to compressive symptoms such as hoarseness, dysphagia, or dyspnea. On examination, they are palpable as a soft, fluctuant cystic mass that moves with deglutition. Ultrasonogram usually reveals an anechoic thin-walled cyst with posterior enhancement, and computed tomography and magnetic resonance imaging demonstrate the cystic nature of the lesion and its anatomical relationship. Scintigraphy may not help determine the exact location of the cyst. Histopathological examination remains the gold standard for the diagnosis. The best treatment option for both functional and non-functional PC is surgical excision. Other options, such as simple aspiration and percutaneous injection of sclerosing agents, may also be attempted in cases of non-functional PC.3 Figure 1 refers to the case of a 24-year-old young female who presented with an asymptomatic neck swelling that progressively increased over the last 4 months. There were no complaints of dyspnea, dysphagia, palpitation, or symptoms of hypothyroidism. On clinical examination, a 5×4 cm swelling was palpable in the left anterior aspect of the neck. It was smooth with regular, well-defined margins, firm, and non-tender, moving with the deglutition but not with tongue protrusion. No lymphadenopathy was present. Lab investigations revealed normal thyroid hormone profile; triiodothyronine (T3: 0.82 ng/ml; RR: 0.35- 1.93 ng/ml), thyrox…
subject: Image in focus
  topic: section
subject: Cysts
  topic: keywords
subject: Parathyroid Glands
  topic: keywords
subject: Parathyroid Hormone
  topic: keywords
creator: Sangamitra Rajasekaran
creator: Adarsh Barwad
creator: Suvradeep Mitra
rights: Copyright (c) 2024 Sangamitra Rajasekaran, Adarsh Barwad, Suvradeep Mitra https://creativecommons.org/licenses/by/4.0
date: 2024-07-30
publication date: 2024-07-30
starting page: e2024505
ending page: e2024505
doi: 10.4322/acr.2024.505

Giant intrapulmonary solitary fibrous tumor
type: item
description: Solitary fibrous tumor (SFT) is a soft tissue tumor of mesenchymal origin involving, most commonly, the pleura. Intrapulmonary SFT is a slow-growing tumor that rarely reaches giant forms. SFTs are asymptomatic and often randomly discovered by routine chest X-rays. The diagnosis requires histopathological and immunohistochemical (IHC) examinations. Most of the SFTs are benign and present an indolent course. Larger tumors are more likely to be malignant and consequently associated with a worse prognosis. Despite having histopathological criteria for malignancy, the behavior of SFTs is challenging to predict. We report a case of giant intrapulmonary SFT of intermediate risk.
subject: Short Communication
  topic: section
subject: Solitary Fibrous Tumors
  topic: keywords
subject: Lung
  topic: keywords
subject: Immunohistochemistry
  topic: keywords
creator: Sheela Devi Chandakavadi Shivalingaiah
creator: Deepika Gurumurthy
creator: Gauri Dadich
rights: Copyright (c) 2024 Sheela Devi Chandakavadi Shivalingaiah, Deepika Gurumurthy, Gauri Dadich https://creativecommons.org/licenses/by/4.0
date: 2024-07-29
publication date: 2024-07-29
starting page: e2024494
ending page: e2024494
doi: 10.4322/acr.2024.494

Bilateral primary ovarian Ewing sarcoma recurring as left submandibular lymphadenopathy diagnosed on cytology
type: item
description: Ewing sarcoma (ES) is a highly malignant and aggressive small round-cell tumor originating from primitive neuroepithelium and mesenchymal stem cells. It is usually seen in children and adolescents with a male predilection and a preponderance to occur in long bones. Although skeletal/soft tissue ES is encountered in clinical practice, primary ES of the genital tract, particularly bilateral primary ovarian ES, is highly uncommon, with only a handful of cases reported worldwide. Ovarian ES is occasionally reported to involve para-aortic and pelvic lymph nodes in advanced stages. Still, cervical lymph node metastasis from ovarian ES is an infrequent clinical occurrence and, when present, indicates a worse prognosis. Here, we present an intriguing case of bilateral peripheral primary ovarian ES in an adult female, recurring as metastasis in the left submandibular lymph node. This case underlines the importance of keeping metastasis from ES as a possible differential while diagnosing metastatic small round cell tumors in peripheral lymph nodes. It also highlights the usefulness of a minimally invasive diagnostic modality of fine needle aspiration cytology and cell block preparation with applied ancillary techniques of immunohistochemistry and confirmatory molecular testing by fluorescence in-situ hybridization (FISH), for an accurate and quick diagnosis of such entities. The cytological diagnosis of our patient helped in the prompt and early initiation of chemotherapy without requiring any invasive procedure.
subject: Clinical Case Report
  topic: section
subject: Ovary
  topic: keywords
subject: Cytology
  topic: keywords
subject: Neoplasm Metastasis
  topic: keywords
subject: Lymph Nodes
  topic: keywords
subject: Molecular Conformation
  topic: keywords
creator: Shaivy Malik
creator: Neha Kawatra Madan
creator: Meetu Agrawal
creator: Rajni Yadav
creator: Adarsh Barwad
rights: Copyright (c) 2024 Shaivy Malik, Neha Kawatra Madan, Meetu Agrawal, Rajni Yadav, Adarsh Barwad https://creativecommons.org/licenses/by/4.0
date: 2024-07-29
publication date: 2024-07-29
starting page: e2024499
ending page: e2024499
doi: 10.4322/acr.2024.499

