Concurrent Onset of Chronic Lymphocytic Leukemia and Atypical Phenotype Acute Myeloid Leukemia Revealed by Autopsy

The concurrent onset of chronic lymphocytic leukemia (CLL) and acute myeloid leukemia (AML) is rare, and no autopsy case has been reported. We report herein the first case of concurrent-onset CLL and AML with an atypical phenotype revealed by autopsy. Notably, the diagnosis of AML was quite difficult during the patient’s lifetime because of the atypical phenotype. However, autopsy revealed that the patient’s bone marrow, liver, and spleen were filled with myeloblasts. In addition, p53 stain and PCR of IgH rearrangement using the autopsy specimen suggested that CLL and AML might be different clones. In conclusion, our case highlights the importance of considering synchronous complications of AML in CLL patients, particularly in those with an atypical clinical course.

Huge cardiac rhabdomyoma in neonate: an unusual presentation

Cardiac rhabdomyoma is the most common primary cardiac tumor in neonatal age group. A full term male neonate, whose antenatal ultrasound revealed mass in foetal heart, became symptomatic on day two of life. Echocardiography revealed pericardial mass with global left ventricular hypokinesia. Diagnosis was confirmed by histopathological examination of autopsy specimen. Due to social stigma, encouragement of the parents for clinical autopsy was of prime importance for definitive diagnosis and preventive measures in future pregnancies.

Targeting potential drivers of COVID-19: Neutrophil extracellular traps

Coronavirus disease 2019 (COVID-19) is a novel, viral-induced respiratory disease that in ∼10–15% of patients progresses to acute respiratory distress syndrome (ARDS) triggered by a cytokine storm. In this Perspective, autopsy results and literature are presented supporting the hypothesis that a little known yet powerful function of neutrophils—the ability to form neutrophil extracellular traps (NETs)—may contribute to organ damage and mortality in COVID-19. We show lung infiltration of neutrophils in an autopsy specimen from a patient who succumbed to COVID-19. We discuss prior reports linking aberrant NET formation to pulmonary diseases, thrombosis, mucous secretions in the airways, and cytokine production. If our hypothesis is correct, targeting NETs directly and/or indirectly with existing drugs may reduce the clinical severity of COVID-19.

Intrathoracic Liver Heterotopia: An Incidental Finding at Autopsy

Heterotopia is the presence of a particular tissue at a nonphysiological site. The most common sites are gastric, pancreatic, and splenic heterotopias. While liver heterotopias are rare, intrathoracic heterotopias are much more limited. It is usually reported incidentally on imaging investigations or at autopsy. There is a high incidence of malignant transformation of heterotopic livers, and hence resection is always recommended. Here we report a case of heterotopic liver tissue in the right lung in a 42-year-old male, incidentally found at the gross examination of autopsy specimen of the lung.

Neonatal Autopsies with Heart Disease: A Challenge for Pathologist

Congenital Heart Diseases (CHD) carry significant morbidity and mortality in paediatric patients. Transposition of Great Arteries (TGA) is a common cyanotic CHD. However, onset of Pulmonary Arterial Hypertension (PAH) is potentially severe and rare complication reported in 1-3% of newborns. Hypertrophic Cardiomyopathy (HOCM) is a primary disease of cardiac muscle usually recognised in adulthood. Neonatal HOCM without other congenital anomalies, no family history of HOCM, no history of exposure to corticosteroids or any inborn errors of metabolism is rarely recognised. Authors hereby report two cases of neonatal autopsy showing TGA with PAH (Grade 2) and another with HOCM without any primary cause received in our hospital. With this case report authors wish to stress on the importance of cardiac examination (heart and the associated vessels) in autopsy specimen which in turn requires training of pathologists in cardiac pathology along with routine fetal anomaly scanning in arriving successively at the final diagnosis and detecting the cause of death which helps in management of future pregnancies by the clinicians.

Collection, preservation and forwarding of biological samples for toxicological analysis in medico legal autopsy cases

Collection of proper autopsy specimen is an essential step in the process of toxicology case work. Improper collection of these specimens can greatly alter or negate chemical and toxicological analysis. This article is an update about the standard methods of biological specimen collection procedures for toxicological analysis which will be helpful for the forensic pathologist and forensicscientists.

Caustics

A caustic is any substance capable of causing full-thickness damage on contact with healthy, intact tissue. Caustic agents are generally classified by pH as acids or bases. Irritants are those substances that do not produce true breakdown of tissue but cause discomfort and inflammation, such as vomiting, burning eyes, or coughing. This review covers caustic and irritant agents, dermal caustic exposure, caustic inhalation and pulmonary irritants, caustic ingestion, and ocular caustic exposure, along with special consideration of hydrofluoric acid, including hydrofluoric acid and dermal exposure, hydrofluoric acid ingestion, hydrofluoric acid inhalation, ocular hydrofluoric acid exposure, and systematic hydrofluoric acid toxicity. Figures show classification of burns; chemical burns; an autopsy specimen of the tongue, epiglottis, and esophagus after caustic ingestion; and an autopsy specimen of the stomach after caustic ingestion. Tables list common caustic and irritant agents, household products containing caustic and irritant agents, agents for which water or saline irrigation is not recommended, indications for endoscopy after caustic ingestion, ocular chemical burn management, and common chemicals and products containing fluoride. Key words: caustic eye injury, caustic ingestion, caustic injury, chemical burn, hydrofluoric acid, pulmonary irritants This review contains 5 highly rendered figures, 6 tables, and 53 references.