Novel PAX3::INO80D Fusion in Biphenotypic Sinonasal Sarcoma in an Adult.

This case report describes a novel gene fusion of PAX3::INO80D in a biphenotypic sinonasal carcinoma in a woman in her 40s.

Loss of Nuclear Basophilic Staining as a Postmortem Interval Marker.

INTRODUCTION: The loss of basophilia (LOB), as an objective marker of postmortem interval (PMI), was evaluated. Such a correlation has been previously reported in stillborn fetuses. METHOD: Loss of basophilia in different tissues was scored using hematoxylin and eosin-stained slides obtained from 65 random autopsy cases. Scatter plots were used to visually assess the correlation of PMI with our LOB scores. Decomposition was assessed using a modified total body score. RESULTS: Loss of basophilia was found to be correlated with PMI (total and unrefrigerated intervals). Specifically in this study, we found full or partial basophilic staining up to 26 hours after death, and complete LOB was seen in cases as early as 36 hours in liver and 60 hours in heart. Loss of basophilia also well correlated with the modified total body score. The LOB varied by tissue and was uncorrelated to histologically observable bacteria and fungi. Refrigeration appeared to stop the autolytic process that causes the LOB. CONCLUSION: Complete LOB can be expected between 1 and 2 days after death in unrefrigerated liver and heart tissues because of autolysis.

Post-Cesarean Section Pyoderma Gangrenosum Presenting with Vasopressor-dependent Shock: Long-term Follow-up after Delayed Primary Closure.

A 28-year-old woman with poor wound healing and surgical site pain presented 5 days post-cesarean section (post-CS) with vasopressor-dependent shock and was eventually diagnosed with postoperative pyoderma gangrenosum (PG). A worsening clinical picture consistent with presumed necrotizing infection necessitated surgical debridement. The patient was ultimately taken to the operating room 4 times with transient improvement after the operations when she received perioperative corticosteroids. We were unable to identify an infectious source and cultures revealed no microorganisms. Dermatopathology revealed neutrophilic infiltrate and focal necrosis without microorganisms. The biopsy site began to concurrently exhibit pathergic changes, leading to a diagnosis of PG. Twelve weeks later, she underwent DPC of her abdominal wound while maintained on an immunosuppressive regimen of cyclosporine and prednisone. Incisional negative pressure wound therapy with a small window was used in the immediate postoperative period to allow for direct visualization of the closed incision. She healed without issue and her immunosuppressive regimen was ultimately discontinued. Postoperative PG is an uncommon diagnosis with high risk of morbidity. It is often mistaken for necrotizing infection. We report a unique case of post-CS PG presenting as vasopressor-dependent shock that was successfully closed with incisional negative pressure wound therapy with a small window.