Metanephric adenoma of kidney: a rare and distinct entity

Metanephric adenoma (MA) is an unusual renal neoplasm with benign behaviour most of the times. Clinically MA mimics malignant renal neoplasms due to nonspecific signs and symptoms such as polycythaemia, haematuria and abdominal pain. MA usually presents as a mass lesion on radiographic studies and can be found incidentally. The treatment of choice is surgical excision. Though MA is usually a benign tumour, increase in the knowledge of MA pathology may lead to less invasive treatments in the future. Less than 200 cases of metanephric adenoma are reported till date in the literature

Solitary fibrous tumor of nasal cavity: a rare case report with review of literature

Solitary fibrous tumor is an unusual soft tissue neoplasm. Commonly the tumor is located in pleural cavity but recently has been described in many extra-thoracic locations. Nose and paranasal sinuses are rare sites for this tumor and so far less than 30 cases have been reported in the literature. In the nasal cavity the tumor usually presents as a polypoidal intranasal mass in a middle aged patient. Erosion of adjacent structures may occur but tumor does not metastasize. Local excision is almost invariably curable. We report SFT in a 50 year old patient with involvement of unilateral nasal cavity and all paranasal sinuses

The hospital autopsy: the importance in keeping autopsy an option

Autopsy has been one of the most powerful diagnostic tools in medicine for over a century. Despite its importance in establishing cause of death and elucidating pathophysiology of disease, rates of hospital autopsies continue to decline. In this study we aim to determine if physicians believe autopsies are essential to patient care through discussion of autopsy with families. At the same time, we analyzed whether families are more willing to consent to autopsy if physicians are involved in autopsy discussion at the time of death, and what may be the reasons for not wanting an autopsy. Our results showed a doubling in autopsy consent when autopsy was discussed by the physician. Additionally, the biggest reason for families not consenting to autopsy was because they believed they already knew what caused death. The emergence of Coronavirus 2019 (COVID-19) has re-established the value of autopsy, as seen by increased autopsy rates in the past year. This study demonstrates that physician conversation with families on autopsy leads to an increased chance of autopsy consent

A Post-Mortem Diagnosis of Idiopathic Giant Cell Myocarditis Presenting as Sudden Death: A Report of Two Cases

Giant cell myocarditis is also known as ‘Granulomatous myocarditis’, of which Idiopathic giant cell myocarditis (IGCM) is a rare clinicopathological entity. IGCM is known to cause sudden death in healthy adults in the absence of any symptomatic heart disease. While performing autopsies if there is no apparent cause of death the autopsy surgeon must keep in mind IGCM, especially in healthy adults with an unexplained sudden death. We report here series of two cases of unexpected sudden death in an undiagnosed heart disease and the utility of histopathological diagnosis after autopsy when other ancillary techniques are unavailable

Acute glomerulonephritis with large confluent IgA-dominant deposits associated with liver cirrhosis

<div><p>Background</p><p>Small glomerular IgA deposits have been reported in patients with liver cirrhosis, mainly as an incidental finding in autopsy studies. We recently encountered nine cirrhotic patients who presented with acute proliferative glomerulonephritis with unusually large, exuberant glomerular immune complex deposits, in the absence of systemic lupus erythematosus (SLE) or monoclonal gammopathy-related kidney disease. Deposits were typically IgA dominant/codominant. Our aim was to further elucidate the etiology, diagnostic pitfalls, and clinical outcomes.</p><p>Methods</p><p>We present clinical features and kidney biopsy findings of nine cirrhotic patients with an unusual acute immune complex glomerulonephritis. We also identified native kidney biopsies from all patients with liver cirrhosis at our institution over a 13-year period (January 2004 to December 2016) to evaluate presence of glomerular IgA deposits in them (n = 118).</p><p>Results</p><p>Six of nine cirrhotic patients with the large immune deposits had a recent/concurrent acute bacterial infection, prompting a diagnosis of infection-associated glomerulonephritis and treatment with antibiotics. In the remaining three patients, no infection was identified and corticosteroids were initiated. Three of nine patients recovered kidney function (one recovered kidney function after liver transplant); three patients developed chronic kidney disease but remained off dialysis; two patients became dialysis-dependent and one patient developed sepsis and expired shortly after biopsy. Within the total cohort of 118 patients with cirrhosis, 67 others also showed IgA deposits, albeit small; and 42 patients had no IgA deposits.</p><p>Conclusions</p><p>These cases provide support to the theory that liver dysfunction may compromise clearance of circulating immune complexes, enabling deposition in the kidney. At least in a subset of cirrhotic patients, a superimposed bacterial infection may serve as a “second-hit” and lead to acute glomerulonephritis with exuberant immune complex deposits. Therefore, a trial of antibiotics is recommended and caution is advised before immunosuppressive treatment is offered. Unfortunately, most of these patients have advanced liver failure; therefore both diagnosis and management remain a challenge.</p></div

Cirrhotic patients with kidney biopsy, over a 13-year period (n = 118).

<p>Demographic features and etiology of liver cirrhosis.</p

Liver function tests and autoimmune serology results in the nine patients with liver cirrhosis and large glomerular immune complex deposits.

<p>(normal reference values are shown in parenthesis).</p

Light microscopy, immunofluorescence, and electron microscopy biopsy findings in patient 7.

<p>A) Strong mesangial and capillary loop staining for IgG (400x). B) Strong mesangial and capillary loop staining for IgA (400x). C) Strong mesangial and capillary loop staining for C3 (400x). D) Endocapillary hypercellularity (hematoxylin & eosin; 400x). E) and F) Large bulky mesangial and subendothelial electron dense immune-type deposits on ultrastructural examination (lead citrate and uranyl acetate fixation; 6,000x and 10,000x, respectively).</p

Kidney biopsy findings in the nine cirrhotic patients with large immune complex deposits.

<p>Kidney biopsy findings in the nine cirrhotic patients with large immune complex deposits.</p

Fine-tuned Alexnet compared to C2 readings.

<p>Fine-tuned Alexnet compared to C2 readings.</p