Pathological features in perinatal autopsy and its relation with clinical and antenatal sonography findings

Background: Perinatal mortality is considered as a yardstick of obstetric and maternal care before and around the time of death. Perinatal autopsy is an inevitable procedure which helps to ascertain the cause of death, identify rare diseases, supplements clinical diagnosis and provide risk estimates for future pregnancies. The aim of the study was to describe the pathological features in perinatal autopsy specimens and to compare the pathological features with clinical and antenatal sonography findings.Methods: A descriptive study was conducted among 43 perinatal autopsy cases. A thorough perinatal autopsy was done. Detailed maternal medical and obstetric history including the laboratory and USG findings were collected. Collected data analysed using Statistical package for social sciences (SPSS) software. Results: The results were grouped into fetal, maternal and placental findings. Congenital anomalies were detected in 20% cases. That included gastrochisis, ebstein anomaly, isolated dextrocardia, hypoplastic left heart syndrome, cleft lip and palate, prune belly syndrome, club foot. Placenta findings observed were chorioamnionitis, placental thrombotic vasculopathy and placental findings in COVID-19 positive cases. The most common maternal comorbidity was hypertension (20.9%). Perinatal mortality was high in those cases with past history of abortions and history of infertility treatment. Full agreement between perinatal autopsy and antenatal USG findings was detected in 36.36% cases. Additional anomalies detected on autopsy was 54.54%.Conclusions: A thorough clinical history, prenatal ultrasonography and perinatal autopsy features could be described in detail in all the cases. Comparison of finding at autopsy with antenatal ultrasonography finding indicate that ultrasonography finding have only a reasonable value in assessing fetal status. Advanced radiology techniques could be maximum helpful.

A study of the diagnostic effectiveness of repeated fine needle aspiration in thyroid and breast lesions

Background: Fine needle aspiration cytology (FNAC) is a relatively safe diagnostic tool with high sensitivity and specificity. Due to lesion inherent properties and lack of proper technique, adequate cellularity is not yielded in some instances, resulting in an inconclusive report. In such instances we have to go for repeat FNA to make a proper diagnosis. Repeat aspirations impose unnecessary workload on the lab and are distressful to the patients. The issue of repeat aspiration is largely unaddressed. Objectives were to identify the proportion of repeated fine needle aspirations in breast and thyroid lesions turning out to be diagnostic and to identify and describe the common factors leading to repeat fine needle aspiration.Methods: 190 cases of repeated FNA including both thyroid and breast lesions are included in the study. FNA done after an initial aspiration with inconclusive smear is considered as repeated FNA. History, clinical examination findings, findings in imaging studies, nature of aspirate obtained for each patient advised repeat FNA, are recorded. Proportion of repeat FNAs turning out to be diagnostic and the documented reasons for repeat were taken as the outcome measure.Results: 78% of repeat FNA in thyroid lesions and 50% of the repeat FNA in breast lesions were diagnostic. Inadequate cellularity, haemorrhagic aspirate and cystic change are the most common factors leading to repeat FNA.Conclusions: Since thyroid and breast are the most common sites where FNA is done and 64% of the total lesions are diagnostic, repeat FNA in all other sites are likely to yield a similar diagnostic outcome. Hence, repeat FNA is advisable in lesions which had initial non diagnostic result

Study on acute transfusion related adverse reactions in surgery department

Background: Blood transfusion is a routine life- saving medical intervention which is generally regarded as safe when done appropriately. Without blood transfusion, many medical and surgical conditions like anemia, road traffic accidents, obstetric hemorrhage, cardiothoracic surgeries are nearly impossible to manage. However, this life-saving procedure is often associated with adverse effects ranging from minor chills and rigors to life-threatening anaphylaxis. Incidence of transfusion reactions is estimated at 0.001% -10%. The knowledge about the adverse transfusion reaction (ATRs) will help in early identification, management, and prevention of adverse transfusion reactions.Methods: Descriptive cross-sectional study done in 1047 patients, admitted and received at least one unit of whole blood and blood components in the surgery department, Government Medical College, Kottayam during the study period. Information regarding the issue of blood component collected from the transfusion medicine department and the details of the reactions were collected from the patients, and the transfusion reaction workups were done in the transfusion medicine department. The collected data was analysed using Microsoft Excel sheets.Results: The frequency of acute transfusion reaction in this study is 1%. The majority of the reactions were seen with a packed PRBC transfusion. Febrile non-hemolytic transfusion accounted for 54.64% followed by allergic reactions (36.36%) and Transfusion associated cardiac overload (9%).Conclusions: The frequency of ATR in our study was 1%. Febrile non-hemolytic transfusion (FNHTR) and allergic reactions were common patterns followed by transfusion associated cardiac overload (TACO) seen

Primary breast actinomyces simulating malignancy: A case diagnosed by fine-needle aspiration cytology

We report a case of primary actinomycosis of breast diagnosed by fine needle aspiration cytology (FNAC) in a postmenopausal lady who presented with a clinical impression of malignancy. Resolution of infection while conserving the breast was achieved by timely diagnosis and effective antibiotic therapy. The literature reports that primary actinomycosis of the breast is very rare after menopause, with only very few cases found after extensive search. It is imperative that this condition should be considered in the differential diagnosis of malignancy. The effectiveness of cell block sections in the final diagnosis is also highlighted

Minimal deviation adenocarcinoma of endometrium: A rare entity in a 72-year-old female

Minimal deviation adenocarcinoma (MDA) of endometrium is considered a differentiated state of endometrioid adenocarcinoma. It is a low-grade tumor associated with areas histologically typical of endometrioid adenocarcinoma in the majority of the cases. Due to deceptively benign microscopy, MDA may be overlooked leading to incorrect assessment of tumor extend and staging

Extramedullary hematopoiesis as a ′clue′ to diagnosis of hepatoblastoma on fine needle aspiration cytology: A report of two cases

Extramedullary hematopoiesis (EMH) evidenced by erythropoietic cells and megakaryocytes is a characteristic feature of hepatoblastoma (HB). The typical cytomorphology, the presence of EMH and associated clinical and radiological findings offer a reliable diagnosis of hepatoblastoma by fine-needle aspiration cytology (FNAC). We describe the cytologic features of hepatoblastomas and discuss the differential diagnosis in two children, aged 53 days and 19 years. The usefulness of EMH in differentiating HB from other small round cell tumors and well differentiated hepatocellular carcinoma (HCC) on cytology is highlighted

Placental mesenchymal dysplasia: A report of two cases with review of literature

Placental mesenchymal dysplasia (PMD) is a recently recognized, rare placental vascular anomaly characterized by placentomegaly and grape-like vesicles mimicking partial molar pregnancy. It is associated with significant fetal morbidity and mortality. We describe the histologic features of PMD in two different cases with different disease outcomes, one in a preterm intrauterine death (IUD) and another in a live birth. Placental examination in both the cases revealed large placenta with multiple vesicles and mesenchymal dysplasia