National pathology day - Commemorating a legend Dr. VR Khanolkar.

The large-scale celebration of National Pathology Day on the birth anniversary of Dr. VR Khanolkar would help pathologists to showcase their role in patient care, medical education, and research, change the image of pathology, and bring this specialty to the forefront.

Morphological evaluation of bulb and distal duodenal biopsies in pediatric celiac disease with clinical and serological correlation.

BACKGROUND AND AIMS: An early correct diagnosis of celiac disease (CD) is fundamental to reversal of symptoms and prevention of complications in pediatric patients. Our aim was to evaluate the role of duodenal bulb biopsy by studying the degree of mucosal damage in the duodenal bulb (D1) and second part of the duodenum (D2) and correlating the findings with serum IgA anti-tTG levels. SETTINGS AND DESIGN: Pediatric patients (age <18 years) with clinical suspicion of CD and positive IgA anti-tTG titers were consecutively enrolled over a period of one year. Demographic variables, anthropometry, clinical history, laboratory values and endoscopic findings were studied. Endoscopic biopsies obtained from D1 and D2 were evaluated and assigned histopathologic grades that were correlated with serology. STATISTICAL ANALYSIS USED: Descriptive statistics were employed. RESULTS: A total of 37 clinically suspected cases of pediatric CD were studied. The mean age was 6.7 years and the M:F ratio was 1:1.3. Thirty-two (32) children had varying degrees of growth impairment. Eight (8) children had only extra-intestinal symptoms. Thirty (30) children were anemic, hypoalbuminemia was seen in five (5) children while transaminitis was seen in two (2) children. IgA anti-tTG >300 U/ml was associated with Marsh-Oberhuber Grade 3 morphology at atleast one site. CONCLUSIONS: Low positive serology values should be confirmed by histopathology. Biopsies should be taken even in the absence of endoscopic abnormality. Additional D1 biopsies placed in a separate container can increase the diagnostic yield.

Fetus papyraceus-A surprise finding in a "normal" placenta.

In the case of single fetal demise in a twin gestation, the fate of the dead twin, surviving twin, and mother depend on the exact time of fetal demise. The dead twin may "vanish" in a first trimester death; form a mummified "fetus papyraceus" due to mechanical compression in the second trimester or show changes of maceration in the third trimester. Hematological complications in the mother and neurological complications in the surviving twin may ensue in later trimester deaths. We report a unique case of an undiagnosed fetus papyraceus incidentally detected in an otherwise normal placenta. Identification of such cases is essential due to the occurrence of severe complications in some of the cases, medicolegal implications for the caregivers, and to improve the understanding of embryological development and fetal demise in twin or multiple gestations.

Sudden cardiac deaths: Role of nonischemic myocardial disorders-Part II.

Sudden death, a catastrophic event, falls within the purview of the forensic experts. It is often caused by cardiovascular diseases, which may be evident or occult. A vast majority of sudden cardiac deaths (to the extent of 90%) are due to ischemia of the working or conducting myocardial tissues consequent to coronary artery diseases. A heterogeneous group of nonischemic myocardial disorders, most producing structural abnormalities are responsible for the remainder; they predominantly represent various cardiomyopathies. This review, in two parts, covers sudden cardiac death in medicolegal autopsies with an approach to some common and uncommon nonischemic myocardial diseases that have a genetic and/or nongenetic basis.

Sudden cardiac deaths: Role of nonischemic myocardial disorders-Part 1.

Sudden death, a catastrophic event, falls within the purview of the forensic experts. It is often caused by cardiovascular diseases, which may be evident or occult. A vast majority of sudden cardiac deaths (to the extent of 90%) are due to ischemia of the working or conducting myocardial tissues consequent to coronary artery diseases. A heterogeneous group of nonischemic myocardial disorders, most producing structural abnormalities are responsible for the remainder; they predominantly represent various cardiomyopathies. This review, in two parts, covers sudden cardiac death in medicolegal autopsies with an approach to some common and uncommon nonischemic myocardial diseases that have a genetic and/or nongenetic basis.

Histomorphology of the lesions of the umbilicus: Are we naïve about the navel?

