Isolated cardiac aspergillosis.

A 40-year-old man, a known case of Wolff-Parkinson-White syndrome, was admitted to the hospital in an unconscious state. In spite of medical treatment, the patient died within two hours of admission. At autopsy, the deceased was found to have aspergillosis involving the interatrial septum, aortic valve and root of the aorta. The rest of the organs were unremarkable. The patient did not show any obvious signs of being immunocompromised. We report this case of isolated cardiac aspergillosis in an apparently healthy individual.

Haemostatic changes in children with cyanotic and acyanotic congenital heart disease.

This study was undertaken to screen children with congenital heart disease for coagulation abnormalities and to compare the groups of cyanotic and acyanotic children with congenital heart disease with respect to abnormalities of the coagulation system. Following investigations were done in all the patients: complete blood count, erythrocyte sedimentation rate, peripheral smear examination, bleeding time, prothrombin time, activated partial thromboplastin time, assay of fibrinogen, D-dimer, factors VII and VIII and antithrombin III. Red cell indices were determined in 12 control, 12 acyanotic and 20 cyanotic children. Twenty-five patients each, with echocardiographically proven cyanotic and acyanotic congenital heart disease under 12 years of age constituted the study group; as many children of the same age group were included as the control group. The results showed isolated abnormalities of laboratory tests with equal frequency (28%) in acyanotic and cyanotic groups but coexisting abnormalities of more than one test were seen in significantly larger number of cyanotic children (5/25 and 16/25, respectively). A significant association was noted between thrombocytopenia and a high haematocrit in cyanotic patients. It is concluded that laboratory abnormalities of tests of haemostasis are more common in cyanotic congenital heart disease patients. The patterns of laboratory abnormalities suggest a chronic compensated disseminated intravascular coagulation at a subclinical level, reduced synthesis of clotting factors and/or deranged platelet aggregation in different subgroups of patients.

Medullary thyroid carcinoma with melanin production--a case report.

Melanin production in medullary thyroid carcinomas is rare. The present case illustrates melanin and other atypical features of medullary carcinoma of the thyroid in a fifty year old female. The diagnosis was suggested on the cytomorphological features seen on fine needle aspiration cytology smears. On histo-pathological examination the tumor was extensively pigmented with frequent mitosis. Amyloid was conspicuously scarce. Confirmation of diagnosis was done by immunohistochemical positivity for calcitonin and HMB-45 on tissue sections. The case is being presented in view of its rarity and distinct immunoreactivity. Review of literature is done and the implications of such dual positivity in the histogenesis and divergent phenotype of this tumor are discussed.

Renal dysplasia: an autopsy study of associated congenital malformations.

A retrospective analysis of infant autopsies in the last 14 years was done with the aim of determining the frequency of associated malformations. Renal dysplasia comprised 36 of 594 autopsies done and was the commonest congenital urologic malformation (6.06% of all infant autopsies). Histologically all cases were characterised by hallmarks of disordered metanephric differentiation and organisation. Extrarenal malformations were seen in all (100%) of the cases of which other urologic anomalies were the commonest (28) followed by those of musculoskeletal (18), gastrointestinal (13), cardiovascular (10) and central nervous system (6). Syndromic association was seen in 5 (14%) cases. There were twenty two percent still births and 47% infants died perinatally. A thorough search for systemic malformations is mandatory in all cases of renal dysplasia as these may influence the survival significantly. Cystic renal dysplasia should be differentiated from other causes of cystic renal diseases.

Basaloid-squamous carcinoma. A distinct histopathological entity.

Basaloid Squamous Carcinoma (BSC) is an uncommon aggressive neoplasm occurring in the upper aerodigestive tract. Lung as a primary site has only recently been reported. A combination of microscopic features is required to make a diagnosis and to differentiate it from other more common malignancies in these sites. Three cases of BSC including one in the lung are reported. There are no prior published reports of this neoplasms in Indian literature. The study highlights the typical microscopic features and the diagnostic difficulties which may be encountered.