The Role of ADAMTS1 and Versican in Human Myocardial Infarction: A Postmortem Study.

OBJECTIVE: To determine the role of a disintegrin and metalloproteinase with thrombospondin type 1 motif (ADAMTS1) and fragmented versican in the myocardial infarction (MI) process in humans and to evaluate the diagnostic efficacy of ADAMTS1 for postmortem diagnosis of MI. METHODS: Thirty autopsied individuals were allocated into 2 groups, namely, a study group of individuals who died of myocardial infarction (n = 20), and a control group who died of trauma (n = 10). We performed standard immunohistochemical staining on myocardial tissue specimens, studying anti-ADAMTS1, anti-versican, and anti-versican C terminal peptide sequence (DPEAAE) fragments. RESULTS: Strong, diffuse staining was observed throughout myocardial tissue for ADAMTS1 in the 2 groups. However, in the study group, we observed no expression for ADAMTS1 around fibrotic areas but detected slight staining in coagulative and necrotic zones. CONCLUSION: Similar localizations of ADAMTS and fragmented versican in human heart tissue indicate that versican presumably is cleaved by ADAMTS1. Hence, ADAMTS1 can be regarded as a new marker for postmortem differential diagnosis of MI.

Right haemothorax related to the rupture of abdominal aortic aneurysm.

Reported case was 63 years old forester died suddenly in the village. Autopsy examination revealed massive coagulated haemorrhage filling the right hemithorax, neither free fluid nor blood were observed in the abdominal cavity. Abdominal aortic aneurysm 20x15x15 cm in size was examined. We aimed to report the rare case of abdominal aortic aneurysm presented with transdiafragmatic rupture and bleeding in the right hemithorax.

Diaphragmatic Eventration: Autopsy Case Report.

Presented case was a 36-year-old deceased man with a sequel of poliomyelitis who was reportedly found death at home. On external examination at autopsy, deformity of the lower extremity secondary to polimyelitis, and an obliquely coursing scar tissue 5 cm in length at the same level with the costal arch on the right axillary line were seen. On internal examination at autopsy, diaphragmatic eventration caused by bilateral elevation of the diaphragm towards thoracic cavity was detected. On the left side, stomach, spleen, and small intestines, and on the right side liver were pushed into the thoracic cavity. Cause of death was reported as heart failure of the patient with bilateral diaphragmatic eventration. We aimed to discuss rarely encountered diaphragmatic eventration in autopsy practice from a perspective of forensic medicine.

Death due to coronary artery anomaly with coexistence of Chiari network.

Coronary artery anomalies rarely detected in autopsy series and angiograms can be a component of complex malformations, besides, can be also associated with sudden cardiac death. Presented case was 22-year-old male, who had suddenly fainted during a football match played on artificial turf, he was transferred into the hospital, however had died during intensive care therapy. He had been evaluated by local prosecutor, and sent to our center for autopsy. At autopsy, internal macroscopic examination revealed absence of the right coronary artery. A total of two coronary artery ostia were observed. One of them originated from the left aortic sinus, and the other one stemmed from 8 mm above the sinotubular line. Besides, Chiari network formation was seen in the right atrium. This case with coronary artery anomaly associated with formation of Chiari network was discussed from the perspective of forensic medicine in the light of the literature information.

A Case of Death Caused by 2700°C Molten Magnesite Burns.

Magnesite (MgCO3) is a mineral which is theoretically composed of 52.2% CO2, 47.8% MgO, and very scarce amounts of Fe2O3 with a degree of hardness varying between 3.4-4.5 kgf, and specific gravity of 2.9-3.1 g/cm(3). Its color varies between white, yellow or gray, and brown. Magnesite is used in agriculture, and drug industry, brick, iron-steel, paper, and sugar industries. Our case was a 30-year-old male whose dead was reportedly associated with exposure to 2700°C molten magnesite in the melting potansiyel of the plant where he was working as a metal worker. At autopsy, on external examination, except from his left forearm, all over his body was charred from severe burns. Both of his legs from ankles, and right forearm from its middle third were nearly amputated, and body muscles were partly detached because of high temperature. Widespread areas of thermal rupture were observed. On internal examination scalded appearance of internal organs was noted. Blood, and urine analysis did not reveal any substance abuse. Herein, we have aimed to discuss, and evaluate dead events because of exposure to very high temperatures from the perspective of forensic medicine, and occupational safety.

A case of cerebral hypoplasia/dysplasia detected at autopsy.

