Primary pleomorphic breast sarcoma - a case report.

Primary mammary sarcomas are very rare, histologically heterogeneous non-epithelial malignant neoplasms. Primary undifferentiated pleomorphic sarcoma is a rare malignant mesenchymal tumor in the breast. It is characterized by marked cellular atypism and pleomorphism. Isolated cases with an aggressive course and poor prognosis have been commonly described in the literature. We present a rare case of a 62-year-old woman with an 18-cm solid tumor of the left breast, 6 months old, which grew rapidly during the last month. Physical examination and mammography revealed no enlarged lymph nodes in the left axilla. A total mastectomy was performed. The diagnosis of undifferentiated pleomorphic sarcoma is challenging due to the lack of specific immunohistochemical markers. It can only be made after excluding other types of soft tissue sarcomas. This report discusses the histopathological and immunohistochemical studies that were conducted. Our case is distinguished from others with the same diagnosis by the atypical clinical presentation, which is painless, and the spontaneous bleeding, as well as the large size of the tumor.

Cause and Manner of Death of a Skeletonized Cadaver: Meeting Some Challenges.

Cause of death is defined as a natural disease or injury that led to physiologic changes resulting in death. Manner of death refers to the circumstances surrounding death. Decomposition, especially in advanced stages, creates difficulties in post-mortem examination for it encompasses the processes that lead to the loss of important observable findings and features. Traumatic injuries observed in decomposed cadavers might be analyzed by their vital features and significance for the occurrence of fatal outcomes that help determine the cause and manner of death. An almost fully skeletonized cadaver was admitted to the Department of Forensic Medicine and Deontology at The Medical University, Sofia, Bulgaria. Along with the obligation to answer the post-mortem interval, what were the anthropological and biological features, the cause and manner of death had to be determined in order to classify the case as criminal or not. The cause of death was established by the morphological finding - gunshot injury of the head, passing the brain. The manner of death remained undetermined because of the absence of soft tissues in the areas of the injuries. It was concluded that there was no sufficient forensic data to answer if it was suicide, homicide, or even an accident.

A Case of Accidental Autoerotic Death by Hanging Linked to Erotic Photography.

Autoerotic death, as a subtype of mechanical asphyxia, refers to a person's fatal outcome while engaging in solitary sexual activity using various devices and methods to reduce oxygen supply and induce cerebral hypoxia, leading to increased sexual gratification. These asphyxial deaths are accidental and sporadic. In cases of sexual asphyxia, especially when strangulation methods such as hanging or ligature are used, thorough crime scene investigation is crucial to determine the type of asphyxia and the manner of death. Inadequate information about specific crime scene findings can lead to significant errors in determining the manner of death and the type of strangulation, potentially leading to cases being mistaken for ligature strangulation in a homicidal manner or hanging in a suicidal manner.

Forensic Pathology and Legal Issues in COVID-19: Case Report and Literature Review.

Autopsy investigations of deaths following nosocomial coronavirus disease 2019 (COVID-19) infection have enormous medical and social significance, as autopsies are essential for the correct statistical recording of COVID-19 deaths, presenting new lessons, which is important to policymakers and in the improvement of public health in general.  Our study is based on the presentation of a case of a road traffic accident involving an elderly 73-year-old female with a complication of nosocomial COVID-19 infection and death leading to forensic pathological investigation. This involved autopsy, histopathological examinations, and other tests, and highlighting the importance of medicolegal matters, including the legal and ethical practicalities encountered in healthcare. This article highlights the fact that patients who have sustained various traumatic injuries accompanied by nosocomial COVID-19 infection have higher risks of morbidity and mortality. The significance of the role of a Forensic Pathologist in dealing with the analysis of injuries and the performance of autopsies to determine the cause, mechanism, and manner of death. In addition, the important lesson of testing patients for COVID-19 more regularly during a long hospital admission period, to offer early treatment and isolation, including avoiding the further spread of the COVID-19 infection variants to patients and healthcare professionals, thereby minimising and preventing hospital-acquired infection and death is stressed.

Mammoth Bilateral Ovarian Serous Cyst Adenomas in a Postmenopausal Woman: A Rare Case Report.

Serous cyst adenomas account for about 40% of all ovarian tumors and most commonly are diagnosed in middle-aged women. The aim of this publication is to present an extremely rare case of mammoth bilateral cyst adenomas in a postmenopausal woman, occupying the pelvis and the most of abdominal cavity. A 67-year-old obese woman was presented to our emergency department with abdominal pain. Ultrasound and computed tomography of the abdomen verified two huge cystic masses. Exploration of the abdominal cavity by laparotomy established two intact giant cystic masses with ovarian origin. The cysts were removed by bilateral salpingo-oophorectomy and hysterectomy was performed. Histological examination revealed that both cystic masses were ovarian serous cyst adenomas. The woman was discharged with an uneventful recovery. We present a case of the largest gigantic bilateral ovarian cyst adenomas in the oldest woman ever reported.