Localized cystic kidney disease: a case report unveiling clinical and histopathological challenges
type: item
description: Localized cystic kidney disease (LCKD) is a distinct renal disorder characterized by the presence of cysts within specific regions of the kidneys. We present a rare case of a 41-year-old African American man, who presented to our medical center with lower urinary tract symptoms and gross hematuria. The initial assessment culminated in the identification of an uncomplicated urinary tract infection, prompting the prescription of appropriate oral antibiotic therapy. On follow-up after 5 months, the patient presented with gross hematuria. Imaging studies revealed a mixed-density cystic lesion of 2.6 cm situated within the interpolar region of the right kidney. This cystic lesion exhibited intricate septations at the superior pole of the kidney. Robotic-assisted right partial nephrectomy was performed, and pathologic examination was diagnostic for LCKD. This report not only underscores the uniqueness of LCKD but also presents a comprehensive review of the existing literature that pertains to this condition. Particular emphasis is placed upon its inherent benign behavior and its marked divergence from the progressive trajectory commonly associated with other renal diseases. We also explored the incidental findings of the disease, its diverse clinical symptomatology, conceivable etiological underpinnings, and the array of diagnostic modalities used. Finally, similarities in histopathologic findings with polycystic kidney disease and other entities are discussed, underscoring the importance of accurate diagnosis and management.
subject: Clinical Case Report
  topic: section
subject: Case Reports
  topic: keywords
subject: Kidney Diseases
  topic: keywords
subject: Polycystic Kidney Diseases
  topic: keywords
subject: Polycystic Kidney
  topic: keywords
subject: Autosomal Dominant
  topic: keywords
subject: Kidney Diseases, Cystic
  topic: keywords
creator: Teresita Mendez
creator: Hisham F. Bahmad
creator: Francesca Polit
creator: Nicole Carpio
creator: Arman Gill
creator: William F. Burke III
creator: Akshay Bhandari
creator: Robert Poppiti
creator: Yumna Omarzai
rights: Copyright (c) 2024 Teresita Mendez, Hisham F. Bahmad, Francesca Polit, Nicole Carpio, Arman Gill, William F. Burke III, Akshay Bhandari, Robert Poppiti, Yumna Omarzai https://creativecommons.org/licenses/by/4.0
date: 2024-07-26
publication date: 2024-07-26
starting page: e2024498
ending page: e2024498
doi: 10.4322/acr.2024.498

A great simulator in clinical practice: mononeuritis multiplex in HIV infection
type: item
description: HIV infection is a chameleon, mimicking several diseases. Herein, we report a previously healthy 39-year-old woman who, over 2 months, developed arthritis, weight loss, and confluent multiple mononeuropathy. Extensive laboratory investigation showed positive serology for HIV, with a CD4 count of 100 cells, and necrotizing vasculitis on a nerve biopsy not associated with CMV co-infection, allowing the diagnosis of polyarteritis nodosa-like vasculitis in an HIV-infected patient. Apart from the infection, HIV-related autoimmunity can affect any organ and contribute to the complexity of the clinical presentation of HIV infection.
subject: Clinical Case Report
  topic: section
subject: Biopsy
  topic: keywords
subject: HIV
  topic: keywords
subject: Mononeuropathies
  topic: keywords
subject: Vasculitis
  topic: keywords
creator: José Pedro Soares Baima
creator: Beatriz Carneiro Gondim Silva
creator: Vanessa Lopes Vieira
creator: Luiz Pedro Meireles
creator: Milton Hideaki Arai
creator: Angelina Maria Martins Lino
rights: Copyright (c) 2024 José Pedro Soares Baima, Beatriz Carneiro Gondim Silva, Vanessa Lopes Vieira, Luiz Pedro Meireles, Milton Hideaki Arai, Angelina Maria Martins Lino https://creativecommons.org/licenses/by/4.0
date: 2024-07-26
publication date: 2024-07-26
starting page: e2024493
ending page: e2024493
doi: 10.4322/acr.2024.493