UNLABELLED: Presented case was a 2-year-old baby girl who had been treated for nearly one year with the indication of multifocal epileptiform anomaly. She was found dead in her bed in morning hours, autopsy was planned after prosecutors investigation. On internal autopsy examination, shrinkage of gyral structures in the frontal, and parietal lobes of the left hemisphere, markedly enlarged sulci, and a hypoplastic appearance were noted. Histopathological examination revealed evidence of pneumonia, brain exposed microgyral formations, disordered cortical stratification, hypercellularity, dysmorphic neuronal structures, balloon cells with diagnosis of cortical dysplasia. Pneumonia was reported as a cause of death. We aimed to discuss in the light of the literature a case with cerebral hypoplasia which is rarely seen at forensic autopsies. KEYWORDS: cerebral hypoplasia/dysplasia - autopsy - congenital malformation - sudden death.

Wischnewsky Spots in Fatal Hypothermia: Case Report.

69-year-old male was found dead at the roadside in October month, death was declared suspicious by local prosecutor and autopsy was mandated. At autopsy, a large number of dark brown colored, ovalshaped lesions ranging from 1-15 mm under the mucosa defined as Wischnewsky spots, when stomach was dissected were observed. For the formation mechanism of Wischnewsky spots, there has no definite conclusions; more studies are needed on a case series.

Retroperitoneal Liposarcoma: an Autopsy Case.

Liposarcoma is very rare mesenchymal tumor that occurs in deep soft tissue and mostly seen in limbs and retroperitoneum, accounts for 24% of extremity and 45% of retroperitoneal soft tissue sarcomas. Retroperitoneal liposarcomas are typically present with advanced disease and often carry a poor prognosis. Retroperitoneal liposarcomas grow slowly in the very expandable retroperitoneal space in the deeply hidden and clinically silent therefore diagnosis is usually made late. Liposarcomas have five histological subtypes; well-differentiated liposarcoma (WDLS), dedifferentiated liposarcoma (DDLS), pleomorphic, myxoid and round cell liposarcoma. Our case is 81-year-old male who was found dead in the village homeless shelter. This was classified as a suspicious death and transferred to our service for autopsy. The external examination revealed rectal prolapse, abdominal distension and scrotal swelling. The internal autopsy showed green membrane on the peritoneum, brown smelly contents in the abdominal space, a perforation area 1.5x1 cm in size that in the first part of the duodenum and the dimension of tumor was 48x30x6 cm in the retroperitoneal space. The pathological report was dedifferentiated liposarcoma. We present a rare case of a dedifferentiated retroperitoneal liposarcoma with duodenal ulcer perforation.

Death Due to Myocardial Bridging.

Myocardial bridging is a congenital coronary pathology described as a segment of coronary artery which courses through the myocardial wall beneath the muscle bridge. Although the myocardial bridging prognosis is benign, have been also reported sudden death in medical literature. ¬A 30-year-old married woman was found dead at her home. After local prosecutors' investigation the death was declared as suspicious and forensic autopsy was obliged. The left anterior descending coronary artery was detected embedded deeply in the myocardium 2 cm from its coronary ostial origin. There were no other pathology to explain death. We analyzed sudden death case occurred because of myocardial bridging and the pathophysiological mechanisms in the light of medico-legal literature.

Medicolegal Approach to Diogenes Syndrome: a Case Report.

Because of the way of life Greek philosopher Diogenes lived, in the medical literature some older individuals characterized with collection of symptoms and the psychopathology associated with the lack of concern about a person's living conditions were called as Diogenes Syndrome. In this study we presented a case in terms of Diogenes Syndrome. We aimed to discuss by using the recent medical literature. Our case was a 62 year old male living alone and there were a variety of diseases he had. Diogenes Syndrome was previously identified in 30 elderly patients for the first time in 1975. As well as the typical clinical features of Diogenes Syndrome were defined, for being of potential forensic value, case characteristics belonging to the crime scene, and also probable changes that may be encountered at autopsy were discussed.

Anatomical variation of hyoid bone: a case report.

Hyoid bone is a solitary bone localized at the level of cervical 3 vertebrae, connected to the adjacent bone structures with muscles and tendons. Anatomical variations of hyoid bone can cause difficulties in the application of forensic medicine together with clinical and surgical problems. We present a case of a 81-year-old woman, reported to got sick, who died at home. In the autopsy, the neck dissection revealed prolonged right and left greater horns of hyoid bone measured 11 cm and 7 cm respectively. We aimed to present a case with long hyoid bone horns and discuss recent literature.

Spontaneous rupture of a renal cell carcinoma associated with fatal bleeding.