Severe Burns of the Genital Area After Laser Hair Removal: A Case Report.

Burn injuries are among the most commonly observed complications of laser hair removal. Here, we present a case, in which severe massive burns were caused in the genital and perineal areas during such a procedure. The consequent scar formation led not only to negative aesthetic effects but also affected the physical and psychological health of the patient.

Difficulties Encountered by Forensic Pathologists in Proving Abusive Head Trauma in Children: A Case Report.

Shaken baby syndrome (SBS) or abusive head trauma (AHT) is one of the most common causes of death or serious neurological injury resulting from child abuse. AHT is defined as injury to the skull or intracranial contents of an infant or child younger than five years due to intentional abrupt impact and/or violent shaking. It is characterized by acute encephalopathy with subdural and retinal hemorrhages. We present a case of AHT that does not show the typical clinical triad. We describe one case of a pediatric patient addressed for forensic autopsy and where suspicion of AHT has arisen. The injury mechanism involved in the production of this syndrome and its clinical manifestation are sources of debate in forensic medicine. Thus, forensic pathologists must analyze all findings to determine SBS/AHT.

Elderly abuse - a forensic case of homicide-suicide as act of intimate partner violence.

Homicide-suicide as a criminal act is a distinct subcategory of homicide in which the assailant kills his wife and/or her children in a relationship that has been broken down. The present case is about the dyadic deaths of an 89-year-old male and an 82-year-old female who are in a relationship as intimate partners (as husband and wife). In the early autumn of 2020, an event report was received in the Police District of Plovdiv about a woman who was found dead in her home. Her husband's body was found next to hers in the same building, with the clinical features of a coma - the man was breathing but unresponsive. Unfortunately, he passed away immediately before the arrival of the emergency crew.

The Moral Dilemma of Euthanasia Through the Eyes of the Medical Society in Bulgaria.

INTRODUCTION: With the development of human society, the question of the value and inviolability of human life begins to occupy a central place in the various social strata and social structures. With the adoption of the Universal Declaration of Human Rights after the Second World War, the basic postulates protecting the right to inviolability of human life were laid. The question focused on euthanasia has been discussed in several European countries, such as Germany, Ireland, France, and Italy, leading to considerable interest in the medical community in Bulgaria. MATERIALS AND METHODS: A prospective study was performed using approved sample cards, analyzing the general knowledge of the medical community in the Republic of Bulgaria about euthanasia and assisted suicide over a period of four months, between January 2023 and May 2023. In this process, 623 people were surveyed, and the questionnaire included several targeted questions through electronically generated samples on the Microsoft Forms platform. The target group had doctors with and without a specialty in various fields of hospital and pre-hospital care, dentists, and students from the fields of medicine and dentistry. RESULTS AND DISCUSSION: The results show that the majority of medical professionals clearly state their positive opinion on the adoption of a law to legalize euthanasia in the Republic of Bulgaria, clearly taking into account the fact that the right to life has always been and always will be the most absolute and fundamental human right. Contrary to the above, it is implied that it is inevitably linked to a quality and fulfilling life without suffering. Identically, they also answered that a person should have the right to know exactly when to end his own life. The medical society in Bulgaria clearly shows its positive opinion regarding the idea that the different forms of euthanasia (active euthanasia and assisted suicide) should be defined as morally and legally permissible. Our research confirms the Bulgarian medical community's opinion that the subject of the problems of euthanasia and its legal regulation are already ripe for public discussion, similar to many other European countries. CONCLUSION: The actual issue of euthanasia as a conclusion raises several questions related to the process of acceptance of standard algorithms for action in such cases where the same action is legalized by law. It also includes the process of acceptance of strict regulations by the countries for the so-called negative phenomenon "death tourism" and several other administrative actions related to the mandatory registration of every case of euthanasia, the implementation of mandatory consultations with a psychiatrist and psychologist for patients seeking euthanasia as the only possible option, and providing possible alternatives regarding their illness. This is the unchangeable cornerstone for standardizing the legalization process and acceptance of "good death" in Bulgaria. In its essence, euthanasia creates both a social and an ethical conflict in our modern society, appearing at the same time as a kind of "stress test" for the health system.

Posttraumatic Parinaud's syndrome as a contrecoup injury in a case of closed head trauma.

The purpose of the study was to present a rare case of post-traumatic Parinaud's syndrome with a history of closed head injury. The clinical characteristics, examination, and management are presented in a 12-year-old boy who was a victim of physical violence at the hands of a young boy who punched him in his chin with his fists, with associated paralysis of the upward gaze of the left eyeball, and convergence nystagmus with pupillary involvement. CT examination indicated posttraumatic lesions in the dorsal midbrain and in the cavity of third ventricle, suggestive of acute hemorrhages. Posttraumatic Parinaud's syndrome is a rare phenomenon that can occur in a case of closed head trauma as contrecoup injury.