Submandibular and sublingual salivary gland involvement in adenoid cystic carcinoma
type: item
description: Adenoid cystic carcinoma (AdCC) is a malignant salivary gland neoplasm that presents as an indolent but aggressive neoplasm. AdCC histogenesis is linked to the intercalated ducts of the salivary glands, equally affecting the major and minor glands. AdCC is associated with distant metastasis, most commonly to the lungs, and a high recurrence rate. AdCC accounts for 4.2% of all tumors. About 55% of all reported cases affect the submandibular gland, and around 50% of AdCC cases occur in the minor salivary glands. The present review describes a case of AdCC which presented a single nodular swelling on the right side involving the floor of the mouth. It also consolidates the histopathological profile of a case of AdCC with all the relevant histopathological features.
subject: Clinical Case Report and Review
  topic: section
subject: Carcinoma, Adenoid Cystic
  topic: keywords
subject: Salivary Gland Diseases
  topic: keywords
subject: Sublingual Gland
  topic: keywords
subject: Submandibular Gland
  topic: keywords
creator: Poonam Ramnath Sawant
creator: Manjeeta Mahesh Sinai Dhume
creator: Anita Spadigam
creator: Anita Dhupar
rights: Copyright (c) 2024 Poonam Ramnath Sawant, Manjeeta Mahesh Sinai Dhume, Anita Spadigam, Anita Dhupar https://creativecommons.org/licenses/by/4.0
date: 2024-07-26
publication date: 2024-07-26
starting page: e2024500
ending page: e2024500
doi: 10.4322/acr.2024.500

Clear cell myomelanocytic tumor of ligamentum teres
type: item
description: Clear cell myomelanocytic tumor (CCMMT) of the falciform ligament/ligamentum teres is a rare hepatic tumor, a variant of the perivascular epithelioid cell tumor (PEComa) family. CCMMT is the rarest variant of hepatic PEComas. Only a few cases of CCMMT have been reported in the English literature. Because of its rarity, less is known about its biological behavior. We present a case of a 31-year-old female who complained of abdominal pain, bilious vomiting, and abdominal fullness over two months. The radiological impression was of focal nodular hyperplasia. The histological examination of the resection specimen revealed a well-circumscribed tumor arranged in fascicles, sheets, and a whorling pattern. The tumor cells were spindle to epithelioid shaped with abundant clear to pale eosinophilic cytoplasm. The tumor cells expressed both myoid (smooth muscle actin) and melanocytic (MelanA and HMB45) markers, while they were negative for hepatocytic and vascular markers. Thus, based on histology and immunohistochemistry, a diagnosis of CCMMT was made. This case presents the diagnostic challenges of CCMMT and discusses the differential diagnosis with a literature review.
subject: Clinical Case Report and Review
  topic: section
subject: Immunohistochemistry
  topic: keywords
subject: Liver Neoplasms
  topic: keywords
subject: Perivascular Epithelioid Cell Neoplasms
  topic: keywords
creator: Ariba Zaidi
creator: Debajyoti Chatterjee
creator: Venu Bhargav
creator: Vikas Gupta
creator: Ashim Das
rights: Copyright (c) 2024 Ariba Zaidi, Debajyoti Chatterjee, Venu Bhargav, Vikas Gupta, Ashim Das https://creativecommons.org/licenses/by/4.0
date: 2024-07-25
publication date: 2024-07-25
starting page: e2024503
ending page: e2024503
doi: 10.4322/acr.2024.503

