Cardiac Valvular Inflammatory Pseudotumor

Inflammatory pseudotumors are quasineoplastic lesions that occur in the lungs as well as other extrapulmonary sites. The heart is an uncommon site of origin. We report a valvular pseudotumor that produced chronic mitral and aortic regurgitation in an elderly woman

An autopsy study of hematolymphoid malignancies

Background: Hematolymphoid malignancies (HLM) are primary cancers of blood, bone marrow and lymphoid organs associated with high mortality. Clinically undetected cases, diagnosed primarily at autopsy, are common.Methods: Cases of HLMs at autopsy performed in our hospital from 1st January 2009 to 30th June 2017 were analysed. Gross and microscopic findings at autopsy along with clinical parameters were studied. Special stains and immunohistochemistry (IHC) were performed wherever possible.Results: There were 49 cases of HLMs (0.98 %) among 4971 autopsies conducted during the study period, occurring predominantly in males (70 %). Fifteen (30.61 %) were primarily diagnosed at autopsy. There were 26 lymphomas and 19 leukemias; three patients had multiple myeloma and one patient had Langherhan cell histiocytosis. Non-Hodgkin’s lymphoma was the commonest (24 patients). Nine were diffuse large B-cell lymphoma; rare sub-types included angiotrophic lymphoma, post-renal lymphoproliferative disorder and hepatosplenic gamma-delta T-cell lymphoma. Among the 19 leukemias, majority were acute (13 cases) with seven cases of myeloid and six of lymphoid types. IHC was performed in 21 cases which aided the diagnosis. The commonest symptoms were fever (43%) and dyspnoea (37%). Splenomegaly (67%), hepatomegaly (61.2%) and lymphadenopathy (57.1%) were the most common autopsy findings. Infiltrations were seen in various organs; an acute myeloid leukemia (M6) had infiltration of the atrio-ventricular node.Conclusions: One-third cases in the present study were diagnosed at autopsy without any prior clinical suspicion thereby emphasizing on the relevance of autopsy in the current practice of pathology and further studies to improve accuracy of ante-mortem diagnosis

Thymoma: A pathological study of 50 cases

BACKGROUND: A combination of epithelial cells and lymphocytes results in a varied histomorphology of thymomas and consequent varied classification systems. AIM: To correlate the Marino and Muller-Hermelink (MMH) classification with the invasive behaviour of thymomas. SETTING AND DESIGN: Retrospective analysis. MATERIALS AND METHOD: Thymomas encountered in the past 21 years were re-classified with the MMH classification and correlated with Masaoka's staging and clinical presentation. RESULTS: The thymomas formed 91% of the primary thymic epithelial tumours. Predominantly cortical thymomas (n=21) and cortical thymomas (n=22) were the common subtypes and 60% and 77% of these, respectively, were in stages II or III. Cystic change, necrosis or haemorrhage played no role in predicting invasive behaviour. Cortical epithelium correlated well with the presence of para-thymic syndromes, especially myasthenia gravis. CONCLUSION: MMH classification is easy to apply. Cortical thymomas in stage I should be followed up for possible recurrence

Sclerosing hemangioma with lymph nodal metastases

A case of sclerosing hemangioma of the lung is reported in a young male, who presented with recurrent cough and streaky hemoptysis for three years. The tumor was situated in the right upper lobe and was large (over 9 cm), multicentric and associated with metastases to the regional lymph nodes. To the best of our knowledge, only 14 cases with such metastases have been reported

