The Incidental Diagnosis of Adenomatoid Tumour on Fallopian Tubes Submitted for Tubal Ligation at a Tertiary Laboratory in Northern Pretoria, South Africa.

Introduction: Adenomatoid tumours are the most common benign mesothelial neoplasms of the fallopian tube. They are usually diagnosed incidentally in specimens submitted for bilateral tubal ligation and can be mistake for vascular or epithelial lesions. Materials and methods: A retrospective analysis of cases with adenomatoid tumour of the fallopian submitted for tubal ligation from 2012 to 2020. The clinicopathological characteristic data was retrieved from the laboratory information system. Results: A total of 11 cases with adenomatoid tumour of the fallopian tubes submitted for tubal ligation were identified in women with average age of 30.9 years. In all the cases, only 1 fallopian tube was affected. Grossly, the fallopian tubes did not show any discernible tumour. Immunohistochemical stains confirmed the diagnosis of adenomatoid tumours in all the cases. Conclusion: Adenomatoid tumours in fallopian tubes are infrequent, and pathologists shouldn't overlook them especially in unsuspicious instances. As frequent as adenomatoid tumour of the fallopian tubes are uncommon, pathologists show be aware of as their misdiagnosis could lead mismanagement of patient with far reaching complication.

Clinicopathological report on epidermoid cysts of the brain: A case series and literature review from an African perspective.

INTRODUCTION: Epidermoid cysts are rare benign lesions of the central nervous system which accounts for approximately 1-2 % of all intracranial tumours. They are commonly located in the parasellar region, cerebellopontine angle; however, brain parenchyma origin is rare. We report clinicopathological features of these rare lesions. METHOD AND MATERIAL: This is a retrospective study of epidermoid cyst of the brain diagnosed between 01 January 2014 and 31 December 2020. RESULTS: The four patients had mean age of 30,8 years (range: 3-63), one male and 3 females. All four patients presented with headache and one associated with seizures. Radiological images showed two posterior fossa; each occipital and temporal locations. All tumours were successfully removed and histopathological assessment confirmed epidermoid cysts. All patients showed clinical improvement and were discharged home. CONCLUSION: Epidermoid cysts of the brain are rare and still remain a preoperative clinico-radiological conundrum as they may be indistinguishable from other intracranial tumours. Therefore, collaboration with histopathologists is advised in the management of these cases.

Fungal infection of the central nervous system: Autopsy analysis of six cases.

Fungal infections of the central nervous system are fatal and rare clinical entities observable in immunosuppressed patients from varying causes. They carry higher risks of morbidities and mortality as compared to viral, bacterial or parasitic central nervous system infections. This study describes clinicopathological description of the central nervous system fungal infections with antemortem diagnostic challenges. This is a 9-year retrospective study of six cases composed of three females and three males with a mean age of 29.3 years. All six decedents presented with signs of meningeal irritation. They all suffered from immunodeficiency of varying causes. The gross and microscopic features revealed cryptococcosis, candidiasis and mucormycosis as the cause of the central nervous system infection. Early diagnosis and appropriate medical treatment are of paramount importance in improving the overall survival of patients with central nervous system mycosis. A few autopsy cases with fungal infection of the central nervous system have been described; therefore, more autopsies studies are needed to re-enforce on the existing epidemiology of these fatal infections. Moreover, this will assist in further elucidating the varying gross features and tissue reaction patterns associated with them.

A thymic cyst presenting as first episode 'status epilepticus'.

Introduction: and importance: We report a rare case of unusual initial neurologic presentation of congenital thymic cyst, which generally is asymptomatic and therefore require additional radiological evaluation. The diagnosis, however, is by histological confirmation after surgical excision. Case presentation: Our patient presented with first time status epilepticus from an infected congenital thymic cyst, resulting in acute cerebral edema. Although initially missed, a careful re-evaluation of chest X-ray provided the diagnostic clue of a mediastinal mass effect on cerebral venous drainage. Cyst excision resulted in clinical and radiological resolution of cerebral edema. Clinical discussion: Although superior mediastinal masses are known to cause convulsions from cerebral edema, congenital thymic cysts rarely cause neurological symptoms and are therefore least expected to present in the emergency department with first time status epilepticus. However, a careful evaluation of the superior mediastinum on chest radiographs is helpful to identify such an example of extra-cranial etiology of this neurological emergency. Conclusion: Acute increase in pressure and or size from localized cyst infection of a congenital thymic cyst may cause acute cerebral edema from acute SVC obstruction, with resultant acute neurological symptoms.

Disseminated Cryptococcal Infection in HIV-Infected Patients: A Retrospective Clinicopathological Review of 4 Autopsy Cases.

Cryptococcosis is an opportunistic infection with high mortality if not diagnosed and treated in time. The objective of this study was to review the clinicopathological information of decendents with final autopsy diagnosis of disseminated cryptococcal infection. This study collected data from 4 decendents who presented to an academic hospital/laboratory between 1 January 2015 to 31 December 2018. Their clinical, radiological and pathological findings including treatment were reviewed. Two decendents presented with respiratory symptoms whilst the other 2 presented with meningeal symptoms. Three were confirmed HIV positive. One decendent was on ART, one had defaulted treatment and one was ART naïve. Two decendents were diagnosed with cryptococcal meningitis, one with bacterial pneumonia and one with pulmonary tuberculosis. Three decendents died in emergency unit and one in the ward whilst on antifungal therapy. The autopsy findings confirmed disseminated cryptococcal infection in all cases. A high index of suspicion should be maintained in the right clinical context. Multi-organ involvement should be suspected in all patients and be actively sought out.