A rare case of Sporadic Creutzfeldt-Jakob disease at a remote mountain hospital in the Indian Himalayan Region
type: item
description: Sporadic Creutzfeldt-Jakob disease (CJD) is a rare neurodegenerative spongiform encephalopathy that causes neuronal derangement secondary to prion protein. Its initial diagnosis is often complex and challenging due to non-specific clinical presentation, lack of awareness, and low clinical suspicion. This disease is invariably fatal, and most patients die within 12 months of presentation. Definite diagnosis of prion disease requires neuropathological analysis, usually done at autopsy. Here, we present the autopsy findings of a 57-year-old male patient, illustrating the complexity of diagnosing this disease early in the clinical course and the need for a broad differential diagnosis at the onset.
subject: Autopsy Case Report
  topic: section
subject: Creutzfeldt-Jakob Disease
  topic: keywords
subject: Neuropathology
  topic: keywords
subject: Prions
  topic: keywords
subject: Electroencephalography
  topic: keywords
subject: Autopsy
  topic: keywords
creator: Nitu Sharma
creator: Jitender Kumar Sharma
creator: Ashima Chander
creator: Khushdeep Shergill
creator: Meghna Yadav
rights: Copyright (c) 2024 Nitu Sharma, Jitender Kumar Sharma, Ashima Chander, Khushdeep Shergill, Meghna Yadav https://creativecommons.org/licenses/by/4.0
date: 2024-07-24
publication date: 2024-07-24
starting page: e2024502
ending page: e2024502
doi: 10.4322/acr.2024.502

Incidental finding of cardiac hydatid cyst during autopsy
type: item
description: Hydatidosis or echinococcosis is an endemic parasitic disease caused by the ingestion of eggs of echinococcal species worldwide. In India, the annual incidence varies from 1 to 200 per one 100,000 hab., with the highest prevalence reported in the Indian states of Andhra Pradesh and Tamil Nadu. The dog is the definitive host, while humans, sheep, and cattle are intermediate hosts. The disease usually involves the liver and lungs, with the kidney and other organs rare involvement. Cardiac hydatidosis is still further rare, seen in 0.2% to 2% of the patients who remain asymptomatic until the development of its complications. Sudden deaths in cardiac echinococcosis are mostly attributed to cardiac arrhythmias, coronary artery diseases, valvular diseases, cardiomyopathies, pericarditis, and cardiac tamponade. We, herein, report a rare case of cardiac hydatid cyst incidentally found during the autopsy of a 26-year-old male who died due to electrical injuries. A single greyish-white cystic mass measuring 1.5cm X 1.2cm was detected on the left anterior ventricular wall 4 cm above the apex and was confirmed microscopically as a hydatid cyst. The cause of death was attributed to external injury.
subject: Autopsy Case Report
  topic: section
subject: Echinococcus
  topic: keywords
subject: Electric Injuries
  topic: keywords
subject: Parasitic diseases
  topic: keywords
subject: Autopsy
  topic: keywords
subject: Forensic Pathology
  topic: keywords
creator: Nishant Purbey
creator: Amit Patil
creator: Shreekant Bharti
creator: Keshav Chandra
creator: Shashank Ranjan
rights: Copyright (c) 2024 Nishant Purbey, Amit Patil, Shreekant Bharti, Keshav Chandra, Shashank Ranjan https://creativecommons.org/licenses/by/4.0
date: 2024-07-24
publication date: 2024-07-24
starting page: e2024501
ending page: e2024501
doi: 10.4322/acr.2024.501

Emerging infection: streptococcal toxic shock-like syndrome caused by group B Streptococcus (GBS), Streptococcus agalactiae
type: item
description: Streptococcus agalactiae or Group B Streptococcus (GBS) infections are commonly associated with infections in neonates and pregnant women. However, there has been a rising incidence in nonpregnant adults. The risk of GBS infection in nonpregnant adults is increased for patients of advanced age and those with underlying medical conditions such as diabetes mellitus and cancer. We present a 77-year-old female with type-2 diabetes mellitus, hypertension, and bilateral foot ulcers that presented in probable septic shock with necrotic foot ulcers and necrotizing fasciitis and underwent bilateral lower limb amputations. The patient fulfilled the Streptococcal Toxic Shock Syndrome (STSS) criteria as defined by The Working Group on Severe Streptococcal Infections. These criteria were created for group A Streptococcus (Streptococcus pyogenes). Our patient fulfilled the Working Group’s criteria, except that the blood culture was positive for group B Streptococcus (Streptococcus agalactiae). Numerous studies demonstrate the importance of early detection and antibiotic treatment for GBS infections in general and early surgical management for necrotizing soft tissue infections (NSTIs) such as necrotizing fasciitis.
subject: Autopsy Case Report
  topic: section
subject: Amputation, Surgical
  topic: keywords
subject: Bacteremia
  topic: keywords
subject: Fasciitis, Necrotizing
  topic: keywords
subject: Shock, Septic
  topic: keywords
subject: Virulence Factors
  topic: keywords
creator: Fareed Rajack
creator: Shawn Medford
creator: Ali Ramadan
creator: Tammey Naab
rights: Copyright (c) 2024 Fareed Rajack, Shawn Medford, Ali Ramadan, Tammey Naab https://creativecommons.org/licenses/by/4.0
date: 2024-07-23
publication date: 2024-07-23
starting page: e2024497
ending page: e2024497
doi: 10.4322/acr.2024.497

