A case of sudden death due to pulmonary embolism of bone marrow origin, masked as acute drug toxicity: A rare case in a bewildering clinical scenario

Introduction: Sudden death is unexpected death within 24 hours from the onset of symptoms with or without known preexisting conditions. Respiratory pathologies are the second most common cause of such deaths. Brief History of Case: 39 years old male patient with a history of mental illness for the last 10 years and on regular treatment with antipsychotic medications, suffered sudden deterioration of higher functions and was admitted to the Medical College, and Hospital, Kolkata with a provisional diagnosis of drug toxicity. He succumbed to his condition within 24 hours of admission and the dead body was referred to Kolkata Police Morgue for a medicolegal autopsy. Gross autopsy findings: Shows multi-system involvement in the form of Pulmonary Oedema, consolidation, broncho-pneumonic changes and subpleural petechiae, Cardiomegaly due to biventricular hypertrophy, Cerebral Oedema, Enlarged kidneys with loss of cortico-medullary differentiation and streaky cortico-medullary haemorrhages. Stomach findings were unremarkable. Salient findings in ancillary investigations: 1) Toxicological Examination of blood, bile, vitreous and routine viscera was negative for any poison or pharmacological agents. 2) Histopathological examination with routine H&E staining showed Pulmonary oedema with lymphocytic infiltration and the presence of fat and hematopoietic precursor cells in pulmonary vessels, Interstitial Oedema and focal glomerulosclerosis and Periportal inflammation in the liver.

Utility of scrape cytology in the diagnosis of ovarian masses

Background: Cytology is a useful adjunct to frozen section for rapid diagnosis of neoplastic pathology. However frozen section facility is available in limited centres. Therefore, we undertook this study to find out role of scrape cytology for diagnosis of ovarian masses.Methods: It is an observational study done in a medical college. One hundred ovarian masses were collected for a period of eighteen months. Cut surface of ovarian masses were scraped with edge of a glass slide. Smears were prepared and stained with H and E stain, examined and a presumptive diagnosis was given. The verification of cytological diagnosis was done by histopathological report. All the data were recorded, tabulated and analyzed with the help of standard statistical methods using Microsoft XL.Results: A total of hundred cases were studied. Left ovary was involved in 38 cases, right ovary in 52 cases and bilateral ovaries in 10 cases. Malignant cases mostly yielded hyper cellular smear. On Chi square test, it was significant with value of less than .001. The overall sensitivity and specificity of scrape cytology in diagnosing ovarian neoplasm, considering HPE as gold standard, are 98% and 78% respectively. In Dysgerminoma, Papillary adenocarcinoma, Mucinous Cystadenoma, Benign cystic teratoma, Granulomatous lesion of ovary, Lymphoma and Mucinous adenocarcinoma, scrape diagnosis corroborated with the histological diagnosis. Notable discrepancy was seen in cases of Endometrioid carcinoma.Conclusions: Scrape cytology can serve as a powerful tool for early diagnosis of ovarian masses in close cooperation of the clinician, radiologist and pathologist. It has a potential for widespread use as knowledge and experience of interpreting cytopathologists increase.

Primary Merkel cell carcinoma of the oral mucosa in a young adult male: Report of a rare case.

Merkel cell carcinoma (MCC) is a highly aggressive neoplasm of skin with neuroendocrine differentiation. Primary MCC of the oral mucosa is exceedingly rare and even more unresponsive to therapy. A 15-year-old male presents with gradually increasing painless swelling in right side of the fl oor of mouth for 6 weeks. Computed tomography of head and neck region showed globular mass (4.6 cm × 1.7 cm) involving right side of the fl oor of mouth. Fine-needle aspiration from the upper deep cervical node suggested small round cell tumor. A trucut biopsy showed mass composed of trabeculae and nests of tumor cells with high N:C ratio, granular speckled chromatin, scanty to moderate amount of clear vacuolated cytoplasm. Cells were immunoreactive for cytokeratin-20, CD56, c-kit, CD99 and negative for p63, thyroid-transcription factor-1, CDX2, synaptophysin, neuron-specifi c enolase. Patient was started on chemotherapy with cyclophosphamide, doxorubicin and vincristine. The mass regressed in size and patient underwent wide local excision with pull-through approach. Patient is currently under combined chemoradiation regime and doing well.