Evaluation of serum cortisol in the postmortem diagnosis of acute adrenal insufficiency.

Normal adrenocortical activity is necessary for electrolyte regulation and the maintenance of cardiovascular function. Although chronic adrenal insufficiency generally presents with the gradual onset of a set of characteristic symptoms and signs, the more sudden loss of adrenal activity can present with acute, rapidly progressive cardiovascular dysfunction that can be fatal if not recognized and treated promptly. We herein describe a patient who had most of his adrenal tissue removed during resection of metastatic renal carcinoma, conventional clear cell type, with much of the remaining adrenal tissue undergoing necrosis during or shortly after surgery. Although the patient appeared to be stable and progressing adequately well, he died suddenly 2 days postoperatively. When the gross autopsy findings suggested the possibility of adrenal insufficiency, clinical laboratory assessment of adrenocortical activity was sought. Analysis of stored antemortem serum samples and of blood obtained at autopsy demonstrated a progressive decrease in cortisol levels which, in this stressed postsurgical patient, proved fatal. The use of both antemortem and postmortem blood in the demonstration of acute adrenal insufficiency at autopsy is discussed.

Chondroblastoma of the femoral diaphysis: report of a rare phenomenon and review of literature.

Chondroblastoma (CB) is a relatively rare yet well-studied benign neoplasm of bone. The purported neoplastic cell is the chondroblast, a cell which normally populates areas of secondary ossification. Numerous studies have shown that CB overwhelmingly arises from the epimetaphyseal region of skeletally immature individuals. Only rare cases have been reported in the diaphyseal region, and many of these involve metacarpals or metatarsals, which may lack a true anatomic diaphysis. The remaining cases of diaphyseal CBs synchronously involve the neighboring epimetaphysis, making determination of the initiation point impossible. We report a case of a CB isolated to the radiologic femoral diaphysis. To our knowledge, this is the first case of a diaphyseal-based CB to be reported in the pathology literature and only the second case published overall.

A red blood cell autoantibody with mimicking anti-E specificity.

BACKGROUND: Uncommonly, antibodies that appear to exhibit antigenic specificity on red blood cell (RBC) panels fail to maintain specificity following alloadsorption (i.e., they mimic antigenic specificity). Understanding both the pitfalls and the proper pathways to establish the diagnosis and to interpret the clinical significance of these mimicking antibodies is important for patient management. CASE REPORT: A 68-year-old woman was admitted with dyspnea, anemia, bilateral pulmonary emboli, and metastatic ovarian cancer. Blood bank evaluation identified anti-E reactivity in the patient's plasma sample and a positive direct antiglobulin test (DAT). RESULTS: The DAT was positive for immunoglobulin G and negative for C3b. An eluate of the RBCs showed E-antigen specificity on a RBC antibody panel. Repeat serologic testing with RBC antibody panels with adsorbed patient plasma showed removal of apparent anti-E reactivity with either E-antigen-positive or E-antigen-negative RBC stroma. CONCLUSION: A mimicking autoantibody with apparent E-antigen specificity was identified in the plasma sample of a woman with newly diagnosed ovarian cancer. Despite their relative low frequency, mimicking antibodies, whether auto- or alloantibodies, may interfere with the timely issuance of compatible blood products and may confuse laboratory and clinical staff. Determining the clinical significance of the antibody, by taking into account the RBC phenotype of the patient and the antigen prevalence in the general population, guides the extent of workup required to best utilize resources while assuring patient safety.