Placental Site Trophoblastic Tumor with lung metastases as cause of death in a young patient: a case report.

Placental Site Trophoblastic Tumor (PSTT) is a rare form of Gestational Trophoblastic Disease (GTD). Approximately 200 cases have been reported in the literature. This disease has unpredictable biological behavior, whereas approximately 10-15% have clinically malignant evolution. We present the case of a 21-year old woman at first pregnancy without known previous abortion at 25 weeks of amenorrhea who was admitted to the hospital for hyperemesis, hepatic problems and important weight loss registered during the last few months. Few days after the admission, the patient suddenly died before the doctors can reach a diagnosis. A forensic investigation for medical malpractice was initiated. Samples collected from uterus at the autopsy revealed large trophoblastic cells with eosinophilic cytoplasm. Deposition of fibrinoid material was noticed between trophoblastic cells. Tumor cells dissected through the myometrium and invaded into the vascular spaces. Specimens of the lungs revealed numerous small neoplastic emboli into the vessels. We show autopsy and histological findings of PSTT in a young woman, which are very rarely described in the literature and we discuss the medico-legal implications related to the great difficulties of the gynecologists who faced this rare condition in term of diagnosis and prediction of biological behavior, outlining effective therapeutic approaches.

Fatal injection of ranitidine: a case report.

INTRODUCTION: Ranitidine hydrochloride (Zantac), a histamine-2-receptor antagonist, is a widely used medication with an excellent safety record. Anaphylactic reaction to ranitidine is an extremely rare event and a related death has never been described in the literature. CASE PRESENTATION: We present the clinical history, histological and toxicological data of a 51-year-old man with negative anamnesis for allergic events, who died suddenly after the intravenous administration of one phial of Zantac 50 mg prescribed as a routine post-surgical prophylaxis for stress ulcer. CONCLUSION: Although the incidence of anaphylactic reactions related to ranitidine is low, caution needs to be exercised on administration of this drug. In addition, further study is needed to define strategies for the prevention of adverse drug reactions in hospitalized patients.

Sellar fracture followed by sudden death: an autopsy case.

The authors describe a case of sellar fracture followed by sudden death. The victim was involved in a wrangle. The autopsy revealed facial damage and sellar fracture and no evidence of cerebral damage, except for a mild subarachnoid hemorrhage in the left parietotemporal regions and undersurface of both frontal lobes. Sellar fracture is a rare and severe entity, associated with serious complications, which is frequently diagnosed postmortem. In any case, death is rarely a direct consequence of the sellar fracture itself and is usually considered to be the result of associated cerebral trauma. This case prompted us to screen the literature on sellar fracture to gain a better understanding of the mechanism of death.