Pulmonary tumor embolism: A retrospective study over a 30-year period

Background Pulmonary tumor embolism (PTE) is difficult to detect before death, and it is unclear whether the discrepancy between antemortem clinical and postmortem diagnosis improves with the advance of the diagnostic technologies. In this study we determined the incidence of PTE and analyzed the discrepancy between antemortem clinical and postmortem diagnosis. Methods We performed a retrospective autopsy study on patients with the history of malignant solid tumors from 1990 to 2020 and reviewed all the slides of the patients with PTE. We also analyzed the discrepancies between antemortem clinical and postmortem diagnosis in 1999, 2009 and 2019 by using the Goldman criteria. Goldman category major 1 refers to cases in which an autopsy diagnosis was the direct cause of death and was not recognized clinically, but if it had been recognized, it may have changed treatment or prolonged survival. Results We found 20 (3%) cases with PTE out of the 658 autopsy cases with solid malignancies. Out of these 20 cases, urothelial carcinoma (30%, 6/20) and invasive ductal carcinoma of the breast (4/20, 20%) were the most common primary malignancies. Seven patients with shortness of breath died within 3–17 days (average 8.4±2.2 days) after onset of the symptoms. Pulmonary embolism was clinically suspected in seven out of twenty (35%, 7/20) patients before death, but only two patients (10, 2/20) were diagnosed by imaging studies before death. The rate of Goldman category major 1 was 13.2% (10/76) in 1999, 7.3% (4/55) in 2009 and 6.9% (8/116) in 2019. Although the rate of Goldman category major 1 appeared decreasing, the difference was not statistically significant. The autopsy rate was significantly higher in 2019 (8.4%, 116/1386) than in 2009 (4.4%, 55/1240). Conclusions The incidence of PTE is uncommon. Despite the advances of the radiological techniques, radiological imaging studies did not detect the majority of PTEs. The discrepancy between the antemortem clinical and the postmortem diagnosis has not improved significantly over the past 30 years, emphasizing the value of autopsy.

A PAEDIATRIC DEATH DUE TO MENINGITIS-AN AUTOPSY DIAGNOSIS OF A RARE COMPLICATION OF INFLUENZA B INFECTION

Influenza virus belongs to a group of single-stranded RNA viruses in the fam- ily Orthomyxoviridae. They are subdivided into four types as A, B, C and D. As Influenza B is considered a milder form of infection not known to be caus- ing pandemics compared to Influenza A, it is equally a less researched topic than Influenza A. However, few studies have shown that the mortality associ- ated with pediatric Influenza B infection is equal to or sometimes even greater than the mortality associated with Influenza A. Complications of Influenza A or B virus infection include pneumonia, myositis, myocarditis and encephali- tis/encephalopathy. Influenza-associated encephalitis/encephalopathy (IAE) is a rare complication of Influenza infection which is commoner following infec- tion with type A. This case elaborates a death of a three-year-old child due to meningoencephalitis following Influenza Type B infection.

Electricity induced burns and lung injury: A rare autopsy observation

Electrocutions injuries are frequently encountered in a domestic setting or as an occupational hazard. Electrocutions injuries sustained in occupational settings are often associated with significant morbidity and mortality globally. Autopsy diagnosis of electrocution is mostly based on gross and histopathological changes in the entry and exit wounds. Gross changes in form of entry and exit wounds, however, may not be present in all cases of electrocution. In such cases, histopathological changes in the internal organs along the path of current can be useful. We report a case of fatal electrocution involving a 23-year-old young male in which remarkable gross and microscopic changes were appreciated in the lung due to the passage of electric current through it. Such observations are rarely reported in literature and highlight on the significance of autopsy pathology in the diagnosis of electrocution.

Canadian Association of Neuropathologists L’Association Canadienne des Neuropathologistes

The Canadian Association of Neuropathologist – L’ Association Canadienne de Neuropathologistes (CANP-ACNP) held their 59th annual meeting at the Delta Kingston Waterfront from October 23rd to 26th, 2019, under the leadership of Dr. Peter Gould, President of the CANP-ACNP, Dr. Julia Keith, Secretary Treasurer of the CANP-ACNP, and Dr. John Rossiter, local organizer. The annual banquet was held at River Mill Restaurant in Kingston.The academic program comprised 14 Abstracts, 14 unknown cases, a Symposium on Neurodegenerative Neuropathology, and a Neuropathology Practice lecture by Dr. Gerard Jansen entitled CJD, CJD Surveillance, and Occupational Risk. Can worms ever be re-canned? The interactive forum on Neuropathology Practice was moderated by Dr. Gould and Dr. Keith and focused on safety around autopsy diagnosis of CJD, the Neuropathology workforce analysis in Canada 2019 presented by Dr. Patrick Shannon, and accreditation of neuropathology laboratories in Canada. Digital pathology images from the 14 unknown cases are available for viewing online (www.canp.ca) thanks to the CANP webmaster Dr. Jason Karamchandani.The Presidential Symposium 2019 on Neurodegenerative Neuropathology featured the Jerry Olszewski Lecture given by Dr. Douglas Munoz on Using eye tracking to identify behavioural biomarkers of neurodegeneration, the David Robertson lecture given by Dr. Tom Beach on Staging systems for Lewy body diseases, and the Gordon Mathieson lecture given by Dr. Ian Mackenzie on C9orf72: FTD, ALS and beyond. The program was completed Dr. Gabor Kovacs’ presentation on Tau pathologies in the aging brain and Dr. Carmela Tartaglia’s presentation on Dementia; the times they are a changing.The award for best clinical science presentation by a trainee (Dr. Mary Tom Award) in 2019 went to Dr. Suzy Kosteniuk (Supervisor Dr. Lothar Resch), and the award for best basic science presentation by a trainee (Dr. Morrison H. Finlayson Award) was won by Hoang D. Nguyen (Supervisor Dr. Maxime Richer).The following abstracts were presented at the 59th annual meeting of the Canadian Association of Neuropathologists – Association Candienne des Neuropathologistes (CANP-ACNP) in October 2019.