Fatal asphyxia due to large laryngeal granuloma
type: item
description: Laryngeal granuloma, vocal process granuloma, or post-intubation granuloma are benign, inflammatory lesions of the arytenoid cartilage vocal process. The etiology of laryngeal granulomas is multifactorial, such as chronic irritation due to endotracheal intubation, vocal cord injury or trauma, and gastroesophageal reflux disease. They can arise postoperatively after mucosal injury due to orotracheal intubation. Clinical manifestations include voice change and dyspnea, which may start one to four months after extubation and may rarely lead to asphyxia. We presented a case of death due to glottic granuloma occurring after a surgical procedure to remove a laryngeal polyp attributed to previous laryngeal injuries by multiple intubations.
subject: Autopsy Case Report
  topic: section
subject: Granulation Tissue
  topic: keywords
subject: Fibrin
  topic: keywords
subject: Granuloma laryngeal
  topic: keywords
subject: Polyp
  topic: keywords
subject: Asphyxia
  topic: keywords
creator: Ajay Kumar
creator: Ravi Rautji
creator: Asit Ranjan Mridha
creator: Chittaranjan Behera
rights: Copyright (c) 2024 Ajay Kumar, Ravi Rautji, Asit Ranjan Mridha, Chittaranjan Behera https://creativecommons.org/licenses/by/4.0
date: 2024-07-23
publication date: 2024-07-23
starting page: e2024496
ending page: e2024496
doi: 10.4322/acr.2024.496

Leiomyoma of maxillary sinus
type: item
description: Leiomyoma is a benign smooth muscle tumor that most commonly occurs in the uterus; however, it can also manifest in various extragenital locations, including the maxillary sinus.1,2 While leiomyomas of the maxillary sinus are occasional, they present unique diagnostic and management challenges. The maxillary sinus, one of the paranasal sinuses in the facial bones, is typically associated with sinusitis or odontogenic infections.1 Therefore, clinicians primarily consider inflammatory or neoplastic etiologies when encountering a mass within the maxillary sinus. Among the possible neoplastic causes, leiomyoma is a less frequently encountered entity, but it should be considered in the differential diagnosis.1,2 Understanding the clinical presentation, radiological features, and appropriate management strategies for leiomyoma of the maxillary sinus is crucial for accurate diagnosis and effective treatment. This case report aims to contribute to the existing medical knowledge by presenting a unique case of leiomyoma arising in the maxillary sinus, discussing the diagnostic approach treatment options, and highlighting any noteworthy findings.2,3 Leiomyoma of the maxillary sinus can present with various symptoms, including nasal obstruction, facial pain or pressure, recurrent sinusitis, epistaxis (nosebleeds), or a palpable mass in the maxillary region.1,3 However, these symptoms are non-specific and can be mistaken for other sinus entities. Therefore, it is essential to consider leiomyoma as a differential diagnosis in patients with such clinical presentations. Diagnosing leiomyoma of the maxillary sinus can be challenging due to its rarity and overlapping symptoms with other sinus entities. Imaging studies, such as compute tomography (CT) or magnetic resonance imaging (MRI), play a crucial role in identifying the presence, location, and extent of the tumor.3,4 However, a definitive diagnosis requires a histopathological examination of the excised tissue. When encountering…
subject: Image in focus
  topic: section
creator: Ravi Hari Phulware
creator: Shalini Jain
creator: Akash Dhiman
creator: Arvind Ahuja
creator: Arvind Kumar
rights: Copyright (c) 2024 Autopsy and Case Reports https://creativecommons.org/licenses/by/4.0/
date: 2024-06-13
publication date: 2024-06-13
starting page: e2024495
ending page: e2024495
doi: 10.4322/acr.2024.495