Spontaneous rupture of the renal parenchyma is rarely reported, usually seen as a complication of an underlying disease like the benign and malignant tumors of the kidney, also except from tumors among the causes of spontaneous renal rupture associated with bleeding, there were claimed vascular anomalies affecting the parenchyma, infections and coagulation disorders. Presented case was a 79-year-old male found dead at home. At the autopsy in macroscopic examination; all of the organs with signs of putrefaction, free blood at perihepatic and post hepatic retroperitoneal area, bloody coat at colon serous surface and 25x30x25 cm of hematoma at the right perirenal area were observed. In dissection, 5x2 cm of crescent shaped residual kidney structure was detected at the inferior pole adjacent to the 15x5x8 cm of pale yellow tumor mass settled in the upper pole of right kidney dissection associated with kidney, and 3x3 cm of tumor rupture and bleeding area in the upper part of tumoral pseudo capsule was inspected. Tumor sections were dirty yellow in color, bleeding and a large area of autolysis in appearance were also observed. Histopathological examination of the samples prepared from the tumoral mass taken from on the right kidney revealed renal cell carcinoma. Our aim was to present a rare case of spontaneous rupture of renal cell carcinoma detected at the autopsy.

Endobronchial lipoma.

Endobronchial lipomas are rare benign tumours of the lung. The reported case was a 56-year-old man who visited the public hospital with complaints of chest pain and persistent cough. On bronchoscopy, a smooth-surfaced polypoid tumour obstructing the main bronchus in the left lobe was detected. The case was evaluated and surgical resection was performed. Histopathological investigation revealed that the tumour was an endobronchial lipoma; the tumour composed of mature fat tissue and was covered with bronchial epithelium.

C-Erb-b2 oncogene expression in intraductal proliferative lesions of the breast.

The ductal intraepithelial neoplasia (DIN) classification which proposes new approaches to the diagnosis, terminology and differential diagnosis of intraductal proliferative lesions of the breast was applied to a series of female patients comprising C-erbB2 oncogene expression which may serve as an adjunct to the morphology by immunohistochemistry. The study was performed using the data of 94 patients. There was no difficulty encountered in the diagnosis of intraductal hyperplasia (IDH). In patients with Atypical Ductal Hyperplasia (AIDH), the diagnosis could be made by using the 2-mm rule of the DIN classification in patients who exhibited cytologic and structural characteristics of Ductal Carcinoma in Situ (DCIS) alone or in conjunction with classical IDH patterns. However, in lesions that mimicked classical IDH patterns despite displaying cytological features of in situ carcinomas, the experience and view point of the pathologist played a more prominent role. When the DIN classification criteria were applied to grade DCIS lesions, although the system was found to be practical, it did not provide adequate differentiation in intermediate grade (grade II-DIN 2) patients and further improvement was considered desirable. Fourty-five cases (47.8%) IDH, 19 (20.2%) AIDH, and 30 (31.9%) were DCIS. There were statistically significant differences in the levels of c-erbB2 oncogene expression between IDH, AIDH and DCIS lesions (p<0.001). In DCISs, grade, cell size, pleomorphic nuclear atypia showed statistically significant associations with c-erbB2 oncogene expression. These results suggest that c-erbB2 oncogene expression is a valuable marker in the differential diagnosis and prognostic evaluation of patients with intraductal proliferative lesions.

Rare tumour of the thoracic wall: elastofibroma.

Soft tissue tumours of the thoracic wall are a rare entity. Elastofibroma which occurs mainly in women, is commonly localized in the subscapular region, and is characterized by slow growth. We report the case of a 64-year-old woman who presented with a soft tissue tumour located in the right pectoral region, anterior chest wall. Magnetic resonance imaging showed a tumour on the right anterolateral thoracic wall that measured 5x4x5 cm with contrast enhancement. The findings were suggestive of partial infiltration of pectoral and intercostal muscles and were suspicious of a malignant tumour. The patient underwent complete resection of the tumour at a district hospital. The tumour was resected with clear surgical margins and minimum defect of the pectoral muscles. The specimen measured 4x4x3 cm and histopathology showed a lesion composed of fibrotic connective tissue of low cellularity with strongly eosinophilic, partially swollen, and plump fibers. Histology from the specimen was consistent with elastofibroma.

Ectopic prostate presenting as a mass in bladder.

A 24-year-old man presented with dysuria and voiding frequency. Cystoscopy revealed a smooth surfaced nodular mass in the trigonal region. Transurethral insisional biopsy of the mass was done. Histopathological and immunohistochemical examination revealed benign prostatic tissue situated ectopically.