Mycotic Pseudotumor of the Breast Secondary to Cryptococcal Infection: Report of Three Rare Cases and Literature Review.

Breast masses in clinical practice are often investigated primarily for neoplastic conditions. Breast fungal infections are unusual, and few cases have been reported in the literature. The differential diagnosis for a breast mass should not be limited to neoplastic conditions as there are treatment implications. The correct diagnosis is associated with reduced and unwanted cases of surgical intervention. We describe 3 cases of cryptococcal infection of the breast that clinically masqueraded as breast malignancies.

Primary cardiac lymphoma in HIV infected patients: A clinicopathological report of two cases.

INTRODUCTION AND IMPORTANCE: Due to advances in diagnostic methods and human immunodeficiency virus, there has been a recent increase in cardiac involvement by lymphoma. CASE PRESENTATION CASE 1: 15-year-old HIV infected male patient presented with features of heart failure and cardiac tamponade. The transthoracic echocardiogram showed pericardial effusion and a right atrioventricular mass. The resected tumour was confirmed to be diffuse large b-cell lymphoma on histopathology. Unfortunately, the patient died few hours after surgery. Case 2: 30-year-old HIV infected pregnant female presented with features of cardiac tamponade. The transthoracic echocardiogram showed pericardial effusion with right atrial mass. The resected tumour was confirmed to be Burkitt's lymphoma on histopathology. She was successfully treated with chemotherapy. CLINICAL DISCUSSION: Cardiac lymphomas are rare with most cases diagnosed on autopsy. However, advances in diagnostic methods has increased antemortem diagnosis with subsequent optimal management. Majority of the cases are of B-cell lineage, although T-cell origin has been reported. CONCLUSION: A high index of suspicion of cardiac lymphoma should be maintained in the right clinical setting in order to receive adequate attention and management.

Synchronous solid pseudopapillary neoplasm of the pancreas with intrahepatic cholangiocarcinoma in a young male patient: An unusual deadly occurrence.

INTRODUCTION AND IMPORTANCE: Solid pseudopapillary neoplasm of the pancreas (SPN) is a tumour with low malignant potential, albeit with good prognosis. Intrahepatic cholangiocarcinoma (iCCA) is a malignant and aggressive tumour with poor prognosis. CLINICAL PRESENTATION: We report a case of a 38 years old African male patient with abdominal pain for 5 years that worsened in the preceding 5 months. Radiology showed pancreatic and liver lesions which were thought to be malignant and benign, respectively. However, intra-operative and histopathological assessment confirmed SPN and iCCA which were contrary to radiological findings. Whilst surgery was uneventful, the patient died after 15 days. CLINICAL DISCUSSION: Whilst SPN is commonly seen in young females, it is rare in males and has been associated with aggressive behaviour. The prognosis is good, albeit the presence of metastasis. iCCA is rare in younger population notwithstanding the presence of risk factor. Combination of iCCA and SPT has not been described. Both these tumours do not share risk factors, pathogenesis or molecular alterations. CONCLUSION: The concomitant occurrence of these two pathologies in young male patient is unusual and preoperative diagnosis may be very difficult.

Malignant nodular melanoma of the vulva: a rare and aggressive tumour of the female genital tract (case report).

Malignant melanoma of the vulva is a rare and aggressive tumour with dismal prognosis. It tends to recur and metastasize early. Surgical excision with or without regional lymph node dissection is still the treatment of choice with adjuvant therapy decided on a case by case. Furthermore, HIV infection has been associated with more aggressive disease. Herein we present a 45-year-old HIV-infected female patient on antiretroviral therapy who presented with vulval ulcer for one year. On examination, she had ulcerated nodule on the labia majora. Radiology showed vulvovaginal tumour without involvement of the adjacent organs. Malignant melanoma was confirmed on both the incisional biopsy and vulvectomy. She responded poorly to radiotherapy. Furthermore, she presented with recurrence and metastatic disease a month after surgery. She was lost to follow-up clinic.

Metastatic Papillary Thyroid Carcinoma in a Paediatric Patient.

Papillary thyroid carcinoma is the most common endocrine cancer in the paediatric population. Although the disease is diagnosed at a later stage, the prognosis is favourable. When these patients present with lymph nodal and/or pulmonary metastases, they may be initially confused for infectious diseases such as tuberculosis. Therefore, thorough clinical assessment including radiology and microbiological and histopathological assessment is important for early and correct diagnosis. We report an 11-year-old female patient who presented with cervical lymphadenopathy and the histopathological assessment confirmed metastatic papillary thyroid carcinoma. Subsequent radiological investigation revealed further metastasis to the lung. This manuscript highlights the difficulties that might be encountered in the initial management of paediatric PTC which present atypically.

COVID-19 in an HIV-infected patient. Lessons learned from an autopsy case.

Despite measures put in place to curb the spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) across South Africa, there has been a rapid spread which caused extensive morbidity and mortality. Whilst there is currently increased COVID-19 associated death, autopsies on COVID positive individuals are not routinely performed. An autopsy was performed on a 19 years old African patient who was recently diagnosed with human immunodeficiency virus (HIV). He presented with clinical features suggestive of SARS-CoV-2, which he subsequently tested positive for. Important histopathological findings included diffuse alveolar damage and fibrin thrombi. No superimposed infections were noted. The cause of death was attributed to COVID-19. We report the first autopsy case of an HIV-infected individual with COVID-19 as the cause of death.