Cardiac MRI in autoimmune diseases: where are we now?

: Cardiovascular magnetic resonance imaging (CMR) allows the early diagnosis of various cardiovascular pathophysiologic phenomena in autoimmune diseases. Preliminary studies suggest that CMR holds a promising role in initiating the necessary changes in anti-rheumatic and cardiac treatment among patients with autoimmune diseases and cardiovascular diseases (CVD). It is widely known that the presence of late gadolinium enhancement (LGE) has been related to worse cardiovascular prognosis. CMR has been documented to be the most valuable tool for diagnosis and risk prediction of cardiac involvement in a sarcoidosis population, while in SLE, the gap between clinical and autopsy diagnosis of myocardial disease could be narrowed with the implementation of CMR. In different connective tissue diseases, including SLE, LGE has been demonstrated to be present, early after the initial diagnosis of SLE. Considering that CMR including LGE identifies more patients with silent myocardial disease in SLE and other connective tissue diseases than echocardiography, CMR should be the preferred imaging modality, especially in the era of modern techniques with a broader availability and expertise. In this review, we summarize the major indications, advantages and limitations of the use of CMR among patients with autoimmune disorders.

How often is autopsy contributory in cases of sepsis?

This study sought to determine how often a medico-legal (coronial) autopsy contributes by identifying the source of infection when there has been a clinical diagnosis of sepsis prior to death. Autopsy reports were retrieved in which it was documented there had been a clinical diagnosis of sepsis preceding death. The autopsy report was reviewed to determine if a source for sepsis had been identified. It was found the autopsy was contributory in this respect in less than one fifth of all cases (35 of 198, 18%). It was also determined if there was a post-autopsy diagnosis of sepsis or if sepsis was excluded by a definite alternative diagnosis. During the study, of the 198 cases, sepsis was excluded by an alternative diagnosis in 78 (39%). Thus, the autopsy may be of more application to confirming or excluding a diagnosis of sepsis than identifying a source for sepsis.

Effect of surgery and chemotherapy on long-term survival in infants with congenital glioblastoma: an integrated survival analysis

OBJECTIVEGlioblastoma (GBM) during infancy is rare, and the clinical outcomes of congenital GBM are not well understood. Correspondingly, the aim of this study was to present a long-term survivor case from the authors’ institution, and establish an integrated cohort of cases across the published literature to better understand the clinical course of this disease in this setting.METHODSThe authors report the outcomes of an institutional case of congenital GBM diagnosed within the first 3 months of life, and performed a comprehensive literature search for published cases from 2000 onward for an integrated survival analysis. All cases were integrated into 1 cohort, and Kaplan-Meier estimations, Fisher’s exact test, and logistic regression were used to interrogate the data.RESULTSThe integrated cohort of 40 congenital GBM cases consisted of 23 (58%) females and 17 (42%) males born at a median gestational age of 38 weeks (range 22–40 weeks). Estimates of overall survival (OS) at 1 month was 67%, at 1 year it was 59%, and at 10 years it was 45%, with statistically superior outcomes for subgroups in which patients survived to be treated by resection and chemotherapy. In the overall cohort, multivariable analysis confirmed resection (p < 0.01) and chemotherapy (p < 0.01) as independent predictors of superior OS. Gestational age > 38 weeks (p < 0.01), Apgar scores ≥ 7 at 5 minutes (p < 0.01), absence of prenatal hydrocephalus (p < 0.01), and vaginal delivery (p < 0.01) were associated with greater odds of surgical diagnosis versus autopsy diagnosis.CONCLUSIONSCongenital GBM can deviate from the expected poor prognosis of adult GBM in terms of OS. Both resection and chemotherapy confer statistically superior prognostic advantages in those patients who survive within the immediate postnatal period, and should be first-line considerations in the initial management of this rare disease.

Concordance between clinical diagnosis of pulmonary thromboembolism at hospital discharge and anatomopathological diagnosis

Half of the cases of pulmonary thromboembolism (PTE) are not diagnosed because of its unspecific clinical presentation; in Mexico, autopsy data reveal a similar incidence to that of developed countries. The objective of this work was to know the concordance between the clinical diagnosis of PTE at hospital discharge and its autopsy diagnosis. The method used was a retrospective cohort study of cases with PTE diagnosis who attended from January 2005 to December 2013. Information was obtained from the autopsies registry and clinical charts. From 177,368 hospital discharges, there were 412 (6.74%) with PTE diagnosis. There were 13,559 deaths, with PTE diagnosis in 139 (1%) patients. There were 479 autopsies, and in 66 (14%) of whom PTE diagnosis was documented, the mean age was 55 years (range, 18–89 years). The premortem diagnosis of PTE at discharge was confirmed in 412 cases. Postmortem diagnosis of principal disease was medical in 49 (74%) and medical-surgical in 17 (26%) patients. We found that nine patients had the clinical diagnosis of PTE, unlike the postmortem diagnosis, which was reported in 66 autopsies. The above allows establishing a 1:7 ratio that represents 14%. D-dimer was determined in 11 cases (16%) and was positive in 8 (73%). Thromboprophylaxis was applied in 15 cases (23%). The study of necropsies and identification of discrepancies is needed to improve the diagnostic accuracy and healthcare quality. The evaluation of hemostasis biomarkers besides D-dimer can better describe the pro-thrombotic state, the risk of thrombosis, and its association with morbidity and mortality.