Child abuse syndrome - a forensic case of fatal impulsive act of violence.

Child abuse syndrome is a medico-social problem widely spread around the world, which includes a complex of clinically manifested forms of violence against children. This syndrome includes different forms of physical violence, sexual violence, neglect, and emotional violence against children. The main problem with this type of violence continues to be the large number of unregistered "hidden" cases. The consequences of violence against children are serious and have a lasting negative effect on the physical and mental health of the victims. Child abuse is often a result of impulsive violent behavior with minimal provocation and may have a fatal outcome.

Penetrating Brain Trauma due to Air Gun Shot - a Case Report.

Cases of severe injuries caused by air guns are really uncommon, but they can lead to a fatal outcome. Usually, these injuries occur in children due to their not fully developed skull bones or in adults through less resistant and thin regions of the cranium. Most of them are accidental events, followed by low percentage of suicidal attempts.In this paper, we present the case of a 68-year-old man suffering from severe depression, with self-inflicted air gun injury to the head. The patient was admitted to the hospital in a coma with a Glasgow Coma Scale (GCS) score of 8, with severe penetrating head injury manifested with brain contusion and intraventricular bleeding seen at the CT examination. Metal particles from the projectile were seen inside the brain. The entry wound had inverted margins, abraded collar and skin defect. The additional neurological examination of the patient showed symptoms of increased intracranial pressure. The treatment started with the air gun wound care. Craniotomy surgery was also done and bone fragments around the entry wound were successfully extracted with subsequent debridement and duraplasty. The patient was treated with new-generation combined antibiotics for preventing inflammatory complications. On the nineteenth day, the patient was discharged with mild hemiparesis on the left side and with GCS score of 15.Air-gun traumatic cases with head injury or with injury to other parts of the body are often mistaken for firearm accidents, because air guns are seriously underestimated devices. Nevertheless, they could lead to severe health consequences and severe disability. This case highlights the necessity of strict monitoring of air guns by the responsible government institutions which should apply the same regulations in controlling these weapons as they implement in controlling the firearm guns. Presence of severe depression, mental illnesses, and neoplasms are risk factors for committing suicide with this type of weapons and the control over the air weapons in this group of people should be stricter.

Complicated spontaneous intercostal lung hernia - A rare clinical case.

Spontaneous lung herniation is a rare pathological entity. We present a case of intercostal type of spontaneous lung hernia after heavy lifting complicated with huge soft tissue hematoma, single rib fracture, hemothorax, diaphragmatic laceration, and great omentum pleural cavity herniation in a 46-year-old man. His comorbidities were arterial hypertension, congestive heart failure, and type II diabetes mellitus and had no history of trauma, surgical procedures in his thoracic wall, or chronic obstructive pulmonary disease. Physical examination revealed a huge left-sided flank hematoma. Chest X-ray determined stable intercostal lung hernia confirmed by chest computed tomography. Conventional approach by left mid-lateral thoracotomy was used for surgical repair of the lung hernia and stabilization of the intercostal space. The patient was discharged on the 9th postoperative day in a good condition. Control examination 2 years after the operation found no deformation of the thorax or recurrence of the lung hernia. This is a case of interest of spontaneous intercostal lung hernia because of the number and type of associated injuries. This case demonstrates low morbidity and good postoperative result by conventional surgery in intercostal lung hernias.

Three unusual cases of gunshot wounds.

We report three unusual and atypical cases of firearm-fatalities. Two of the victims had two gunshot wounds. The two gunshot wounds were in the head in one of the cases and in the chest in the other. The third case was a suicide with a gunshot wound in the back of the neck. It is a very rare case in forensic practice to have more than one gunshot wounds in a suicide. A suicide case with the gunshot wound located in the back of the neck is still rarer. There were obvious difficulties in the three unusual and atypical cases we report to decide whether they were homicide, suicide or accident. Reports of firearm-related suicide cases with more than one gunshot wound or unusual wound site enriches forensic practice, providing additional data that may help differentiate between homicide and suicide.

The advantage of the virtual forensic autopsy - A new approach which could benefit forensic expertise.

We aimed to assess the accuracy and advantages of postmortem CT examination and three-dimensional (3D) view of the cadaver with the Sectra Visualization Table compared to the full conventional autopsy of a forensic suicidal case. Our survey concerned unusual case of self-strangulation where a body was found in the stage of mummification with a nylon cable tie around the neck and another around the feet. The case was initially determined as a homicide, but later reconsidered a suicide based on objective scene investigation, virtual autopsy and the positions of knots. Unlike the physical autopsy in case of mummification 3D examination does not alter evidence and can revisit the body for additional investigation.