Microscopic thymoma: A report of four cases with review of literature

Context: Thymectomy is an effective therapy for patients with myasthenia gravis, and the lesions usually identified are lymphoid hyperplasia and thymomas. Nodular epithelial proliferations, termed as microscopic thymoma, are rare. Aims: Our aim was to assess the incidence and clinicopathological features of microscopic thymomas. Setting and Design: Retrospective analyses. Materials and Methods: Thymectomies performed in 105 patients with myasthenia gravis were reviewed, and patients with microscopic thymomas were studied with respect to their clinicopathological features. These were compared with those in other reports in literature. Results: Four thymuses showed features of microscopic thymomas, an incidence of 3.8%. There were 2 males and 2 females, all myasthenic; the mean age was 31 years. The resected thymic tissues were seen as soft, capsulated adipose tissue. They showed variable degrees of involution or were atrophic. All had multifocal proliferation of ovoid-to-polygonal cells with tongue-like insinuations into the fat. After thymectomy, there was improvement in the symptoms. Eight patients reported in literature had similar clinicopathological features. Conclusions: Thorough examination of the thymectomies is required to increase the detection of these lesions for assessment of their incidence, causes, pathogenesis and functional significance

Shaggy aorta—An autopsy analysis

Aims: Shaggy aorta is defined as “very extensive atheromatous disease with diffuse ulcers associated with soft, loosely held debris and a paucity of actual thrombus” and often results in visceral or peripheral arterial embolization (shaggy aorta syndrome). Most of the studies are clinico-radiological with hardly any assessment of the pathological features. We present an autopsy analysis of shaggy aorta. Materials and Methods: A retrospective study of autopsied cases of shaggy aorta over 15 years was conducted. The involvement of the various segments of the aorta (ascending, transverse, thoracic, and abdominal) was correlated with the clinical manifestations and cardiac/extra-cardiac findings at autopsy. The mortality was categorized as those related to shaggy aorta (Group I), related to cardiac diseases (Group II), and those unrelated to cardiovascular diseases (Group III). Statistical Analysis: Nil. Results: In a span of 15 years, there were 76 cases of shaggy aorta affecting predominantly males (85.5%) and patients in the sixth decades of life (mean age of 64.5 years). The important associated cardiovascular risk factors included hypertension, tobacco use, and diabetes mellitus. Predominant involvement of the entire aorta and arch + descending aorta was seen in 39.5% and 35.5% of the cases, respectively. Regardless of extreme severity, only half of the patients (37 cases, 48. 7%) had clinical presentation due to shaggy aorta. Conclusions: The occurrence of shaggy aorta may be more common than expected, and it would be important to keep this possibility in mind even in asymptomatic elderly patients with cardiovascular risk factors since aorto-arterial manipulations and anti-coagulant therapy can prove detrimental in such patients

Septic pulmonary embolism: Is it an underestimated diagnosis?

Background: Non-thrombotic pulmonary embolism, an uncommon entity, is defined as the embolization of tissues, microorganisms, air, or foreign material. One subset in this non-thrombotic category is septic pulmonary embolism (SPE) that refers to embolism of microorganisms with or without a thrombotic mantle into the pulmonary vasculature. This condition is often recognized on the basis of imaging with a clinical correlation. Unfortunately, data regarding the pathological features are meager. This has prompted to review such cases at autopsy. Aims: To study the pathological features of SPE at autopsy. Materials and Methods: Ten-year (2012 to 2021) autopsy records of the hospital were retrospectively reviewed. The diagnosis was based on the identification of acute necrotizing pulmonary arteritis with peri-bronchoarterial consolidation. These cases were analyzed with reference to the demographics, clinical characteristics, and pulmonary/extrapulmonary findings at autopsy. Statistical Analysis: Nil. Results: According to the inclusion criterion, 19 cases demonstrated the presence of SPE. There were 11 men and 8 women with a mean age of 32.1 years. The major source of infection included infection arising from skin and musculo-skeletal system (11 patients, 59.7%). The common clinical presentation included fever, dyspnea, chest pain, hemoptysis, and altered sensorium. The cause of death was mainly due to septicemia and/or confluent lung consolidations. A large number of bacterial colonies were seen in all; Candida species were also identified in two cases. Other lung findings included diffuse alveolar damage, fresh arterial thrombosis, infarction, arterial pseudo-aneurysms, abscess formation, and pyogenic pleuritis. Conclusion: Presence of an extrapulmonary infection with persistent fever, bacteremia, and pulmonary complaints should raise suspicion for this entity, particularly in resource-poor settings, to prevent grave pulmonary complications