CONTEXT: Twelve-year retrospective study of surgically excised umbilical lesions received for histopathology in a pediatric tertiary care hospital. AIMS: To study histopathology of the umbilical lesions and review pertinent literature on the embryological basis of these lesions. SUBJECTS AND METHODS: We reviewed cases of umbilical lesions and classified them as "developmental" and "others." Developmental cases were sub-classified based on the mechanism as those due to defect in the closure of body wall, defect in the closure of the umbilical ring, persistence of embryonic remnants, or failure of epithelization. Persistent embryonic remnants were subdivided into fistula, sinus, and cyst. Histology of all the cases was studied and the different types of tissue in omphalomesenteric ducts (OMD) remnants were identified. STATISTICAL ANALYSIS USED: Descriptive statistics were used as required. RESULTS: Seventy-one cases in the age range of 1 day to 13 years were studied and male preponderance was noted. The developmental lesions included 4 omphalocele sacs with dense acute inflammation, 2 umbilical hernial sacs with fibrocollagenous tissue, 30 OMD remnants, 10 allantoic duct remnants, 19 umbilical granulomas, and 2 cases showing more than one developmental mechanism. Four cases were classified as "others" including 3 epidermal inclusion cysts and 1 skin tag. Among OMD remnants, sinuses (arising from the distal tract) were found to be the most common. Histological examination of the OMD remnants showed enteric (18), enteric and gastric (5), colonic (4), enteric and colonic (2), and pancreatic and enteric and gastric mucosae (1). CONCLUSION: Accurate diagnosis is essential for definite treatment of these lesions.

Spontaneous aortic rupture: Report of two cases with review of literature.

Acute aortic syndromes comprise a heterogeneous group of life-threatening disorders, characterized by acute-onset chest or back pain with or without cardiovascular collapse. The major entities include acute aortic dissection, penetrating atherosclerotic ulcer, and intramural hematoma. Spontaneous rupture of the aorta is an additional, rare cause of this syndrome, which frequently leads to sudden cardiac death. This is a report of two cases of this uncommon entity with detailed pathological analysis.

Pathology of atherosclerotic coronary artery disease in the young Indian population.

Atherosclerotic coronary artery disease (CAD) is of great concern in young adults because of its potential to cause great incapacitation. This arena of cardiology has gained importance in South Asian countries, particularly India due to increased prevalence that is related to traditional risk factors, altered life styles and inherent risk factors. In this study, we sought to evaluate, at autopsy, the pathology of atherosclerotic CAD in young patients with ischemic heart disease (IHD). A 10-year retrospective autopsy-based study was carried out in a large tertiary-care centre and patients aged ≤45 years with IHD were selected. Out of 545 autopsied cases of IHD, 95 patients (17.4%) were young. Among these 95 patients, 84 (88.4%) had IHD related to atherosclerotic CAD; the youngest patient was 18 years old. Predictably there was sole involvement of left anterior descending artery and the presence of fibrous plaques. Irrespective of the plaque morphology, the commonest complication was thrombosis produced by plaque erosion seen in 36.9% of patients. Acute coronary insufficiency was noted in 52 patients (61.9%), while healed infarctions were surprisingly noted in 28 patients (33.3%). Screening for IHD in the young population may help to improve prognosis by detecting subclinical disease, although more studies are necessary to establish reference limits for this young population. Additional research must also focus on treatment concerns that are specific to young patients.

Discontinuity of the arch beyond the origin of the left subclavian artery in an adult: Interruption or coarctation?

Congenital aortic anomalies are uncommon causes of secondary hypertension and are seldom suspected in the adult age group. We present a case of aortic interruption unexpectedly diagnosed on autopsy in a 38-year-old male who presented with cardiovascular collapse. Apart from interruption, a finding unique to our case was aneurysmal dilation of the proximal descending aorta just before the obstruction with thrombosis. We also attempt to review the literature for interrupted aortic arch in adults and clarify the nomenclature of interruption versus coarctation.

The thyroid in ischemic heart disease: An autopsy study.

Thyroid dysfunctions, particularly hypothyroidism, predispose to cardiovascular diseases, such as atherosclerotic coronary artery disease. However, thyroid functions are not always assessed in such patients. In this report, we studied the cases with pathologically evident ischemic heart disease (IHD) at autopsy and correlated with the absence or presence of thyroid disease. In a 5-year retrospective autopsy-based study, cases with IHD in whom the thyroid gland was dissected at autopsy were analyzed. The thyroid gland was available for assessment in 181 of the 255 autopsied cases with IHD. The majority were males with a mean age of 59.9 years. Thyroid pathology was noted in 58 patients (32.0%) in the form of uninodular or multinodular goiter (56.9%), lymphocytic thyroiditis (37.9%), and Hashimoto's thyroiditis (5.2%). Based on our experience, we feel it may be worthwhile to assess the thyroid by simple inspection and palpation followed by ultrasonographic imaging and estimations of hormones, thyroid-stimulating hormone and antithyroidal antibodies, in all patients presenting with IHD.

Primary retroperitoneal mucinous cystadenocarcinoma in a male patient.

Primary retroperitoneal mucinous neoplasms are extremely rare tumors. Less than sixty cases have been reported in international literature until date, with striking female predominance. We report a case of primary mucinous cystadenocarcinoma of the retroperitoneum in a 51-year-old male presenting with nonspecific abdominal complaints. This case is being highlighted for its rare occurrence in a male patient.